摘要目的 分析以肠道表现为首发症状的滤泡性淋巴瘤之临床特征、内镜表现、病理诊断与治疗.方法 对9例以肠道表现为首发症状的滤泡性淋巴瘤做临床、内镜和病理观察及随访,用HE染色和免疫组织化学EliVision法行CD3、CD5、CD20、CD21、Ki-67、bcl-2、bcl-6、CD10和cyclin D1染色分析免疫表型特征.结果 9例以肠道表现为首发症状的滤泡性淋巴瘤患者年龄5～60岁(中位年龄44岁),男女比例2∶7.5例表现为腹部无明显诱因疼痛,3例便血,1例腹胀.回盲部为最常受累部位(6/9).6例内镜检查均表现为多发性息肉,基底宽,无出血及坏死.其中5例行小活检,病理学特征为:内镜活检病例的病变呈息肉状,位于黏膜层内,肿瘤细胞呈模糊的结节状,边界欠清,排列较紧密,主要由中心细胞组成,浆细胞及嗜酸性粒细胞不明显；手术切除的4例病例有3例累及肠道全层,1例局限于黏膜层内,其内均可见境界清楚的肿瘤性结节.免疫表型:9例之肿瘤性结节均强表达CD10和bcl-2,结节间及腺体周围可见散在细胞弱表达CD10.4例行手术治疗(其中2例加做化疗),3例单纯化疗,2例观察；所有患者均存活.结论 该组以肠道表现为首发症状的滤泡性淋巴瘤是一类好发于中年女性的疾病,常见于回盲部,具有惰性临床进程,内镜表现为多发性息肉,通常在出现临床症状或疾病进展期采取干预性治疗,具有较好的预后.

abstractsObjective To study the clinical features,endoscopic findings,pathologic diagnosis and treatment options of intestinal follicular lymphoma first presenting with gastrointestinal symptoms.Methods The clinical features,pathologic findings and follow-up data were retrospectively studied in 9 cases of intestinal follicular lymphoma.Immunohistochemical study for CD3,CD5,CD20,CD21,Ki-67,bcl-2,bcl-6,CD10 and cyclin D1was carried out.Results Seven of the 9 patients were females and two were males.The age of patients ranged from 5 to 60 years ( mean =44 years ).The clinical manifestations included abdominal pain ( 5 cases),blood in stool ( 3 cases) and abdominal distension ( 1case).The commonest site of involvement was ileocecal region (6/9).Endoscopic examination had been carried out in 6 patients and all showed the presence of multiple polyps.Five cases had undergone endoscopic biopsy.Histologic examination of the endoscopic biopsies showed lymphoma cells located mainly in mucosal layer,forming vague nodules with ill-defined boundaries. Plasma cells and eosinophils were not conspicuous.Immunohistoehemically,the tumor cells in all cases diffusely expressed CD20,CD10 and bcl-2.The staining for CD3,CD5 and cyclin D1was negative. Lymphoid cells with weak CD10-positivity were identified in the interfollicular regions.Four cases were treated with surgical resection and chemotherapy.The other 3 cases received chemotherapy only and the remaining cases were treated conservatively.All of them were still alive on follow up. Conclusions Primary intestinal follicular lymphoma affects predominantly elderly patients and has a female predilection.The commonest site of involvement is ileocecal region.Endoscopic examination shows polypoid changes.The disease often runs a relatively indolent clinical course.The prognosis is better than that of primary nodal follicular lymphoma.