原发性睾丸恶性淋巴瘤12例诊治分析  

Diagnosis and Treatment of Primary Malignant Lymphoma of the Testis: an Analysis of 12 Cases

作　　者：崔朝阳 于满[2] 王泽民[2] 宋殿宾[2] 肖永跃 

机构地区：[1]河北省平泉市医院普外科,067500 [2]承德医学院附属医院泌尿外科,河北省承德市067000

出　　处：《中国全科医学》2017年第36期4571-4575,共5页Chinese General Practice

摘　　要：目的分析原发性睾丸恶性淋巴瘤12例(PTML)患者的诊治资料,提高临床医生对该病的认识及诊治水平。方法回顾性分析1995年1月—2016年1月承德医学院附属医院泌尿外科收治的12例PTML患者的临床资料,包括PTML患者的一般资料、影像学检查结果、病理检查结果、治疗情况、随访情况。结果 12例PTML患者年龄24~78岁,其中>60岁者(9/12)居多;病程1~14个月;肿瘤发生在右侧睾丸者(6/12)居多;主要症状为患侧睾丸肿大、伴有阴囊坠胀。12例患者均行B超检查,仅显示睾丸内低回声或实性肿物,提示睾丸占位。9例患者行睾丸CT检查,显示患侧睾丸增大,病灶边缘清晰或不清晰,密度相对均匀。术后病理检查诊断为弥漫性大B细胞淋巴瘤。12例PTML患者均行根治性睾丸切除术,其中4例患者术后联合放疗,5例患者术后联合放、化疗。随访12~120个月,死亡8例,其中3例死于肺转移,3例死于全身转移,1例死于脑转移,1例死于心脑血管疾病;其余4例在26~120个月存活良好。结论 PTML临床较少见,60岁以上体格检查有睾丸肿块者应首先考虑恶性淋巴瘤的可能,手术联合放、化疗可提高临床疗效。Objective To analyze the diagnosis and treatment of primary malignant lymphoma of the testis with the aim offurtehring our understanding of the disease and improving its diagnosis and treatment. Methods We retrospectively reviewed the medical records of 12 patients with primary malignant lymphoma of the testis who were admitted to the Department of Urology,Affiliated Hospital of Chengde Medical University,from January 1995 to January 2016,including general patient characteristics,imaging examination results,pathology,treatment and follow-up. Results The patients were aged 24-78 years,with 75%（ 9/12） being older than 60 years. The disease course ranged from 1-14 months. Half of the patients hadlymphoma in the right testis. The main symptoms included swelling of the affected testis,accompanied by scrotal swelling. All patients underwent B-Ultrasound examinations,which displayed a low-echo or solid mass, suggesting atesticular space-occupying lesion. Nine patients also underwent computed tomography scans of the testis,which showed enlargement of the affected testis,and clear or unclear margins of the foci with relatively even density. Post-surgical pathological examination revealed diffuse large-B-cell lymphoma. All patients underwent radical orchidectomy,followed by post-surgical radiotherapyin four cases and post-surgical chemotherapy and radiotherapy in five cases. The patients were followed up for 12-120 months,during which time eight patients died,including three of lung metastasis, three of systemic metastases, one of brain metastasis, and one of cardiovascular diseases. The remaining four patients survived for 26 – 120 months,respectively. Conclusion Primary malignant lymphoma of the testis is a rare clinical disorder. The possibility of malignant lymphoma is the first consideration for physical examination of testicular masses in patients over 60 years of age. Surgery combined with chemotherapy and radiotherapy may improve outcomes in these patients.

关 键 词：睾丸肿瘤 淋巴瘤 诊断 治疗 预后 

分 类 号：R737.21[医药卫生—肿瘤]