[Diagnosis and Treatment of Gastric Mucosa-associated Lymphoid Tissue Lymphoma].
[Diagnosis and Treatment of Gastric Mucosa-associated Lymphoid Tissue Lymphoma].
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DOI：
10.4166/kjg.2019.74.6.304
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发表时间：
2019-12-25
影响因子：
--
通讯作者：
Choi, Kee Don
中科院分区：
文献类型：
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作者：
Gong, Eun Jeong;Choi, Kee Don
胃是粘膜相关淋巴组织（MALT）型淋巴结边缘区淋巴瘤最常见的原发部位，其特点是临床过程缓慢。胃MALT淋巴瘤的诊断需要内镜活检，应由有经验的病理学家证实。胃MALT淋巴瘤的内镜表现多种多样，包括糜烂、红斑、变色、萎缩、溃疡和上皮下病变。分布往往是多灶性的。因此，临床怀疑和多个活检是必不可少的准确诊断。胃MALT淋巴瘤几乎总是与幽门螺杆菌（H。pylori）感染。H.幽门螺杆菌根除疗法是治疗的主要手段，必须对所有患者进行治疗，而不管是否存在幽门螺杆菌。幽门螺杆菌感染状态或阶段。对于根除治疗后未能达到缓解的患者，可以考虑放疗或化疗。放射治疗是一种有效的治疗方式，局部阶段，并显示出良好的结果。在存在播散性或晚期疾病的情况下，可以应用抗CD 20单克隆抗体利妥昔单抗的化疗和/或免疫治疗。治疗应根据阶段和症状以及患者的偏好进行个体化。鉴于胃MALT淋巴瘤的临床过程通常是惰性的，在保证计划随访的情况下，观察等待可能是一个适当的策略。
The stomach is the most common primary site of an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type, which is characterized by an indolent clinical course. A diagnosis of gastric MALT lymphoma requires an endoscopic biopsy that should be confirmed by an experienced pathologist. Gastric MALT lymphoma shows a variable endoscopic appearance, including erosion, erythema, discoloration, atrophy, ulcer, and subepithelial lesion. The distribution is often multifocal. Therefore, clinical suspicion and multiple biopsies are essential for an accurate diagnosis. Gastric MALT lymphoma is almost invariably associated with a Helicobacter pylori (H. pylori) infection. H. pylori eradication therapy is the mainstay of treatment, which must be delivered to all patients regardless of the H. pylori infection status or stage. For patients who have failed to achieve remission following eradication therapy, radiotherapy or chemotherapy can be considered. Radiotherapy is an effective treatment modality for a localized stage and shows excellent outcomes. In the presence of disseminated or advanced disease, chemotherapy and/or immunotherapy with the anti-CD20 monoclonal antibody, rituximab, can be applied. Treatment should be individualized according to the stage and symptoms, as well as the patients' preference. Given that the clinical course of gastric MALT lymphoma is usually indolent, watchful waiting may be an adequate strategy in selected cases where scheduled follow-up is guaranteed.