胃炎样原发性非霍奇金淋巴瘤和胃神经内分泌肿瘤的内镜鉴别诊断

V. Lozovaya, O. Malikhova, A. Tumanyan, A. Malikhov, O. Gusarova
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引用次数: 0

摘要

背景。胃原发性非霍奇金淋巴瘤(NHL)的胃炎样形式是最罕见的胃恶性肿瘤的宏观变异,内镜下类似于粘膜的炎症改变,在单次观察中,类似于胃息肉样和平坦升高形式的神经内分泌肿瘤(NET)。尽管在原发性胃NHL和胃NET的诊断和治疗方面获得了丰富的经验,但在临床实践中,仍有一些例子导致了内镜图像的正确解释和及时诊断的困难。分析诊断为胃炎样原发性NHL和胃NET的患者的综合内镜检查资料,并确定每种肿瘤类型的主要差异显著的内镜标准特征。材料和方法。在FSBI进行的一项前瞻性研究中俄罗斯卫生部“Blokhin国家肿瘤医学研究中心”于2017 - 2022年对69例胃炎样恶性肿瘤患者的内镜和形态学研究数据进行了分析。所有患者均行上消化道内镜-食管胃十二指肠镜综合检查,采用所有明确的检查方法(窄谱检查、放大检查、窄谱检查与放大检查相结合),同时取活检材料对诊断进行形态学验证,并进行超声检查。形态学检查结果显示,原发性胃NHL确诊38例(55.1%),胃NET确诊31例(44.9%)。69例(100%)患者中有3例(4.3%)因形态学检查结果而改变诊断。复杂内镜检查的灵敏度和诊断准确率均高于白光模式下的内镜检查,分别为92.11%、95.65和13.16%、52.17%。为了正确评估内镜下的图像,有必要进行全面的内镜检查,使用所有明确的诊断方法,这比在白光模式下检查具有更高的灵敏度和特异性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Endoscopic differential diagnosis of the gastritis-like form of primary non-Hodgkin’s lymphomas and neuroendocrine tumors of the stomach
Background. The gastritis-like form of primary non-Hodgkin’s lymphomas (NHL) of the stomach is the rarest macroscopic variant of malignant neoplasms of the stomach, endoscopically resembling inflammatory changes in the mucous membrane and, in single observations, polypoid and flatly elevated forms of neuroendocrine tumors (NET) of the stomach. Despite the great experience gained in the diagnosis and treatment of primary NHL of the stomach and NET of the stomach, in clinical practice there are examples that cause difficulties in the correct interpretation of the endoscopic picture and the timely diagnosis.Aims. To analyze the data of a comprehensive endoscopic examination of patients with diagnoses of a gastritis-like form of primary NHL and NET of the stomach, and to identify the main differentially significant endoscopic criteria characteristic of each individual type of neoplasia.Materials and methods. In a prospective study conducted at the FSBI “N.N. Blokhin national medical Research Center of Oncology” of the ministry of Health of Russia in the period from 2017 to 2022, data from endoscopic and morphological studies of 69 patients with gastritis-like malignancies were analyzed. All patients underwent a comprehensive endoscopic examination of the upper gastrointestinal tract – esophagogastroduodenoscopy using all clarifying examination methods (narrow-spectrum mode, examination in magnification mode, a combination of narrow-spectrum examination with magnification mode), accompanied by the taking of biopsy material for the purpose of morphological verification of the diagnosis, and endosonographic study.Results. According to the results of a morphological study, the diagnosis of primary NHL of the stomach was confirmed in 38 patients (55.1 %), NET of the stomach – in 31 patients (44.9 %). A change in diagnosis based on the results of a morphological study occurred in 3 (4.3 %) of 69 (100 %) patients. The sensitivity and diagnostic accuracy of complex endoscopic examination were higher compared to endoscopic examination in white light mode, and amounted to 92.11, 95.65 and 13.16 %, 52.17 %, respectively.Conclusion. for a correct assessment of the endoscopic picture, it is necessary to conduct a comprehensive endoscopic examination using all clarifying diagnostic methods, which shows greater sensitivity and specificity compared to examination in white light mode.
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