原发性睾丸弥漫大B细胞淋巴瘤临床分析  

Clinical analysis of primary testicular diffuse large B-cell lymphoma

作　　者：杨斌[1] 程伟[1] 张明聪[1] Yang Bin;Cheng Wei;Zhang Mingcong(Department of Urology,the Second People's Hospital of Lianyungang,Lianyungang 222006,China)

机构地区：[1]江苏省连云港市第二人民医院泌尿外科,222006

出　　处：《白血病．淋巴瘤》2020年第3期179-182,共4页Journal of Leukemia & Lymphoma

摘　　要：目的探讨原发性睾丸弥漫大B细胞淋巴瘤(PT-DLBCL)的临床特点、诊治方法及预后。方法回顾性分析连云港市第二人民医院2013年5月及2018年4月收治的2例PT-DLBCL患者的临床资料,结合国内文献报道的42例患者资料,对PT-DLBCL的临床特点、诊治方法及预后进行总结。结果例1患者71岁,主诉为双侧阴囊肿大伴疼痛不适2个月。例2患者85岁,主诉为左侧阴囊肿块3个月。2例患者均行睾丸切除术,术后诊断均为PT-DLBCL、非生发中心B细胞(non-GCB)型、Ann Arbor分期ⅠE期。例1患者术后因经济困难仅行2个周期CHOP(环磷酰胺、表柔比星、长春新碱、泼尼松)方案化疗,例2患者术后因高龄拒绝化疗和右侧睾丸放疗。2例患者随访时间分别为71、12个月,均无瘤生存。结合国内文献报道的42例共44例PT-DLBCL患者,中位发病年龄64岁(45~87岁),最常见表现为单侧增大的睾丸肿块(左侧17例,右侧24例);Ann Arbor分期Ⅰ期21例,Ⅱ期6例,Ⅲ期6例,Ⅳ期11例;non-GCB型31例;国际预后指数(IPI)评分≥3分12例;血清乳酸脱氢酶(LDH)升高13例。所有患者均行睾丸切除术,联合CHOP或R-CHOP方案化疗40例,预防性对侧睾丸放疗12例,预防性鞘内注射化疗22例。中位随访时间17个月(3~135个月),生存30例,死亡14例,中位总生存时间13个月(3~96个月)。结论PT-DLBCL临床罕见,早期肿瘤及non-GCB型多见,确诊主要依靠病理。PT-DLBCL易局部复发和全身转移,应尽早行根治性睾丸切除术联合R-CHOP方案化疗,早期可治愈,进展期患者预后差,预防性对侧睾丸放疗和鞘内注射化疗可降低复发风险。Objective To investigate the clinical features,diagnosis,treatment and prognosis of primary testicular diffuse large B-cell lymphoma(PT-DLBCL).Methods The clinical data of 2 patients with PT-DLBCL in the Second People's Hospital of Lianyungang treated in May 2013 and April 2018 was retrospectively analyzed.The clinical features,diagnosis,treatment and prognosis of PT-DLBCL were summarized with review of these 2 cases combining with other 42 cases reported in domestic literature.Results Case 1,a 71 years old man,complained of bilateral scrotal enlargement with pain and discomfort for 2 months.Case 2,an 85 years old man,presented with left scrotal mass for 3 months.All 2 patients underwent orchiectomy.Both of the 2 patients were diagnosed as PT-DLBCL and non-germinal center B-cell(non-GCB)subtype and had Ann Arbor stageⅠE after operation.Case 1 received only 2 cycles of CHOP(cyclophosphamide,epirubicin,vincristine,prednisone)due to lack of financial support.Case 2 refused chemotherapy and right testis irradiation because of advanced age.They were followed up for 71 months and 12 months,respectively.They were both alive without recurrence at last time of the follow-up.The median age of 44 patients(2 cases in this study and 42 cases reported in the domestic literature)was 64 years old(range 45-87 years old).The most common symptom was unilateral painless testicular swelling(left testis 17 cases and right testis 24 cases).Twenty-one patients were Ann Arbor stageⅠ,6 patients were stageⅡ,6 patients were stageⅢ,and 11 patients were stageⅣ.Thirty-one patients were non-GCB subtype.Twelve patients were international prognostic index(IPI)score≥3.Serum lactate dehydrogenase(LDH)level was elevated in 13 patients.All patients underwent orchiectomy.CHOP/R-CHOP chemotherapy was given to 40 patients and prophylactic radiation to contralateral testis was given to 12 patients.Twenty-two patients received prophylactic intrathecal chemotherapy.After a median follow-up of 17 months(range 3-135 months),14 patients died and t

关 键 词：睾丸肿瘤 淋巴瘤 大B-细胞 弥漫性 诊断 治疗 预后 

分 类 号：R737[医药卫生—肿瘤]