胃肠淋巴瘤PPT.ppt

胃肠淋巴瘤;;胃肠道淋巴组织 ; GI-NHL  占所有的NHL中4%-20% 是最主要的结外受累部位;危险因素:;原发性GI-NHL;1991年西方国家小肠淋巴瘤分级; I 级　累及小肠局部肠段，没有淋巴结转移 II 级　累及小肠局部肠段，伴有局部淋巴结转移 III 级　累及小肠和膈上.下淋巴结，脾脏 IV 级　广泛累及器官和组织，无任其有无淋巴结受累;Latest Proposal of Lymphoma Classification (Modified From REAL);B cell Lymphoblastic Small lymphocytic lymphoplasmacytoid Mantle cell Follicular center (follicular, diffuse, small) Marginal-zone (nodal, extranodal, splenic) Diffuse large B cell Burkitts and Burkitt-like ;T cell ;;我院1952-1985年67例肠道淋巴瘤(鲁重美,1987);检 查;怀 疑;? Gastric MALT lymphoma; ?Presence of H pylori in most case ?Also can arise at the site of chronic gastritis  ?High-grade MALT lymphomas are believed to have evolved from low-grade lesion. ?Eradication of Hp. Results in disappearance of acquired gastric MALT and regression of gastric MALT lymphoma; Recommended anti-Helicobacter therapy: Amoxicillin 1g Bid Clarithromycin 250mg Bid 7days Omeprazole 20mg Bid Antibiotic-refractory gastric MALT lymophoma Chlorambucil (苯丁酸氮芥); ?Multiple lymphomatous polyposis  (MLP); ?Most involve the jejunum and terminal ileum. Also at the stomach,duodenum,colon,rectum ?The tumor cells express CD19,CD20,CD5, surface-membrane Ig,but negative for CD10 ?Few reports of specifical therapy Anthracycline(蒽环)-based chemotherapy High-dose autologous stem-cell support;? Primary intestinal T-cell lymphoma; ?Most in the proximal small intestine ?Celiac disease-associated DQ A1*0501  DQ B1*0201phenotype  HLA-DR/DQ alleles EB virus infection ?Therapy is the same as that for other types of aggressive lymphoma; ? HIV infection; ?GI-tract involvement in 1/4 to 1/3