以肾上腺占位为主要表现的非霍奇金淋巴瘤21例临床分析  

A clinical analysis of 21 cases of adrenal non-Hodgkin＇s lymphoma

作　　者：布楠 吴红花[1] 姚军[1] 张俊清[1] 高燕明[1] 郭晓蕙[1] 

机构地区：[1]北京大学第一医院内分泌科,100034

出　　处：《中华内科杂志》2015年第1期22-26,共5页Chinese Journal of Internal Medicine

摘　　要：目的 通过分析肾上腺淋巴瘤的临床特点,拓展肾上腺占位诊断思路.方法 回顾性分析1994年1月—2012年12月于北京大学第一医院住院诊治的肾上腺占位及淋巴瘤患者,从中筛选肾上腺淋巴瘤患者并分析其临床特点.结果 期间共收治肾上腺占位患者1 100例,淋巴瘤患者1 002例,其中肾上腺淋巴瘤患者21例,男14例,女7例,年龄35 ～80岁,平均56岁.临床表现腰背部疼痛15例,发热3例,消瘦1例,体检发现2例.仅2例伴浅表淋巴结肿大,10例腹腔淋巴结肿大.其他结外器官受累11例,其中脾脏增大4例,肾脏受累3例,胃受累3例,精索受累1例.双侧肾上腺受累8例,左侧9例,右侧4例.肿物平均直径7.2 cm.CT、MRI表现无特异性.内分泌功能检查均为无功能瘤.病理检查结果：弥漫大B细胞型18例,T细胞型2例,间变性大细胞型1例.仅7例在手术前诊断淋巴瘤.2014年9月电话回访到17例,其中死亡14例,平均生存时间5.5个月,2例分别无瘤生存4、10个月,另1例化疗治疗中.结论 肾上腺淋巴瘤少见,较少侵犯浅表淋巴结,恶性程度高,进展快,预后差.临床及影像学表现均缺乏特异性,误诊率高.病理是诊断金标准,多为弥漫大B细胞型.Objective To elaborate the clinical characteristics of adrenal non-Hodgkin＇s lymphoma and to expand the clinical thinking of adrenal tumors.Methods Subjects with adrenal tumors and nonHodgkin＇s lymphomas between January.1994 and December.2012 in Peking University First Hospital retrospectively were included and these with adrenal lymphoma patients were analyzed in the present study.Results Among 1100 adrenal tumors and 1 002 non-hodgkin＇s lymphomas,21 patients （aged 35 to 80 years,mean 56 years） were diagnosed as having adrenal non-Hodgkin＇s lymphoma with 14 males and 7 females.Among the 21 patients,15 were with pain on the waist and the back,3 with fever,1 had weight loss.Two patients were diagnosed by regular health examination.Only 2 subjects accompanied by superficial lymph node enlargement,while 10 by abdominal cavity lymph node enlargement.Eleven subjects were with extranodal involvement.Bilateral adrenal were involved in 8 patients with 9 on the left and 4 the right.The average diameter of the masses was 7.2 cm.There were no specific features in conventional imaging such as CT and MRI scan.All of the 21 cases were found normal adrenal function by endocrinological examinations.Pathology reviewed that 18 of 21 were diffuse large B cell non-Hodgkin＇s lymphoma,2 were T cell lymphoma,1 were anaplastic large cell lymphoma.Only 7 of 21 cases were diagnosed with adrenal lymphoma pre-operation.Seventeen patients were followed up by telephone in September 2014,in which 14 died and the average survival time was 5.5 months,2 were tumor-free survival for 4 and 10 months respectively,1 were currently undergoing chemotherapy.Conclusions Adrenal lymphoma is rare with less superficial lymph node,more bilateral adrenal involved with high malignant degree.It progressed quickly with poor prognosis.Clinical and imaging features were not specific,so misdiagnosis was very common.Pathology is the diagnostic gold standard.The most common type was diffuse large B cell type.

关 键 词：淋巴瘤 非霍奇金 肾上腺 

分 类 号：R736.6[医药卫生—肿瘤]