肺部症状首发的肠病型T细胞淋巴瘤2例并文献复习  

Two cases of enteropathy-type T-cell iymphoma with pulmonary complications primarily appeared and review of literature

作　　者：张挪富[1] 别英晖[1] 赖微微[1] 孙聪[1] 顾莹莹[2] 

机构地区：[1]广州医学院第一附属医院呼吸疾病国家重点实验室(广州医学院),510120 [2]广州医学院第一附属医院病理科,510120

出　　处：《国际呼吸杂志》2011年第14期1067-1070,F0003,共5页International Journal of Respiration

摘　　要：目的提高对以肺部症状为首发的肠病型T细胞淋巴瘤的认识。方法收集2例以肺部症状首发的肠病型T细胞淋巴瘤，并结合相关文献对其临床表现、诊断思路及治疗方法进行分析总结。结果仅以肺部症状首发的肠病型T细胞淋巴瘤较为少见，不易诊断。临床表现主要为反复无规律性发热、咳嗽，后期可伴腹部症状（肠出血、肠穿孔）。纤维支气管镜和经皮肺穿刺活检往往难以诊断，确诊需腹部手术探查取活组织行病理学及免疫组化分型。治疗方面仍存在争议。结论当以肺部症状为首发表现，行抗感染等经验性治疗无效，而多次肺组织活检又无阳性结果时，应考虑全身性疾病的可能性，尤其在卅现肠出血或肠穿孔等肠道症状时，更应警惕肠病型T细胞淋巴瘤的诊断。争取早期确诊、早期治疗，提高患者生存率。Objective To recognize the cases of enteropathy-type T-cell lymphoma （ETCL） with pulmonary complications primarily appeared. Methods Two cases of ETCL with pulmonary complications primarily were collected and relevant literatures were reviewed. The clinical features, diagnosis and treatment of the disease were analyzed. Results ETCL with pulmonary complications primarily appeared was so rare that it was difficult to be diagnosed. The main clinical features were repeated irregular fever and cough with abdominal symptoms which may be intestinal hemorrhage or perforation in the later period. Confirmed diagnosis depended on pathology and immunohistochemistry following laparotomy since it tended to be hard by fiberoptic bronchoscope or percutaneous lung biopsy. There was no consensual treatment currently. Conclusions The possibility of systemic disease should be prospected when pulmonary complications primarily appear with the inefficacy of conventional therapy and the negative results of the biopsy for several times. More attention could be paid to the diagnosis of ETCL especially when intestinal hemorrhage or perforation occurs. The earlier diagnosis and treatment are urgently required to improve the prognosis of these patients.

关 键 词：肠病型T细胞淋巴瘤 肺部症状首发 肠穿孔 

分 类 号：R734.2[医药卫生—肿瘤]