累及肺部的结外鼻型自然杀伤细胞或T细胞淋巴瘤三例临床分析  

Pulmonary extranodal natural killer/T-cell lymphoma:clinical analysis of three cases

作　　者：胡群 赖国祥 徐礼裕 曲利娟[3] 柳德灵 叶嘉 黄爱清 江秀芳 林彩燕 张雷 Hu Qun;Lai Guoxiang;Xu Liyu;Qu Lijuan;Liu Deling;Ye Jia;Huang Aiqing;Jiang Xiufang;Lin Caiyan;Zhang Lei(Department of Pulmonary and Critical Care Medicine,Fuzhou General Clinical Medical College,Fujian Medical University 350025;Department of Respiration,Affiliate Fuzhou City First Hospital of Fujian Medical University,Fuzhou 350009;Pathology Department,Fuzhou General Clinical Medical College,Fujian Medical University,Fuzhou 350025;Pathology Department,Fuqing Hospital 350300;Pathology Department,Jian′ou Municipal Hospital 353100;the Department of Respiration,Changle District Hospital,350200)

机构地区：[1]福建医科大学福总临床医学院呼吸与危重症医学科,福州350025 [2]福建医科大学附属福州市第一医院呼吸内科,350009 [3]福建医科大学福总临床医学院病理科,福州350025 [4]福建省福清市医院病理科,350300 [5]福建省建瓯市立医院病理科,353100 [6]福州市长乐区医院呼吸内科

出　　处：《中华结核和呼吸杂志》2019年第3期193-197,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：福建省科技计划重点项目(2014Y0037);福建省2014年临床重点专科(西医类别)建设项目(闽卫医政函(2015)593号).

摘　　要：胡群赖国祥徐礼裕曲利娟柳德灵叶嘉黄爱清江秀芳林彩燕张雷目的分析累及肺部的结外鼻型自然杀伤细胞或T细胞淋巴瘤(ENKTL)的临床表现、影像学特点及病理资料,提高对该病的认识水平。方法收集福建医科大学福总临床医学院经肺组织病理确诊的3例累及肺部的结外鼻型ENKTL患者,并对相关资料进行分析。结果3例均为男性,年龄分别为74、61和49岁。临床表现均为畏寒、发热,1例伴有鼻塞、流涕。胸部CT表现双肺多发结节(3/3)、肿块(2/3)和斑片影(2/3),病灶形态不规则,边界清晰。3例均误诊为社区获得性肺炎,给予静脉滴注盐酸莫西沙星等治疗无效,后经CT引导下经皮肺穿刺活检病理确诊为肺结外鼻型ENKTL。3例免疫组织化学染色CD56、CD2及EB病毒编码的小mRNA(EBER)均阳性,CD20均阴性;2例CD3与颗粒酶B均阳性;1例T淋巴细胞胞质内抗原-1阳性。3例患者均给予化疗,死亡2例,其中1例行骨髓移植后1个月因排斥反应死亡;好转1例,但仍在随访中。结论ENKTL患者临床常表现为畏寒、发热;肺部影像学以多发结节和(或)斑片影为主,易被误诊为肺炎;确诊需行肺组织活检及免疫组织化学染色。ObjectiveTo improve the understanding of pulmonary involvement of extranodal natural killer/T-cell lymphoma(ENKTL)by analyzing the clinical manifestations,imaging and pathological features of this disease.MethodsThree cases of ENKTL,proven by pathological diagnosis in Fuzhou General Clinical Medical College of Fujian Medical University,were retrospectively analyzed.ResultsAll of the 3 cases were males,aged 74,61 and 49 years,respectively.The main clinical symptoms included cold and fever.One patient had nasal congestion and runny nose.Chest CT showed multiple lung nodules(n=3),masses(n=2)and patchy shadows(n=2),with irregular lesions and clear boundaries.The 3 cases had been misdiagnosed as community acquired pneumonia,and treated with intravenous injection of moxifloxacin.ENKTL was confirmed by CT-guided percutaneous biopsy with immunohistochemical staining,which showed that 3 cases were positive for CD56,CD2,in situ hybridization for EBV encoded RNA(EBER),while negative for CD20,and 2 cases were positive for CD3,Granzyme B;and 1 case was positive for T-cell intracytoplasmic antigen-1.All 3 patients received chemotherapy,but 2 patients died,one of rejection 1 month later after bone marrow transplantation.One patient had improved after chemotherapy with follow-up.ConclusionENKTL should be considered when patients presented with fever,multiple lung nodules or consolidations which were non-responsive to antibiotics.Lung biopsy was the key to diagnosis.

关 键 词：肺 淋巴瘤 

分 类 号：R733.1[医药卫生—肿瘤]