引用本文:温宗华,周秀坚,张小红,张绍阳.眼结膜黏膜相关淋巴组织边缘区淋巴瘤临床病理分析[J].中国临床新医学,2019,12(9):1000-1004.
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眼结膜黏膜相关淋巴组织边缘区淋巴瘤临床病理分析
温宗华,周秀坚,张小红,张绍阳
530021 南宁,广西壮族自治区人民医院病理科(温宗华,周秀坚,张小红),眼科(张绍阳)
摘要:
[摘要] 目的 探讨眼结膜黏膜相关淋巴组织边缘区淋巴瘤临床病理特征、诊断、治疗及预后。方法 回顾性分析了11例原发性眼结膜黏膜相关淋巴组织边缘区淋巴瘤患者的临床、病理资料并进行了随访。结果 11例患者中男4例,女7例,发病年龄23~74岁,平均年龄为45岁。累及单侧结膜10例,双侧结膜1例,其他部位及系统未见淋巴瘤。病理形态:结膜固有层内弥漫性小-中等大小的淋巴样细胞及单核样细胞浸润,核形轻度不规则。免疫表型:弥漫性浸润细胞CD20(+)、CD3(-)、CD5(-)、CD10(-)、CD23(-)、CyclinD1(-),5例异常表达CD43,ki67增殖指数为1%~10%。5例行Ig基因克隆性分析,均呈单克隆。6例单纯肿物完整切除,2例肿物完整切除加局部放疗,1例肿物部分切除加局部放疗,1例单纯活检,1例活检后局部注射化疗,肿物未消退,随后行肿物完整切除加局部放疗。随访时间3~122个月,截止随访日期,除2例失访,其他患者生存。其中行肿物单纯活检的患者长期带瘤生存,余8例未见复发。结论 眼结膜黏膜相关淋巴组织边缘区淋巴瘤好发于中年女性,结膜见粉红色肿物为临床特征,镜下为小-中等大小的淋巴样细胞及单核样细胞弥漫性浸润,肿瘤细胞表达B淋巴细胞表型,增殖指数低,部分病例异常表达CD43,Ig基因克隆性分析有助于诊断,单纯肿物完整切除或术后辅以局部放疗均有较好的疗效,预后良好。
关键词:  黏膜相关淋巴组织边缘区淋巴瘤  淋巴瘤  结膜
DOI:10.3969/j.issn.1674-3806.2019.09.18
分类号:R 739.7
基金项目:
Clinical and pathological features of conjunctiva mucosa-associated lymphoid tissue lymphoma
WEN Zong-hua, ZHOU Xiu-jian, ZHANG Xiao-hong, et al.
Department of Pathology, the People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
Abstract:
[Abstract] Objective To explore the clinical and pathological features, diagnosis, treatment and prognosis of conjunctiva mucosa-associated lymphoid tissue lymphoma(MALToma). Methods The clinical and pathological data of 11 cases of conjunctiva MALToma were retrospectively analyzed and the patients were followed up. Results Of the 11 cases, 4 cases were males, 7 females, with age ranging from 23 to 74 years(mean age 45 years). Locations: 10 cases were unilateral, and 1 case was bilateral, and no lymphomas were found in other sites or systems. The pathological morphology showed a large number of dense small to medium sized lymphoid cells and monocytoid B cells were diffusely infiltrated in the mucosal lamina propria, and their nuclei were mildly irregular. The immunophenotyping analysis showed that the infiltrating cells expressed CD20, and did not express CD3, CD5, CD10, CD23 and CyclinD1, with a low proliferation index of ki67(1%~10%) and aberrant expression of CD43 in 5 cases. Five cases were performed Ig gene clonal analysis and the results showed that all cases were monoclonal. Six cases were performed complete resection of the tumors; 2 cases received complete resection of the tumors plus local radiotherapy; 1 case received partial resection of the tumor plus local radiotherapy; 1 case was performed simple biopsy; 1 case received local injection of chemotherapy after biopsy, but the tumor did not regress, and then complete excision and local radiotherapy were performed. The follow-up period ranged from 3 to 122 months, and all the patients survived except for 2 cases who were lost to follow-up. Long-term survival with tumor was observed in the patients receiving simple biopsy of tumor, and no recurrence was observed in the remaining 8 patients. Conclusion MALToma tends to occur in middle-aged women. The pink mass seen in the conjunctiva is a clinical feature of typical conjunctiva MALToma. Microscopically, there are diffuse infiltration of small to medium sizes of lymphoid cells and monocytes. Tumor cells express B-lymphoid phenotype with low proliferation index, and CD43 is abnormally expressed in some cases. Ig gene cloning analysis is helpful for the diagnosis. Simple complete resection of the tumor or postoperative adjuvant local radiotherapy has good clinical efficacy and good prognosis.
Key words:  Mucosa-associated lymphoid tissue lymphoma(MALToma)  Lymphoma  Conjunctiva