胃肠结外淋巴瘤详解演示文稿.pptVIP

Lymphoma Nodal Extranodal Gastro-intestinal Non Gastro-intestinal Gastric : B-cellMALTDLBCLH. Pylori Intestinal : T-cell Celiac disease TestisBrainT/NK nasal Type EATL 当前第29页\共有29页\编于星期四\8点 胃肠结外淋巴瘤详解演示文稿 当前第1页\共有29页\编于星期四\8点 （优选）胃肠结外淋巴瘤 当前第2页\共有29页\编于星期四\8点 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 当前第3页\共有29页\编于星期四\8点 发病率 占非霍奇金淋巴瘤的25% 当前第4页\共有29页\编于星期四\8点 淋巴瘤 淋巴结 淋巴结外 胃肠道 非胃肠道 胃 : B-cell MALT DLBCL H. Pylori 肠道 : T-cell Celiac disease 睾丸脑T/NK 鼻型 当前第5页\共有29页\编于星期四\8点 INTERNATIONAL EXTRANODAL LYMPHOMA STUDY?GROUP Extranodal Lymphoma Survival by histology and site in the IELSG series 当前第6页\共有29页\编于星期四\8点 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 P Koch J Clin Oncol 2001 15% 3% 75% 当前第7页\共有29页\编于星期四\8点 Non Hodgkin’s Lymphoma Classification Project. Blood 1997;89:3909-18 Frequency % G Gastric I Intestin Nodal site 1.4%G - 4%I 0%G - 25%I 0%G - 20%I 胃肠道淋巴瘤分类 Mantle cell L. Diffuse large B cell lymphoma T-cell lymphoma Burkitt. L MALT Lymphoma 1%G - 20% (colon) Follicular L. 38%G - 10%I 60% 当前第8页\共有29页\编于星期四\8点 系统检查分期 MALT lymphoma : ESMO GUIDELINES Dreyling M, Thieblemont C. et al. Ann Oncol 2012 Lymphoma GI lymphoma Mandatory physical exam complete blood counts basic biochemical studies (renal and liver function, LDH and β2MG, serum protein immunofixation) HIV, HCV and HBV serology CT of the chest, abdomen and pelvis - GASTRIC : Gastroduodenal endoscopy with multiple biopsies taken from each region of the stomach, duodenum, gastro-esophageal junction and from any abnormal-appearing site; H. pylori status must be evaluated in gastric L. - SMALL INSTESTINE (IPSID – Immuno-Proliferative Small Intestinal Disease): Campylobacter Jejuni search in the tumor biopsy by PCR, immunohistochemistry or in situ hybridization may be performed. LARGE INTESTINE : colonoscopy Recommended bone marrow aspirate and biopsy If clinically indi