9例原发性乳腺弥漫大B细胞淋巴瘤的临床病理分析  

Clinical and Pathological Analysis of 9 Patients with Primary Breast Diffuse Large B-cell Lymphoma

作　　者：韦中玲[1] 黄东平[1] 苏贵平[1] 汪兴洪[1] 蒋艺枝[1] 黄来全[1] 

机构地区：[1]安徽省芜湖市弋矶山医院血液内科,安徽芜湖241000

出　　处：《中国实验血液学杂志》2015年第2期435-440,共6页Journal of Experimental Hematology

摘　　要：目的:探讨原发性乳腺弥漫大B细胞淋巴瘤(PBDLBCL)的临床特征、诊断及治疗方法。方法:回顾性分析皖南医学院附属弋矶山医院2001年08月-2014年01月收治的9例原发性乳腺弥漫大B细胞淋巴瘤患者的临床特征、诊断及治疗方法。结果:所有患者均为女性,年龄28-75岁,中位年龄为48岁;8例单侧乳腺受累,1例累及双侧乳腺;Ann arbor分期为I E期2例,II E期7例;所有患者均无B组症状;国际预后指数0分6例,1分3例;生发中心(GCB)型2例,非生发中心(non-GCB)型7例;伴双重打击(Double-Hit)3例。所有患者均行手术确诊,其中3例行空芯针活检,5例行包块切除术,1例行改良根治术明确诊断。1例行单纯乳腺癌根治切除术;1例行单侧乳腺切除术联合化疗;1例活检后放弃治疗;1例行包块切除联合化放疗;5例行包块切除联合化疗;9例中1例进行中枢预防PBDLBCL,其中一线化疗后6例获得CR,中位随访时间为18个月。3例复发,5例死亡。结论:PBDLBCL多发于女性,病理类型以non-GCB伴Double-Hit型为主;空芯针取组织活检有助于明确PBL的诊断。治疗以R-CHOP或CHOP类方案化疗和(或)联合放疗为主,辅以鞘内注射化疗药物可能有助于预防PBL中枢复发。Objective： To explore the clinical features, diagnosis and treatment of primary breast diffuse large B- cell lymphoma （PBDLBCL）. Methods： Clinical records of 9 PBDLBCL patients treated in Department of Hematology of Yijishan Hospital Affiliated to Wannan Medical College from August 2001 to January 2014 were analyzed retrospectively. Results： All of the 9 patients were female, with an average age of 48 years （ range 28 to 75 ）, 8 cases had unilateral breast tumors and 1 case had bilateral. According to the Ann Arbor stage standard, 2 cases were of stage IE and 7 were HE. None of them was concurrent with B symptoms ; 6 cases had IPI （ International prognostic Index） score 0 and 3 had score 1. 2 cases belonged to germinal center B cells type （ GCB ） and 7 belonged to non-GCB. Double-Hit lymphomas were presented in 3 cases. Out of 9 cases, 3 cases were diagnosed by using tubular needle biopsy, 5 cases were diag- nosed by using resection of breast mass, and 1 case was diagnosed by using modified radical mastectomy. 1 case received radical mastectomy, 1 case received unilateral breast removal, 1 case gave up, 1 case received mass excision with chemotherapy and radiotherapy, 5 cases received mass excision with chemotherapy and 1 case received central prophylax- is. A complete response （CR） was observed in 6 cases after first-line chemotherapy. The median follow-up time was 18 months （range 0.1 to 150）, 3 cases relapsed and 5 cases died. Conclusion： PBDLBCL mostly occurs in female. The main pathological type is non-GCB coupled with Double-Hit lymphoma. Tubular needle biopsy offers benifit in the diag- nosis of PBL, R-CHOP or R-CHOP combined with chemotherapy/radiotherapy produce best outcome among all the treatments. Intrathecal injection of chemotherapy drugs may help to prevent recurrence of PBL central.

关 键 词：原发性乳腺淋巴瘤 原发性乳腺弥漫大B细胞淋巴瘤 病理分析 

分 类 号：R733.1[医药卫生—肿瘤]