胃肠道淋巴瘤2009-12-16郭丽2教学提纲.ppt

胃肠道淋巴组织位于上皮细胞层、粘膜固有层、粘膜下层及肠系膜淋巴结。上皮层内大多数为T淋巴细胞，粘膜固有层内有T细胞及B细胞，及产生体内免疫球蛋白的浆细胞，有的排列成滤泡状。在小肠内多个滤泡集结称Peyer 滤泡集结（Peyers‘s patches），主要位于小肠（回肠末端为主）的肠系膜侧粘膜下层。上述这些淋巴组织是宿主免疫防御系统的主要组成部分，近来认为其为粘膜相关淋巴组织的一部分。 发病部位和地域相关：上述西方国家的结果；中东、非洲和南亚以小肠最多见。 Figure 2. Diffuse large B-cell lymphoma of the stomach in an 81-year-old man who presented with epigastric pain. (a) Spot radiograph from an upper gastrointestinal study shows a mass with luminal narrowing in the gastric antrum and deep ulceration in the inferior wall (arrow). Other nodules of various sizes (arrowhead) are seen adjacent to the mass. (b) Contrast-enhanced CT scan shows diffuse, homogeneous gastric antral wall thickening with a lobulated inner surface and a smooth well-defined outer wall (arrowheads). (c) High-power photomicrograph (original magnification, 600; hematoxylin-eosin [H-E] stain) shows a large blast cell infiltrate (short arrow) extending around epithelial glands (arrowhead). Mitoses, an important feature of high-grade tumors, are clearly seen (long arrow). (d) High-power photomicrograph (original magnification, 600; immunohistochemical stain CAM5.2) shows the destruction of epithelial glands by infiltrating blast cells (arrow). Brown areas represent cytokeratin. Primary gastric lymphoma often originates as a low-grade MALT lymphoma, which, it has been suggested, transforms into intermediate or high-grade large cell lymphoma if not diagnosed or treated in time。 However, non-Hodgkin gastric lymphoma should be recognized as another cause of linitis plastica, an appearance that results from dense infiltrates of lymphomatous tissue in the gastric wall without associated fibrosis Figure 4. Low-grade MALT lymphoma of the stomach in a 56-year-old woman who presented with dyspepsia. (a, b) Axial contrast-enhanced CT scan (a) and sagittal multiplanar reformatted image (b) show minimal thickening (arrowheads) in the antrum of the stomach (S). The rest of the stomach was normal. G gallbladder. (c) Intermediate-power p