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Clinicopathologic Analysis of 6 Lymphomatoid Gastropathy Cases: Expanding the Disease Spectrum to CD4-CD8+ Cases.

6例淋巴瘤样胃病的临床病理分析:扩展该疾病的谱系到CD4-CD8+的病例

Takata K,Noujima-Harada M,Miyata-Takata T,Ichimura K,Sato Y,Miyata T,Naruse K,Iwamoto T,Tari A,Masunari T,Sonobe H,Okada H,Iwamuro M,Mizobuchi K,Gion Y,Yoshino T

Abstract

Lymphomatoid gastropathy, which was first reported in 2010, is a rare NK-cell proliferation of cyCD3, CD4, CD5, CD8, CD56 phenotypes with unknown etiology. The diagnosis is challenging, as there is histopathologic similarity to malignant lymphoma. In the 2010 report on 10 cases, all lesions were located in the stomach, and all regressed without any therapy. In the present study, we analyzed 6 cases of lymphomatoid gastropathy by investigating the clinicopathologic, immunohistochemical, and molecular findings. Endoscopic and morphologic appearances of all cases were consistent with previous reports, but 2 cases showed previously unreported unique immunophenotypes of CD4CD8. Three of 6 patients underwent lower gastrointestinal examination (1 case underwent double-balloon endoscopic examination), but no patient had lesions in the lower gastrointestinal tract. No obvious difference of histology was found between the cases of CD4-CD8-typical phenotype and ones of CD4CD8 phenotype. Both cases had similar clinical behavior as the other 4 cases, implying that the spectrum of the disease is broader than initially thought. Careful clinical and endoscopic follow-up is required for the diagnosis of lymphomatoid gastropathy, and additional case studies and molecular studies are warranted to further investigate the pathophysiology of this peculiar benign mimic of lymphoma.

摘要

淋巴瘤样胃病于2010年首次报道,是一种罕见的、病因未知的NK细胞增生性疾病,免疫表型cyCD3+、CD4-、CD5-、CD8-、CD56+。由于组织病理学上与恶性淋巴瘤具有相似性,诊断极具挑战性。2010年报道的10例中,均位于胃部,且未经任何治疗,所有病变均消退。

本研究中作者分析6例淋巴瘤样胃病的临床病理、免疫表型和分子学结果。所有病例的内窥镜和形态学表现与先前报道的一致,仅2例显示了先前未报道过的独特免疫表型:CD4-CD8+。3/6例患者接受了低位胃肠道检查(1例接受了双气囊内镜检查),但是患者的低位胃肠道均无病变。4例CD4-CD8-的典型免疫表型病例与2例CD4-CD8+的病例在组织学上没有明显的差别,所有病例具有相似的临床表现,提示该疾病的谱系要比最初认为的更加宽泛。

对于淋巴瘤样胃病的诊断,仔细的临床与内窥镜随访是必须的。更多的病例和分子研究对于进一步研究这种特殊的、模拟淋巴瘤的良性病变病理生理非常有必要。

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