Gastric MALT Lymphoma with Secondary Pulmonary Lymphoma: A Case Report

罕見胃粘膜相關淋巴組織（MALT）淋巴瘤合併肺部的淋巴瘤：病例報告及文獻回顧

鄭景泉(Jing-Quan Zheng) ； 鄭彩梅(Chi-Mei Zheng) ； 王誠一(Cheng-Yi Wang) ； 歐偉仁(Wei-Jen Ou) ； 林進耀(Chin-Yao Lin) ； 林恆毅(Hen-I Lin)

《胸腔醫學》 27卷1期 (2012/02) Pp. 55-63

https://doi.org/10.29806/TM.201202.0008

摘要

黏膜相關的淋巴組織之淋巴瘤是一種不常見的緩慢型淋巴瘤。這些低年級淋巴瘤是最常見的診斷為胃。『與黏膜相關的淋巴組織之淋巴瘤』若侵犯至胃部，常與幽門螺旋桿菌（Helicobacter pylori）有關。此種淋巴瘤在診斷時常是局部性的，局限於一定的範圍，較不常侵犯至肺，骨髓，且生長速度緩慢，好發於有自體免疫疾病的人。我們提出一位63歲女性在接受肺結核治療了六個月，因長期咳嗽情形未見改善，來門診救醫時意外發現右上肺葉有疑似「肺部黏膜相關淋巴組織淋巴瘤」。另外腹部電腦斷層檢查，胃鏡檢查顯示胃的黏膜增厚並合併有Helicobacterpylori幽門桿菌感染。最後病理學檢查確定診斷為胃黏膜相關的淋巴組織之淋巴瘤。後續檢查顯示淋巴瘤已侵犯至肺和骨髓。我們回溯文獻並對胃和肺黏膜相關的淋巴組織之淋巴瘤的流行病學、臨床、病理、治療、預後做一整理。針對來討論肺黏膜相關淋巴組織淋巴瘤的非典型的臨床症狀，臨床影像相關表現，早期治療的重要性。

關鍵字

胃黏膜相關淋巴組織淋巴瘤 ； 幽門桿菌 ； 肺淋巴瘤

並列摘要

Primary lymphomas of mucosal-associated lymphoid tissue (MALTomas) are rarely encountered in clinical practice. Non-Hodgkin’s lymphoma (NHL) accounts for 2-3% of all malignancies, while MALTomas comprise approximately 5% of all NHLs. The simultaneous presentation of gastric MALTomas with pulmonary lymphoma is relatively rare. The radiological appearance of pulmonary lymphoma is also variable. We report the case of a 63-year-old female initially diagnosed with and treated for pulmonary tuberculosis (TB). Due to her persistent cough, chest computed tomography (CT) was done, which revealed findings consistent with pulmonary lymphoma. In addition, the CT scan also showed diffuse thickening of the gastric mucosa wall with a mass lesion. An abdominal CT scan disclosed diffuse thickening of the stomach mucosal wall, with masses that were histopathologically confirmed as gastric MALToma. This case report highlights a common atypical clinical presentation of MALToma, which is easily mistaken to be a chronic inflammatory disease like TB, and reviews its nature, staging, management approach, and outcome.

並列關鍵字

gastric malt lymphoma ； Helicobacter pylori ； pulmonary lymphoma