原发性肺黏膜相关淋巴组织淋巴瘤4例临床病例分析  

Clinical analysis of four cases with primary pulmonary mucosa-associated lymphoid tissue lymphoma

作　　者：王玉霞[1] 方芳[2] 张旻[3] 柯会星[1] 范芸[4] 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呼吸与危重症医学科,100730 [2]北京医院国家老年医学中心病理科,100730 [3]北京医院国家老年医学中心放射科,100730 [4]北京医院国家老年医学中心血液科,100730

出　　处：《国际呼吸杂志》2017年第18期1384-1389,共6页International Journal of Respiration

摘　　要：目的总结原发性肺黏膜相关淋巴组织（MALT）淋巴瘤的临床表现、影像学特点、诊断手段、治疗方法及预后，提高临床诊治水平。方法回顾性分析4例经病理确诊的原发性肺MALT淋巴瘤的临床资料并随诊分析预后。结果4例原发性肺MALT淋巴瘤患者均为老年女性，为原发性肺非霍奇金淋巴瘤的最常见类型。其中3例为查体发现，1例因咳嗽、咳痰和痰中带血就诊。发病时间为7个月至5年。肺部体征无特异性。血炎症指标和肿瘤相关指标多为正常。影像学以肿块影和结节为主要表现。患者肺通气和弥散功能正常。经胸腔镜、CT引导下肺穿刺、开胸手术获取病变组织而确诊。病理表现为弥漫浸润生长的小淋巴细胞，可见淋巴上皮增生。治疗主要是化疗和手术。随访1～8．8年，1例随访4．5年时可疑复发，其余3例均病情稳定。结论肺原发性MALT淋巴瘤为少见病，好发于老年女性，起病隐匿，临床表现不典型。诊断须靠有经验的病理专家作出。治疗尚无指南，无症状者可采取“观察等待”策略，待肿瘤进展或出现症状时，首选苯丁酸氮芥化疗，联合利妥昔单抗与否均可。预后良好，但复发率高。Objective To sum up the clinical, radiological, diagnostic, therapeutic, and prognostic manifestations of primary pulmonary mucosa-associated lymphoid tissue （MALT） lymphoma, and improve the diagnosis and treatment of the disease. Methods The clinical data of four patients with primary pulmonary MALT lymphoma confirmed by pathology were analyzed retrospectively, and they were followed up to analyze prognosis. Results The four cases were all senile females. Primary pulmonary MALT lymphoma was the most common pathologic type of primary pulmonary non Hodgkin lymphoma. Three cases were found from health check, and one case went to hospital because of cough, expectoration and blood in the sputum. Onset time of four cases was from seven months to five years. Four cases had no special physical signs. Inflammation indexes and tumor related indexes were usually normal. Radiological features of the four cases mainly presented nodules or masses. The patients had normal ventilation and diffusion function. The veracious methods included CT-guided percutaneous lung puncture, thoracoscope and thoracotomy. Histopathological finding showed small lymphoid cells with diffuse infiltration and lymphoid hyperplasia. The main treatment was chemotherapy and surgery. They were followed up for 1- 8.8 years, three cases were stable, one case was found of suspected recurrence in 4.5 years. Conclusions Primary pulmonary MALT lymphoma is a rare disease, of which clinical manifestation is atypical, mainly occurs in senile females. This disease has insidious onset. Diagnosis should be made by experienced pathology specialists. There is no guidelines for treatment. For asymptomatic patients, the strategy of watch-and-wait can be adopted. When tumor progresses or symptoms occur, the first choice is chemotherapy with chlorambucil, combined with rituximab or not. 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 

分 类 号：R734.2[医药卫生—肿瘤]