Gastric T-cell lymphoma with cytotoxic phenotype
Gastric T-cell lymphoma with cytotoxic phenotype
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DOI：
10.1111/j.1440-1827.2006.02065.x
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发表时间：
2007-02-01
影响因子：
2.2
通讯作者：
Noguchi, Masayuki
中科院分区：
文献类型：
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作者：
Sugita, Shintaro;Iijima, Tatsuo;Noguchi, Masayuki
原发性胃淋巴瘤通常起源于幽门螺杆菌感染的粘膜相关淋巴组织（MALT）的B细胞。当T细胞淋巴瘤在胃中发展时，它们通常与人类嗜T淋巴细胞病毒1型感染和成人T细胞白血病的胃受累有关。本文报告了一个独特的和翔实的情况下，胃外周T细胞淋巴瘤的细胞毒性表型，组织学模拟，并仔细区分，MALT型B细胞淋巴瘤。患者为73岁女性，接受胃镜检查，组织学检查结果提示MALT型胃淋巴瘤。免疫球蛋白重链（IgH）基因和T细胞受体γ（TCR γ）基因的分析揭示了TCR γ基因的单克隆重排。肿瘤细胞表现出轻度的免疫反应性，与抗CD 3、抗CD 8、抗T细胞胞内抗原1、抗颗粒酶B和抗穿孔素抗体呈免疫反应性，但与抗CD 20、抗CD 10和抗CD 79 a抗体不呈免疫反应性。该病例最终被诊断为具有细胞毒性表型的胃T细胞淋巴瘤，并在手术切除后得到证实。在这种情况下，应该仔细检查胃的小活检标本是否有低度恶性B细胞型恶性淋巴瘤（MALT淋巴瘤），因为有时增殖的B细胞会隐藏真正的恶性T细胞，重排分析对诊断T细胞恶性肿瘤很有用。
Primary gastric lymphoma usually originates from B cells of mucosa-associated lymphoid tissue (MALT) infected with Helicobacter pylori. When T-cell lymphomas develop in the stomach, they usually occur in association with infection by human T-lymphotropic virus type 1 and gastric involvement of adult T-cell leukemia. Reported herein is a unique and informative case of gastric peripheral T-cell lymphoma with a cytotoxic phenotype that histologically mimicked, and had to be carefully distinguished from, MALT-type B-cell lymphoma. The patient, a 73-year-old woman, underwent a gastric endoscopy examination, and the histological findings suggested MALT-type gastric lymphoma. Analysis of the immunoglobulin heavy chain (IgH) gene and T cell receptor gamma (TCR gamma) gene revealed monoclonal rearrangement of the TCR gamma gene. The tumor cells exhibited mild atypia and immunoreactivity with anti-CD3, anti-CD8, anti-T-cell intracellular antigen-1, antigranzyme B and antiperforin antibodies, but not with anti-CD20, anti-CD10, and anti-CD79a antibodies. The case was finally diagnosed as gastric T-cell lymphoma with cytotoxic phenotype, and this was confirmed after surgical resection. In cases such as this, small biopsy specimens from the stomach should be examined carefully for low grade B-cell-type malignant lymphoma (MALT lymphoma), because sometimes the proliferating B cells can hide the truly malignant T cells, and rearrangement analysis is useful for diagnosing T-cell malignancy.