15例鼻腔鼻窦非霍奇金淋巴瘤患者的临床特征分析  

Clinicopathologic analysis of extranodal non-hodgkin lymphoma of the sinonasal cavities:a 15-case report

作　　者：张迎宏[1] 段清川[1] 左强[1] 杜晨[1] 谢立峰[1] 朱丽[1] 

机构地区：[1]北京大学第三医院耳鼻咽喉科,北京100191

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第21期1653-1657,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨鼻腔鼻窦非霍奇金淋巴瘤不同组织学亚型的临床表现、影像学特征、免疫组织学类型及其早期诊断价值。方法:回顾性分析北京大学第三医院耳鼻咽喉科2010-2016年经手术及活检病理证实的15例鼻腔鼻窦非霍奇金淋巴瘤患者的临床、影像学和病理资料,并对不同病理分型的临床症状、影像学特点进行统计分析。结果:15例患者中NK/T淋巴瘤患者9例,中位年龄39岁,其中男5例,女4例;弥漫大B淋巴瘤患者6例,中位年龄64岁,其中男3例,女3例,组间年龄差异有统计学意义(P<0.05)。弥漫大B淋巴瘤按照病理学Han′s分型可分为生发中心型(1例)和非生发中心型(5例)。NK/T及弥漫大B淋巴瘤患者临床症状中鼻塞、复视、溢泪、突眼症状差异有统计学意义(均P<0.05)。不同病理类型2组间影像特点中肿物外侵下鼻甲及肿物外侵眼眶差异有统计学意义(均P<0.05)。NK/T淋巴瘤患者免疫组织化学检测结果中CD56(+)8例,CD3(+)5例,EBER(+)9例;生发中心型弥漫大B淋巴瘤患者(1例)免疫组织化学:Bcl-6(+)、CD10(+),MUM1(-);非生化中心型弥漫大B淋巴瘤患者Bcl-6(+)5例,MUM1(+)5例,CD10(-)5例。结论:(1)NK/T淋巴瘤在中国人鼻腔鼻窦非霍奇金淋巴瘤中发病率较高,与之对应弥漫大B淋巴瘤发病率较低,这与亚洲地区其他国家的发病率相似,但与西方国家的发病率差别较大;(2)早期出现复视、溢泪及突眼症状,并且影像学上出现眼眶外侵的鼻腔鼻窦肿瘤患者应高度怀疑弥漫大B淋巴瘤;肿瘤的早期诊断对早期治疗尤为重要;(3)组织病理学:NK/T淋巴瘤患者免疫组织化学结果中CD56及EBER阳性率较高;弥漫大B细胞淋巴瘤MUM1阳性率高。Objective：To investigate the clinical manifestation,imaging and histological features of different histological subtypes of non-Hodgkin′s lymphoma of nasal cavity and paranasal sinuses.Method：Fifteen NHL patients of the sinonasal region were collected from the Department of Otolaryngology of Peking University Third Hospital from 2010 to 2016.HE staining and immunohistochemical staining were performed.The clinical characteristics and imaging features of different subtypes were described and analyzed.Result：We analyzed a total of 6 patients with localized sinonasal diffuse large B cell lymphoma and 9 patients with localized sinonasal extranodal NK/T cell lymphoma.The age distribution for these two subtypes is very distinct.The median age of the patients with localized sinonasal extranodal NK/T cell lymphoma was 39 years.There were 5 males and 4 females.Nine sinonasal NHLs were NK/T-cell lymphoma,nasal type,all of which were infected with EBV.The median age of the patients with localized sinonasal diffuse large B cell lymphoma was 64 years.There were 3 males and 3 females.Symptoms for patients with SN-DLBCL and SN-ENKTL were significantly different in epiphora,proptosis,diplopia and nasal congestion（P=0.18,0.004,0.18,0.18）.Imaging features for patients with SN-DLBCL and SNENKTL were significantly different in tumor extended to orbit and inferior turbinate（P0.05）.Positive staining for CD 56 was detected in 9 patients,for CD 3 in 9 patients,for EBER in 9 patients.The Hans algorithm identified 1 patient with the germinal center B-cell（GCB）subtype and 5 with the non-GCB subtype.Conclusion：Early symptoms of epiphora,proptosis,diplopia,and images finding with orbital invasion should be highly suspected of diffuse large B cell lymphoma.Positive staining for CD 56 and EBER were detected in all patients with extranodal NK/T cell lymphoma,and positive staining for CD20 was detected in all patients with SN-DLBCL.

关 键 词：结外非霍奇金淋巴瘤 NK/T细胞 弥漫大B细胞 影像学 组织病理学 

分 类 号：R739.6[医药卫生—肿瘤]