Objective: To study the clinical and endoscopic features of mantle cell lymphoma (MCL). Methods: The clinical data and endoscopic characteristics of 20 patients with gastrointestinal MCL treated in the Affiliated Hospital of Zunyi Medical University and the Digestive Endoscopy Center of Guizhou Medical University from January 2011 to January 2021 were collected, and the histological and immunohistochemical characteristics of the tumor were observed. Meanwhile, 44 cases of non-gastrointestinal MCL in the above two hospitals in the same period were also enrolled. The clinical and endoscopic differences between the two groups were compared. Results: Among the 20 patients with gastrointestinal MCL, the male to female ratio was 4∶1 (16/4), the average age was (60.3±9.7) years, and 11 patients (55.0%, 11/20) were over 60 years old. The main clinical manifestations of 20 patients at the onset of the disease were bloody stool or black stool in 9 cases (45.0%), abdominal pain in 8 cases (40.0%). Moreover, 5.0% (1/20) had B symptoms (fever, night sweat and weight loss). The most frequently involved site was colorectum (50.0%). Endoscopic findings showed mucosal polypoid lesions in 13 cases (65.0%, 13/20), involving multiple intestinal segments, with polyp diameter of 0.2-3.5 cm. Two cases (10%) were in stage Ⅲ and 18 cases (90%) were in stage Ⅳ according to Ann Arbor staging. Seven cases (35.0%, 7/20) had the involvement of the peritoneal and retroperitoneal lymph nodes, 9 cases (45.0%, 9/20) had the involvement of the superficial lymph nodes in 45.0% (9/20), and 4 cases (20%, 4/20) had other extranodal invasion. Splenomegaly accounted for 35.0% (7/20). CD20, Bcl-2 and CD5 were positive or strongly positive in all gastrointestinal MCL tumor cells in 20 cases. Cyclin D1 was positive or strongly positive, accounting for 90.0% (18/20). The sex-determining region of Y chromosome-related high-mobility-group box 11 (SOX11) was positive or strongly positive, accounting for 65.0% (13/20). The positive index of Ki-67 was 5%-80%. Twenty cases (100%, 20/20) were followed up. The median follow-up was 41.2 months (1-74 months). There was no significant difference in the 3-year overall survival rate between the gastrointestinal MCL patients (70.0%) and non-gastrointestinal MCL patients (72.7%) (χ2=0.051, P=0.822). Conclusions: Abdominal discomfort is the main symptom of gastrointestinal MCL, which often occurs in the colorectum and often presents with multiple polypoid lesions. There are relatively few cases with B symptoms and extranodal invasion, and the prognosis is not different from that of patients with non-gastrointestinal MCL.
目的： 观察胃肠道套细胞淋巴瘤（MCL）的临床及内镜特征。 方法： 收集遵义医科大学附属医院及贵州医科大学附属医院消化内镜中心2011年1月至2021年1月诊治的20例胃肠道MCL患者临床资料，观察肿瘤组织学形态和免疫组织化学（免疫组化）特征。选取同期在两所医院诊断的44例非胃肠道MCL患者，比较两组患者临床和内镜特征的差异。 结果： 20例胃肠道MCL患者中，男16例，女4例，年龄（60.3±9.7）岁，>60岁者11例（55.0%，11/20）。患者起病时主要临床表现为：便血或黑便9例（45.0%）、腹痛8例（40.0%），有B症状（发热、盗汗、体重下降）者1例（5.0%），肿瘤最常累及结直肠（50.0%）。内镜下表现为黏膜息肉样病变13例（65.0%），可累及多个肠段，息肉直径0.2~3.5 cm。Ann Arbor分期：Ⅲ期2例（10.0%），Ⅳ期18例（90.0%）。肿瘤侵犯腹腔及腹膜后淋巴结者占35.0%（7/20），累及浅表淋巴结者占45.0%（9/20）；伴有其他结外侵犯者占20.0%（4/20）；脾脏肿大者占35.0%（7/20）。20例胃肠道MCL患者肿瘤组织免疫组化CD20、B淋巴细胞瘤2基因（Bcl-2）、CD5均呈阳性或强阳性表达，占100.0%（20/20）；细胞周期蛋白D1呈阳性或强阳性表达者占90.0%（18/20）；Y染色体性别决定区相关高速泳动族框因子11（SOX11）呈阳性或强阳性表达者占65.0%（13/20）；Ki-67阳性指数5%~80%。20例患者中位随访41.2个月（1~74个月）。胃肠道MCL与非胃肠道MCL患者3年总生存率差异无统计学意义（70.0%比72.7%，χ2=0.051，P=0.822）。 结论： 胃肠道MCL多以腹部不适为首发症状，好发于结直肠，常呈多发息肉样病变，B症状、结外侵犯等情况相对较少，预后与非胃肠道MCL患者无明显差异。.