摘要
目的探讨原发性肺淋巴瘤（PPL）的临床表现、病理和影像学特点、诊断及治疗方法，提高其诊断率。方法回顾性分析1989年1月至2007年2月北京协和医院住院的原发性肺淋巴瘤18例，总结其临床表现、病理和影像学特点、诊断手段、治疗方法及预后。生存时间按月记录，以手术日至患者最后一次就诊时间为准。计量资料采用秩和检验，计数资料采用卡方检验。使用SPSS10．0统计软件进行数据分析。结果18例中男6例，女12例，年龄17～71岁，中位年龄47．5岁。外科肺活检确诊15例（其中1例曾行经支气管镜活检发现肿瘤细胞，但未能明确病理类型），经皮肺活检确诊1例（1／6），经皮肺活检及经支气管镜活检标本共同确诊1例，经支气管镜活检确诊1例（1／10）。病理结果为霍奇金淋巴瘤2例，其中混合细胞型和结节硬化型各1例；黏膜相关淋巴组织淋巴瘤9例，滤泡性淋巴瘤1例，弥漫性大B细胞淋巴瘤2例，间变性大细胞淋巴瘤2例，2例外院切片我院会诊后诊断为非霍奇金淋巴瘤。主要症状为咳嗽（11／18）和发热（6／18）。18例中影像学表现为肺内结节或团块影14例，片状浸润影11例，实变影5例。胸腔积液和肺不张各5例，肺门或纵隔淋巴结肿大7例，空洞病变1例，病灶内液化1例。11例曾被误诊。3例手术完全切除病灶，8例单纯化疗，6例在肺叶切除术后化疗，1例放疗及化疗。中位随访时间为11个月（10d至205个月），目前存活13例，失访4例，死亡1例。非霍奇金淋巴瘤患者白细胞异常升高与疾病进展（预后不良）相关，预后不良组中位数为25、1×10^9／L（18．1～39．1）×10^9／L，预后良好组中位数为6．7×10^9／L（5．48～8．41）×10^9／L，u=0．000，P〈0．05。结论PPL临床表现不典型，易误诊；及时行外科肺活检获取组织病理标本有利于早期诊断。
Objective To study the clinical characteristics, pathology, diagnosis and treatment of primary pulmonary lymphoma. Methods Eighteen cases of primary pulmonary lymphoma diagnosed from Jan 1989 to Feb 2007 were retrospectively analyzed. Results There were 6 males and 12 females, with a median age of 47. 5 years （17-71years）. Fifteen cases were diagnosed by surgical lung biopsy; 1 by percutaneous needle lung biopsy （1/6）, 1 by percutaneous needle lung biopsy and bronchoscopic examination at the same time, the other 1 by bronchoscopic examination （1/10）. Histological diagnosis showed that 2 cases were Hodgkin lymphoma, 9 mucosa-associated lymphoid tissue lymphoma, 1 follicular lymphoma,2 diffuse large B cell lymphoma 2 anaplastic large cell lymphoma, 2 non-Hodgkin lymphoma whichcould not be classified because the slides were from other hospitals. The most common symptoms were cough （9/18） and fever （6/18）. ESR elevation was common （10/12）. CT features included solitary or multiple nodules （ 14/18 ）, patchy opacities （ 11/18 ）, consolidations （ 5/18 ）, pleural effusions （ 5/18 ）, atelectasis （5/18）, and cavities （1/18）. Misdiagnosis was found in 11 patients. Treatment modalities included surgical resection, radiotherapy and chemotherapy. Median follow-up time was 11 months （ 10 d to 205 mon）. Thirteen patients were still alive, 4 patients were lost, and 1 patient died. The prognosis was associated with the level of [ 25.1 ×10^9/L（ 18. 1 -39. 1 ） ×10^9/L in poor prognosis group, 6. 7 ×10^9/L （5.48-8.41） ×10^9/L in good prognosis group, u =0.000, P 〈0.05] leukoeytosis （3/3 vs 1/10, P 〈0.05 ）. Conclusions The clinical rnanifestations of primary pulmonary lyrnphorna are nonspeeifie. Misdiagnosis is eornrnon. Surgical lung biopsy is necessary for early diagnosis.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2008年第6期401-405,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
关键词
淋巴瘤
肺
诊断
治疗
Lymphorna
Lung
Diagnosis
Treatment
