原发性肺淋巴瘤临床特点分析  

Clinical Analysis of 5 Cases with Primary Pulmonary Lymphoma and Literature Review

作　　者：王玉霞[1] 方芳[1] 张旻[1] 柯会星[1] 范芸[1] 郭岩斐[1] 李燕明[1] 孙铁英[1] 

机构地区：[1]北京医院国家老年医学中心,北京100730

出　　处：《中国临床医生杂志》2017年第6期18-20,共3页Chinese Journal For Clinicians

基　　金：北京市自然科学基金(7132220)

摘　　要：目的总结原发性肺淋巴瘤临床表现、影像学特点、诊断手段、治疗方法及预后,提高临床诊治水平。方法回顾分析5例经病理确诊原发性肺淋巴瘤患者的临床资料并随诊分析预后。结果 5例原发性肺淋巴瘤患者均为女性,年龄34~79岁。查体发现3例,因咳嗽、咳痰和痰中带血就诊2例。发病时间8周至5年。肺部体征无特异性。炎症指标稍升高1例,肿瘤相关指标均正常5例。影像学以肿块影(2/5)、结节(2/5)和实变影(1/5)为主要表现。少数患者肺弥散功能减退(1/5)。经胸腔镜(2/5)、CT引导下肺穿刺(2/5)、开胸手术(1/5)获取病变组织而确诊。原发性肺黏膜相关淋巴组织淋巴瘤4例,原发性肺霍奇金淋巴瘤1例。化疗和手术治疗后随访1.0~8.8年,5例均存活,1例随访至4.5年时可疑复发,其余4例均病情稳定。结论原发性肺淋巴瘤为少见病,临床表现不典型,容易漏诊误诊。病变局限者可考虑手术或放疗,弥漫者首选化疗。预后较好,但复发率高。Objective Primary pulmonary lymphoma is a rare disease, so it is important to analyze 5 cases with primary pulmonary lymphoma confirmed by pathology in Beijing Hospital through 20 years, sum up the clinical,radiological, di- agnostic ,therapeutic, and prognostic manifestations, and improve the diagnosis and treatment of this disease. Method To analyze retrospectively clinical data of 5 cases with primary pulmonary lymphoma confirmed by pathology, and to follow up prognosis. Result 5 cases all were females, with a median age of 34 - 70 years. 3 cases were found from health check, and 2 eases went to hospital because of cough and expectoration of blood in the sputum. Onset time of 5 cases was from 8 weeks to 5 years. 5 cases had no special physical signs. Elevation of Inflammation indexes was found only in 1 case. Tumor related indexes were usually normal. CT features of the 5 cases mainly presented nodules（2/5 ） , masses（ 2/5 ）, consolidation（ 1/5 ）. 1 patients had decrease in diffusion dysfunction. The veracious methods included CT- guided percutaneous lung puncture （ 2/5 ） , thoracoscope （ 2/5 ） and thoracotomy （ 1/5 ）. Histological diagnosis showed that 1 case was Hodgkin lymphoma,4 mucosa-associated lymphoid tissue lymphoma. The main treatment was chemo- therapy and surgery. Followed up for 1.0-8.8 years ,5 eases all were survival. 4 eases were stable, 1 ease was found of suspected recurrence in 4.5 years. Conclusion Primary pulmonary lymphoma is a rare disease ,which clinical manifes- tation is atypical. Misdiagnosis and missed diagnosis are common. Diagnosis should be made by experienced pathology specialist. There is no guidelines for treatment. Localized lesions can be considered surgery or radiotherapy, diffuse pre- ferred chemotherapy. The tumor has a good prognosis and high relapse rate.

关 键 词：原发性肺淋巴瘤 黏膜相关淋巴组织 霍奇金淋巴瘤 

分 类 号：R733[医药卫生—肿瘤]