原发性乳腺淋巴瘤27例临床分析并文献复习  

Primary Breast Lymphoma-A Report of 27 Cases with Literature Review

作　　者：曹亚兵[1,2] 王树森[1,2] 黄慧强[1,2] 徐光川[1,2] 何友兼[1,2] 管忠震[1,2] 林桐榆[1,2] 

机构地区：[1]华南肿瘤学国家重点实验室 [2]中山大学肿瘤防治中心化疗科,广东广州510060

出　　处：《癌症》2007年第1期84-89,共6页Chinese Journal of Cancer

基　　金：广东省科技计划项目(No.2003C30314)~~

摘　　要：背景与目的:原发性乳腺淋巴瘤(primarybreastlymphoma,PBL)发病率低,预后较差。本研究旨在分析该病例的临床和病理特征,从而探讨PBL的合理治疗模式。方法:收集并回顾性分析1976年到2005年间在中山大学肿瘤防治中心诊断为PBL,并接受治疗的27例患者的临床资料和治疗情况。结果:27例中有26例女性和1例男性患者;年龄12～84岁;90%的患者为ⅠE期或ⅡE期。按照WHO2001淋巴瘤病理分类系统,有22例B细胞性淋巴瘤(17例弥漫大B细胞性淋巴瘤,2例黏膜相关性淋巴瘤,1例边缘区淋巴瘤,2例未能分类),3例外周T细胞性淋巴瘤,2例患者的病理类型未能分类。初始治疗时有20例患者接受了综合治疗,其中8例患者为根治术加术后化疗,12例患者为肿物切除术后加全身化疗,两组的5年生存率分别为23.0%和58.0%(P=0.006);其余有5例患者仅接受全身化疗,2例患者仅接受肿物切除手术。24例患者在初始治疗后取得完全缓解,1例患者部分缓解,2例患者疾病进展。随访时间1个月～10年,中位随访时间38个月。全组患者的5年总生存率和无病生存率分别是47.0%和23.0%;其中20例中高度恶性淋巴瘤患者(17例弥漫大B细胞性淋巴瘤和3例外周T细胞性淋巴瘤)的5年总生存率和无病生存率分别是48.0%和27.0%;随访中有16例复发,部位见于同侧乳腺6例、对侧乳腺4例、中枢神经系统(centralnervoussystem,CNS)3例、骨髓1例和淋巴结侵犯2例。结论:PBL的病理类型以中高度恶性淋巴瘤为主;根治性手术在其治疗中作用有限,肿物切除术加术后化疗和放疗的效果较好。PBL患者易发生CNS复发,在随访中应定期进行颅脑CT或MR检查。BACKGROUND ＆ OBJECTIVE： Primary breast lymphoma （PBL） is an uncommon disease with poor clinical outcome. This study was to investigate clinicopathologic features and optimal treatment of PBL. METHODS： Clinical records of 27 PBL patients, treated in Cancer Center of Sun Yat-sen University from 1976 to 2005, were reviewed. RESULTS, Of the 27 patients, 26 were women and 1 was man, with the age ranged from 12 to 84; 18 were at stage Ⅰ E, 6 at stage Ⅱ E, and 3 at stage Ⅲ/IVE; according to the WHO 2001 lymphoma classification system, 22 had B-cell lymphoma （including 17 cases of diffuse large B-cell lymphoma, 2 cases of mucosa-associated lymphoid tissue lymphoma, 1 case of marginal zone lymphoma, and 2 cases of unclassified B-cell lymphoma）, 3 had peripheral T-cell lymphoma, and 2 had unclassified lymphoma. Of the 27 patients, 8 received mastectomy and chemotherapy, 12 received excision of the breast lesion and chemotherapy （the 5-year overall survival rates were 23% and 58%, P=0.006）, 5 received chemotherapy alone, and 2 received lesion excision alone;24 achieved complete remission （CR） after scheduled treatment, 1 achieved partial remission （PR）, and 2 patients had progressive disease （PD）. With a follow-up of 10 years and median 38 months, the 5-year overall and disease-free survival rates of the 27 patients were 47% and 23%, respectively. As to the 20 patients with high or moderate grade diseases （diffuse large B-cell lymphoma and peripheral T-cell lymphoma）, the 5-year overall and disease-free survival rates were 48% and 27%, respectively. Sixteen patients had tumor relapse during the follow-up in the homolateral breast （6 cases）, controlateral breast （4 cases）, central nerve system （CNS） （3 cases）, bone marrow （1 case）, and lymph nodes （2 cases）. CONCLUSIONS：The main subtypes of PBL are diffuse large B-cell lymphoma and peripheral T-cell lymphoma. The effect of radical operation is limited in PBL; the optimal sequence is lumpectomy followed by stan

关 键 词：乳腺肿瘤 淋巴瘤 外科手术 化学疗法 病理学 疗效 

分 类 号：R737.9[医药卫生—肿瘤]