小肠淋巴瘤的临床病理特征及预后因素:一项回顾性单中心研究。

Emanuel Dias, Renato Medas, Margarida Marques, Patrícia Andrade, Hélder Cardoso, Guilherme Macedo
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摘要

背景:关于小肠淋巴瘤的诊断和治疗的信息很少,最佳的治疗策略仍然不明确。本研究旨在描述其主要临床和病理特征,并确定不良预后因素。方法:回顾性观察2010年1月至2020年12月期间所有组织学诊断为小肠淋巴瘤的患者。结果:我们纳入了40例患者,男性占多数(60%),平均年龄60.7岁。回肠是最常见的部位,最常见的组织学亚型为滤泡性淋巴瘤和弥漫性大b细胞淋巴瘤。临床表现从无症状患者(30%)到急性手术并发症(35%)不等,包括穿孔、肠梗阻、回肠肠套叠或严重出血。22例(55%)患者通过内窥镜确诊,最常见的发现包括息肉、单个肿块、弥漫性浸润或溃疡,而18例(45%)患者因急性表现或肿瘤切除而需要手术,术后诊断为淋巴瘤。手术治愈了三分之一的患者。中位生存期为52个月。急性表现(P = 0.001)、症状性疾病(P = 0.003)、晚期(P = 0.008)、弥漫性大b细胞淋巴瘤(P = 0.007)、贫血(P = 0.006)、低白蛋白血症(P < 0.001)、乳酸脱氢酶升高(P = 0.02)、c反应蛋白升高(P < 0.001)和无治疗反应(P < 0.001)是死亡率的重要预测因素。结论:小肠淋巴瘤是一种罕见的恶性肿瘤,临床和内镜表现多样,需要高度怀疑。与较差预后相关的主要因素包括急性表现、晚期、组织学亚型、生化异常和缺乏治疗反应。
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Clinicopathological characteristics and prognostic factors of small bowel lymphomas: a retrospective single-center study.

Background: There is little information on diagnosis and management of small bowel lymphomas, and optimal management strategies are still undefined. This study aims to describe their main clinical and pathological characteristics and identify poor prognostic factors.

Methods: A retrospective observational study of all patients with histological diagnosis of small bowel lymphoma between January 2010 and December 2020 was performed.

Results: We included 40 patients, with male predominance (60%) and mean age of 60.7 years. The ileum was the most common location, and the most common histological subtypes were follicular lymphoma and diffuse large B-cell lymphoma. Clinical presentation was variable from asymptomatic patients (30%) to acute surgical complications (35%) including perforation, intestinal obstruction, ileal intussusception, or severe bleeding. Diagnosis was established by endoscopy in 22 patients (55%), and the most common findings included polyps, single mass, diffuse infiltration, or ulceration, whereas 18 (45%) required surgery because of acute presentations or tumor resection, and lymphoma was diagnosed postoperatively. Surgery was curative in one-third of those patients. Median survival was 52 months. Acute presentation (P = 0.001), symptomatic disease (P = 0.003), advanced stage (P = 0.008), diffuse large B-cell lymphoma (P = 0.007), anemia (P = 0.006), hypoalbuminemia (P < 0.001), elevated lactate dehydrogenase (P = 0.02), elevated C-reactive protein (P < 0.001), and absence of treatment response (P < 0.001) were significant predictors of mortality.

Conclusion: Small bowel lymphoma is a rare malignancy with diverse clinical and endoscopic presentations that require a high index of suspicion. Primary factors associated with worse outcome included acute presentation, advanced stage, histological subtype, biochemical abnormalities, and absence of treatment response.

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