2019年 胃肠结外淋巴瘤PPT ppt课件.ppt

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1、原发胃肠结外淋巴瘤诊疗进展刘艳艳河南省肿瘤医院淋巴综合内科P-MAR-2019.06-046ValidUntil2019.06专业资料，仅供医药卫生专业人士使用声明本幻灯片代表个人观点。处方请参考国家食品药品监督管理总局批准的药物说明书。定义来源于淋巴结外的淋巴组织甚至来源于正常情况下不含淋巴组织的部位当结内和结外病变同时存在时，定义较困难发病率占非霍奇金淋巴瘤的25%淋巴瘤淋巴结淋巴结外胃肠道非胃肠道胃:B-cellMALTDLBCLH.Pylori肠道:T-cellCeliacdisease睾丸脑T/NK鼻型INTERNA

2、TIONALEXTRANODALLYMPHOMASTUDY GROUPExtranodalLymphomaSurvivalbyhistologyandsiteintheIELSGseries少见:所有胃肠道肿瘤的3%绝大多数胃肠道淋巴瘤来源于胃原发胃肠道淋巴瘤PKochJClinOncol201915%3%75%NonHodgkin’sLymphomaClassificationProject.Blood2019;89:3909-18Frequency%GGastricIIntestinNodalsite1.4%G-4%I0%G-

3、25%I0%G-20%I胃肠道淋巴瘤分类MantlecellL.DiffuselargeBcelllymphomaT-celllymphomaBurkitt.LMALTLymphoma1%G-20%(colon)FollicularL.38%G-10%I60%系统检查分期MALTlymphoma:ESMOGUIDELINESDreylingM,ThieblemontC.etal.AnnOncol2019LymphomaGIlymphomaMandatoryphysicalexamcompletebloodcountsbasicbi

4、ochemicalstudies(renalandliverfunction,LDHandβ2MG,serumproteinimmunofixation)HIV,HCVandHBVserologyCTofthechest,abdomenandpelvis-GASTRIC:Gastroduodenalendoscopywithmultiplebiopsiestakenfromeachregionofthestomach,duodenum,gastro-esophagealjunctionandfromanyabnormal-appe

5、aringsite;H.pyloristatusmustbeevaluatedingastricL.-SMALLINSTESTINE(IPSID–Immuno-ProliferativeSmallIntestinalDisease):CampylobacterJejunisearchinthetumorbiopsybyPCR,immunohistochemistryorinsituhybridizationmaybeperformed.LARGEINTESTINE:colonoscopyRecommendedbonemarrowa

6、spirateandbiopsyIfclinicallyindicated,head&neckMRIstudiesandotherimagingaretoberealizedAuto-antigens-ThyroidHashimotothyroiditis-SalivaryglandMyoepithelialsialoadenitis+/-SjögrenS.--LungLymphoidinterstitialpneumopathyMZL（边缘区淋巴瘤）:与慢性抗原刺激相关MALTLymphomasSiteInfectiousage

7、nts-StomachHelicobacterpylori-IntestinCampylobacterjejuni-OcularadnexaChlamydiapsittaci-skinBorreliaburgdorferiHepatitisCVirusMicrobialpathogens1.2.+SplenicMZLIsaacsonP,WrightDH.Cancer1983HELICOBACTERPYLORIinSTOMACHMZL:associatedwithachronicantigenicstimulationchronic

8、Agstimulation->chronicinflammationINFECTIONAUTOANTIGENAcquisitionofMALTAg-dependantMALTlymphomaAg-independantMALTlymphomaEpi