原发性肺黏膜相关淋巴组织淋巴瘤47例回顾性分析  

A retrospective analysis of 47 patients with primary pulmonary mucosa-associated lymphoid tissue lymphoma

作　　者：李秋红[1] 谢惠康[2] 周瑛[1] 张苑[1] 胡洋[1] 苏奕亮[1] 张芬[1] 沈瓅 史景云[3] 尤小芳[3] 李惠萍[1] LI Qiuhong , XIE Huikang , ZHOU Ying , ZHANG Yuan , HU Yang , SU Yiliang , ZHANG Fen, SHEN Li, SHI Jingyun, YOU Xiaofang, LI Huiping.(Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China)

机构地区：[1]同济大学附属上海市肺科医院呼吸科,上海200433 [2]同济大学附属上海市肺科医院病理科,上海200433 [3]同济大学附属上海市肺科医院影像科,上海200433

出　　处：《上海医学》2018年第7期405-410,共6页Shanghai Medical Journal

基　　金：上海市卫生局青年科研项目(20124Y101)

摘　　要：目的通过回顾性分析47例原发性肺黏膜相关淋巴组织(MALT)淋巴瘤患者的临床、影像学、免疫功能和病理特点,以及诊断、治疗和随访的情况,提高临床医师对该病的认识和诊治水平。方法收集2002年1月—2015年1月在同济大学附属上海市肺科医院经病理活组织检查初次诊断为原发性肺MALT淋巴瘤的47例患者的临床资料和随访结果(截至2015年12月31日),分析其临床、影像学、免疫功能和病理学特点,以及诊断、治疗和随访的情况。结果 (1)临床特点:47例原发性肺MALT淋巴瘤患者中,男女比例为1.35∶1,中位年龄为55岁,42.55%(20/47)的患者通过体格检查发现。(2)影像学特点:主要表现为肺实变或斑片状病灶(65.96%,31/47),74.47%(35/47)的患者肺实变伴支气管充气征,23.40%(11/47)的患者伴纵隔或肺门淋巴结肿大,10.64%(5/47)的患者伴胸腔积液;26例患者行正电子发射计算机断层显像(PET)-CT或肺单光子发射计算机断层显像(SPECT)检查,其中有放射性核素浓聚者占88.46%(23/26),良性病变者占61.54%(16/26)。(3)免疫功能变化:行免疫功能检查26例,其中存在缺陷者占57.69%(15/26);行细胞免疫检查21例,其中存在缺陷者占71.43%(15/21);行体液免疫检查23例,其中存在缺陷者占26.09%(6/23)。42例患者行12项血清肿瘤标志物筛查,其中全阴性者占69.05%(29/42)。(4)病理学特点:47例患者病灶组织免疫组织化学染色CD20、CD79α均为阳性,CD5均为阴性;CD10阴性45例(95.74%)、bcl-2阳性33例(70.21%)。38例行外科手术的患者病理学检查结果显示,Ki-67表达阳性<5%者占44.74%(17/38),Ki-67表达阳性5%～15%者占47.37%(18/38),Ki-67表达阳性>15%者占10.53%(4/38)。(5)诊断:首诊诊断为淋巴瘤仅5例(诊断正确率10.64%),其余分别被误诊为肺炎20例(42.55%)、肺癌16例(34.04%),以及其他肺部疾病6例(12.77%,其中肺结核3例、间质性肺病2例、真菌感染1例);第1次就诊至确诊时间为0.25～108个Objective To retrospectively analyze the clinical, radiological, immunological and pathological characteristics and the diagnosis, treatment and follow-up of primary pulmonary mucosa-associated lymphoid tissue （MALT） lymphoma. Methods We performed a retrospective review of 47 patients diagnosed with tissue-confirmed primary pulmonary MALT lymphoma from January 2002 to January 2015 in the Shanghai Pulmonary Hospital. The clinical and follow-up data of those patients were collected and their clinical features, treatment and prognosis were analyzed. Results There were 27 males and 20 females （M/F： 1.35： 1） with a median age of 55 years old. 42.55% （20/47） patients were found with the disease by physical examinations. The radiological main feature was pulmonary consolidation or patch （65.96 %, 31/47）. Lung lesions accompanied with air bronchograms were the most common findings （74. 47%, 35/47）, followed by mediastinal or hilar lymphadenopathy （23. 40%, 11/47） and pleural effusions （10. 64%, 5/47）. The concentrations in positron emission tomography （PET）/computed tomography （CT） or single photon emission computed tomography （SPECT） were found in 88.46% （23/26） patients, but 61.54% （16/26） were diagnosed as benign diseases. There were 15 patients （57.69%, 15/26） with immunological function defect, 15 patients （71.43%, 15/21 ） with cellular immune dysfunction, 6 patients （26.09 %, 6/23） with humoral immune dysfunction. The results of 12 tumor markers were all negative in 69.05% （29/42） patients. In the pathological tissues of 47 patients, CD20 and CD79a were all positive and CD5 were all negative, 95.74 % （45/47） of CD10 were negative, and 70.21% （33/ 47） of bcl-2 were positive. In 38 patients with surgical pathology, the expression of Ki-67〈5% was positive in 17 （44.74%, 17./38）, the level of Ki-67 between 5% and 15% was positive in 18 （47.37%, 18/38） and the level of Ki-67 〉15% was positive in 4 （10.53%, 4/38）. The diagnosis ac

关 键 词：原发性肺黏膜相关淋巴组织B细胞性淋巴瘤 胸部CT 免疫缺陷 治疗 

分 类 号：R734.2[医药卫生—肿瘤]