以阻塞性睡眠呼吸暂停综合征为首发症状的扁桃体非霍杰金淋巴瘤临床病理观察  

Clinicopathologic observation of tonsillar non-Hodgkin’s lymphoma presenting as obstructive sleep apnea syndrome

作　　者：刘磊玉[1] 杨桂芳[2] 周赤[1] 

机构地区：[1]湖北省中医院病理科,湖北武汉430061 [2]武汉大学中南医院病理科,湖北武汉430030

出　　处：《中国现代医生》2013年第14期133-135,共3页China Modern Doctor

摘　　要：目的探讨以阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)为首发症状的扁桃体非霍杰金淋巴瘤的临床病理特征、诊断及鉴别诊断。方法复习2例扁桃体非霍杰金淋巴瘤引起OSAS的临床和影像学资料,行组织学和免疫组织化学观察,并复习相关文献。结果 60岁男性及71岁男性,睡眠打鼾,易醒,后者伴有无痛性双侧颈部包块。CT示前者双侧扁桃体肥大,口咽腔狭窄,咽旁淋巴结无明显肿大;后者T1加权MRI增强扫描示双侧扁桃体肿大,与周围软组织界限清晰,并双侧颌下淋巴结肿大。组织学前者可见滤泡样结构,缺乏极性和外套区,由小-中等大的淋巴细胞构成,核仁不明显,部分区域似单核细胞样。后者滤泡样结构消失,弥漫分布大-中等大小的生发中心样细胞,可见核仁。免疫组织化学示前者CD3(-)、CD20(+)、CD10(-)、Bcl-2(+)、Ki-67 25%(+)。后者CD20(+)、Bcl-6(+)、MUM-1(+)、CD10(-)、CD45RO(-)、Ki-67 50%(+)。诊断:(右侧扁桃体)非霍杰金淋巴瘤(弥漫性大B细胞淋巴瘤)。结论以OSAS为首发症状的扁桃体非霍杰金淋巴瘤罕见,临床容易误诊。影像学有助于诊断,组织形态学及免疫组织化学分析是确诊分型的唯一依据。Objective To study clinical and pathological features, diagnosis and differential diagnosis of tonsillar nonHodgkin＇s lymphoma as the first manifestation of obstructive sleep apnea syndrome （OSAS）. Methods We reviewed the clinical and imaging data of 2 cases of tonsillar non-Hodgkin＇s lymphoma causing OSAS, histological and immunohistochemical characteristics, and the literature. Results 60-71-year-old males presented as snoring and easy to wake up during sleep, one of whom with bilateral painless cervical mass. Stegnotic oropharyngeal cavity and bilateral enlarged tonsils without obvious enlarged parapharyngeal lymph node were detected by computed tomography （CT） scanning and bilateral enlarged tonsils , clear boundary with surrounding soft tissue and bilateral submandibular lymph node enlargement were revealed by T1 weighted MRI scanning respectively. Histologically, the former had follicles-like structure and was lack of polar and the outer zone, composed of small and medium large lymphoeytes with inconspicuous nucleoli, partial area like monocytoid; the latter lost follicles-like structure , large-medium size of germinal-centerlike cells with visible nucleoli distributed diffusely. The former was CD3（-）, CD20（＋）, CDI0（-）, Bcl-2（＋）and Ki-67 25%（＋）; the latter was CD20（＋）, Bcl-6（＋）, MUM-1 （＋）, CD10（-）, CD45RO（-） and Ki-67 50%（＋） by immunohistochemistry assay. Diagnosis： （the right tonsil） non-Hodgkin＇s lymphoma （diffuse large B cell lymphoma）. Conclusion Tonsillar non-Hodgkin＇s lymphoma as the first manifestation of OSAS is uncommon and often misdiagnosed clinically. Imaging is helpful to its diagnosis. Histological and immunohistochemical analysis is the only basis for definite diagnosis.

关 键 词：阻塞性睡眠呼吸暂停综合征 扁桃体 淋巴瘤 

分 类 号：R733.1[医药卫生—肿瘤]