直肠扁桃体18例临床病理分析-现代医学

直肠扁桃体18例临床病理分析

单位：江苏省人民医院/南京医科大学第一附属医院病理学部, 江苏南京 210029

分类号：R574;R322.25

出版年·卷·期（页码）：2021·49·第十二期（1428-1433）

摘要：

目的： 探讨直肠扁桃体（RT）的临床病理特征和鉴别诊断。方法： 回顾性分析我院2016年1月至2021年7月共18例RT或直肠淋巴样息肉患者的临床及病理资料，并对患者进行随访。结果： 18例患者中男4例，女14例；中位年龄55岁。11例为肠镜筛查发现，其他患者因腹痛、腹泻、便秘、腹胀、黑便等症状就诊发现。内镜下RT多呈息肉或息肉样隆起（8例）或黏膜下隆起（8例）。光镜下表现为黏膜固有层和（或）黏膜下层致密的淋巴组织结节样增生，可见大小、形态不一的滤泡结构，免疫组化染色显示滤泡增生的特点。6例EB病毒编码的小RNA原位杂交及4例免疫球蛋白基因重排克隆性检测均为阴性。对患者进行了1~64.5个月的随访，未出现复发。结论： RT是发生在直肠的局限性淋巴组织反应性增生，临床罕见，病因未明，活检标本中与淋巴瘤鉴别有一定困难。因此，建议内镜下发现的直肠局限性隆起病变需完整切除并进行相关病理学检查。

Objective: To investigate the clinicopathological features and differential diagnosis of rectal tonsil (RT). Methods: The clinical and pathological data of 18 RT/rectal lymphoid polyp cases in our hospital from January 2016 to July 2021 were analyzed retrospectively, and the patients were followed up. Results: This study was composed of 4 males and 14 females with a median age of 55 years. 11 patients had the lesion found on routine colonoscopy screening, and others had one or more symptoms such as abdominal pain, diarrhea, constipation, abdominal distention and melena. The endoscopic appearance of RTs was mainly described as polyp/polypoid(8 cases) or submucosal eminence(8 cases). All lesions were characterized microscopically by a dense nodular lymphoid hyperplasia in the lamina propria and(or) submucosa with follicles of different sizes and shapes. Immunohistochemistry suggested follicular type of proliferation. 6 cases of Epstein-Barr virus-encoded RNA in-situ hybridization and 4 cases of immunoglobulin gene rearrangement were negative. The patients showed no recurrence with follow-up of 1-64.5 months. Conclusion: RT, a prominent and localized reactive lymphoid proliferation in the rectum, which is rare and the etiology is unknown. It is difficult to distinguish RT from lymphoma on biopsy specimens. Therefore, we suggest that the localized protrusion lesions of rectum founded by endoscopy should be resected completely and examined by pathology.

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