临床病例讨论——以腹痛、纳差、消化道溃疡为首发表现的儿童NK/T细胞淋巴瘤  

A child case of NK/T cell lymphoma with abdominal pain,poor appetite and gastrointestinal ulcer

作　　者：高杨洁 周锦[2] 杨菁 曾骐[4] 王焕民[5] 段晓岷[6] 杨宝凤[7] 张晶[2] Gao Yangjie;Zhou Jin;Yang Jing;Zeng Qi;Wang Huanmin;Duan Xiaomin;Yang Baofeng;Zhang Jing(General Ward,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院综合科,100045 [2]国家儿童医学中心首都医科大学附属北京儿童医院消化科,100045 [3]国家儿童医学中心首都医科大学附属北京儿童医院血液肿瘤中心,100045 [4]国家儿童医学中心首都医科大学附属北京儿童医院胸外科,100045 [5]国家儿童医学中心首都医科大学附属北京儿童医院肿瘤外科,100045 [6]国家儿童医学中心首都医科大学附属北京儿童医院影像中心,100045 [7]国家儿童医学中心首都医科大学附属北京儿童医院病理科,100045

出　　处：《北京医学》2020年第11期1156-1159,共4页Beijing Medical Journal

摘　　要：目的总结儿童NK/T细胞淋巴瘤的临床特征及诊断经验。方法回顾性分析2016年首都医科大学附属北京儿童医院收治的1例经肺组织病理确诊的NK/T细胞淋巴瘤患儿的临床资料及诊疗经过。结果患儿间断腹痛、纳差1月。胸部CT示右下肺胸膜下肺野内小病灶;腹部影像学示胰腺周围结节影,肝右叶内多发病灶,胃壁、十二指肠肠壁不规则增厚、渗出,经抗感染治疗肝内病变消失,但十二指肠出现溃疡面,以"腹痛待查"收入院。入院后胃镜提示存在十二指肠球部巨大溃疡,出现间断发热、腹痛伴腹胀。影像学检查提示胰腺周围不均匀低回声结节持续存在,肠系膜淋巴结逐渐增大融合,皮髓质分辨不清。十二指肠溃疡逐渐进展至穿孔,肺部病灶位置固定,范围逐渐增大,完善肺组织活检,病理确诊NK/T细胞淋巴瘤。结论NK/T细胞淋巴瘤罕见,临床无特异表现,缺乏病理诊断金标准,诊断较困难,需积极完善组织活检,并提请多家同等资质医院病理科共同诊断。Objective To discuss the clinical manifestations and diagnostic experience of NK/T cell lymphoma.Methods The clinical manifestations and diagnostic procedure of a case of NK/T cell lymphoma diagnosed by lung histopathology in Beijing Children’s Hospital in 2016 were reviewed.Results The child had intermittent abdominal pain and poor appetite for one month.Chest CT showed small lesions in the right lower lung,abdominal imaging showed nodules around the pancreas,multiple lesions showed in the right lobe of the liver,and thickening and exudation showed in the gastric and duodenal walls.After antibiotic treatment,liver lesions disappeared,but ulcers appeared in the duodenum,so the child was admitted to the hospital.After hospitalized,gastroscopy revealed a giant duodenal bulb ulcer.Fever,abdominal pain and abdominal distension appeared intermittently.Imaging examinations revealed hypoechoic nodules around the pancreas persisted,mesenteric lymph nodes gradually increased and merged.Duodenal ulcer gradually progressed to perforation.As the range of lung lesions gradually increased,a lung biopsy was done.Lung tissue pathology revealed NK/T cell lymphoma.Conclusions NK/T cell lymphoma has no characteristic clinical manifestations,and pathology does not has a standard for diagnosis.It is difficult to make a clear diagnosis.Tissue biopsy needs to be actively performed and diagnosed by multiple hospital pathology departments.

关 键 词：NK/T细胞淋巴瘤 诊断 儿童 

分 类 号：R733.1[医药卫生—肿瘤]