心脏淋巴瘤4例临床病理分析  

Cardiac lymphoma: a clinicopathological analysis of 4 cases

作　　者：王利群[1] 马亚琪[1] 李杰[1] 孙璐[1] 宋欣[1] 郭爱桃[1] WANG li-qun;MA Ya-qi;LI Jie;SUN Lu;SONG Xin;GUO Ai-ta(General Hospital of the People's Liberation Army)

机构地区：[1]解放军总医院第一医学中心病理科

出　　处：《诊断病理学杂志》2019年第12期793-796,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨心脏淋巴瘤的临床和病理组织学特点,提高临床及病理医师对心脏淋巴瘤的认识。方法对4例心脏淋巴瘤进行回顾性分析,详细复习临床资料,复阅全部病理切片,统计相关的免疫组化结果,分析其临床病理学特征,随诊其预后,并复习相关文献。结果在4例心脏淋巴瘤中,1例为原发性弥漫大B细胞淋巴瘤;3例为继发性,其中弥漫大B细胞淋巴瘤2例,T淋巴母细胞淋巴瘤/白血病1例。患者发病年龄35~68岁,平均年龄51岁,临床多表现为胸闷、气短。组织学上,弥漫大B细胞淋巴瘤以中等-大淋巴细胞弥漫浸润,细胞异型性明显;免疫组化主要表达B细胞淋巴瘤的标记,如CD20、CD79a(+)。T淋巴母细胞淋巴瘤/白血病以小淋巴细胞弥漫浸润为特点,背景中见散在组织细胞及纤维素性渗出;免疫组化主要表达T细胞标记如CD3、CD5、CD45RO(+)。电话随访截止2018年8月,随诊时间2个月~6年,1例原发性和2例继发性心脏淋巴瘤患者均已死亡,1例继发性患者现情况良好、无复发。结论心脏的原发性淋巴瘤诊断时必须与继发性淋巴瘤相鉴别,心脏淋巴瘤不管是原发还是继发,均以弥漫大B细胞淋巴瘤较多见。临床确诊晚,治疗方法包括化疗、放疗、自体干细胞移植与肿块切除,预后均较差。Objective To investigate the clinical and pathological features of primary and secondary cardiac lymphoma, and to improve the understanding of cardiac lymphoma by clinicians and pathologists. Methods Four cases of cardiac lymphoma were analyzed retrospectively. The clinical data were reviewed in detail. All the pathological sections were reviewed. The relevant immunohistochemical results were statistically analyzed. The clinicopathological features were analyzed with follow-up. Results Of the 4 cardiac lymphomas, 1 was primary diffuse large B-cell lymphoma, 3 were secondary, including 2 diffuse large B-cell lymphoma and 1 T-lymphoblastic lymphoma/leukemia. The onset age of the patients ranged from 35 to 68 years, with an average age of 51 years. Histologically, diffuse large B-cell lymphoma was characterized by diffuse infiltration of medium-large lymphocytes with distinct cellular atypia, and pathological mitosis, nuclear debris and necrosis were common. Immunohistochemically, B-cell lymphoma markers such as CD20 and CD79 a were expressed. T-lymphoblastic lymphoma/leukemia was characterized by diffuse infiltration of small lymphocytes without cytoplasm, fine granular nuclear chromatin, occasional small nucleoli, scattered in the background of tissue cells and cellulosic exudation;immunohistochemistry showed T-cell markers such as CD3, CD5, CD45 RO were positive. Telephone follow-up was completed in August 2018, and the follow-up date was from two months to 6 years. One case of primary and two cases of secondary cardiac lymphoma died, and one case of secondary cardiac lymphoma was in good condition without recurrence. Conclusion Cardiac primary lymphoma must be differentiated from secondary lymphoma in diagnosis. Diffuse large B-cell lymphoma is the most common type of cardiac lymphoma, whether primary or secondary. The final diagnosis is delayed and the treatment methods include chemotherapy, radiotherapy, autologous stem cell transplantation and mass resection. The prognosis is poor.

关 键 词：心脏淋巴瘤 原发性 继发性 弥漫大B细胞淋巴瘤 T淋巴母细胞淋巴瘤/白血病 

分 类 号：R732.1[医药卫生—肿瘤]