以肺部病变首诊的弥漫性大B细胞淋巴瘤17例分析
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摘要
目的分析总结本院以肺部病变首诊的弥漫性大B细胞淋巴瘤(DLBCL)的临床特点,以提高对该病的认识。方法回顾性分析2007年5月～2017年8月我院收治的17例以肺部病变首诊的DLBCL患者的临床资料,分析和总结其临床特点、实验室相关指标检查情况、影像学特点、误诊情况、病理学特点、治疗及预后。结果 17例患者中,男女比例接近1∶1,平均年龄(54.4±15.7)岁;患者主要症状表现为咳嗽、咳痰、气喘、发热等;实验室检查可见部分患者血清乳酸脱氢酶(LDH)、神经元特异性烯醇化酶(NSE)升高;胸部CT表现为肺内肿块结节影、渗出影、弥漫小结节、磨玻璃浸润影、肺不张等多种病变形态;所有患者均行组织病理学确诊:4例行支气管镜黏膜活检,4例行CT引导下经皮肺穿刺活检,9例行淋巴结活检。结论以肺部病变首发表现的DLBCL临床缺乏特异性,影像学表现呈多样性,确诊需完善病理学检查,以利于早期治疗,改善预后。
Objective To analyze and summarize the clinical features of diffuse large B cell lymphoma(DLBCL), which was first diagnosed as pulmonary lesions, in order to improve the understanding of DLBCL. Methods A retrospective analysis was made of the clinical data of 17 cases of DLBCL with pulmonary lesions first diagnosed in our hospital from May 2007 to August 2017, the clinical characteristics, laboratory examination, imaging characteristics, misdiagnosis,pathological characteristics, treatment and prognosis were analyzed and summarized. Results Among the 17 patients,the ratio of male to female was close to 1:1, with an average age of(54.4±15.7) years. The main symptoms were cough,sputum, asthma and fever. Lactate dehydrogenase(LDH) and neuron specific enolase(NSE) were increased in some patients. Thoracic CT manifestations included nodular, exudative, diffuse nodules, ground glass infiltration, atelectasis and other pathological changes. All patients were confirmed by histopathology. Bronchoscopic mucosal biopsy was performed in 4 cases, CT-guided percutaneous lung biopsy in 4 cases and lymph node biopsy in 9 cases. Conclusion The clinical manifestations of DLBCL, which is the first manifestation of pulmonary lesions, are lack of specificity, and the imaging manifestations are diverse. It is necessary to improve the pathological examination in order to facilitate early treatment and improve the prognosis.
Objective To analyze and summarize the clinical features of diffuse large B cell lymphoma(DLBCL), which was first diagnosed as pulmonary lesions, in order to improve the understanding of DLBCL. Methods A retrospective analysis was made of the clinical data of 17 cases of DLBCL with pulmonary lesions first diagnosed in our hospital from May 2007 to August 2017, the clinical characteristics, laboratory examination, imaging characteristics, misdiagnosis,pathological characteristics, treatment and prognosis were analyzed and summarized. Results Among the 17 patients,the ratio of male to female was close to 1:1, with an average age of(54.4±15.7) years. The main symptoms were cough,sputum, asthma and fever. Lactate dehydrogenase(LDH) and neuron specific enolase(NSE) were increased in some patients. Thoracic CT manifestations included nodular, exudative, diffuse nodules, ground glass infiltration, atelectasis and other pathological changes. All patients were confirmed by histopathology. Bronchoscopic mucosal biopsy was performed in 4 cases, CT-guided percutaneous lung biopsy in 4 cases and lymph node biopsy in 9 cases. Conclusion The clinical manifestations of DLBCL, which is the first manifestation of pulmonary lesions, are lack of specificity, and the imaging manifestations are diverse. It is necessary to improve the pathological examination in order to facilitate early treatment and improve the prognosis.
引文
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[3]Xu H,Xu K,Wang R,et al.Primary pulmonary diffuse large B-cell lymphoma on FDG PET/CT-MRI and DWI[J].Medicine(Baltimore),2015,94(29):e1210.
[4]Yoshino N,Hirata T,Takeuchi C,et al.A case of primary pulmonary diffuse large B-cell lymphoma diagnosed by transbronchial biopsy[J].Ann Thorac Cardiovasc Surg,2015,21(4):396-398.
[5]Du C,Gao F,Wen E,et al.Successful treatment of coexistence of diffused large b cell lymphoma and lung adenocarcinoma,a case report[J].Int J Gerontol,2016,10(4):242-244.
[6]Wang T,Zhang M,Sun J,et al.A rare case of primary pulmonary diffuse large B cell lymphoma with CD5 positive expression[J].Open Med(Wars),2016,11(1):49-51.
[7]Zhu Z,Liu W,Mamlouk O,et al.Primary pulmonary diffuse large b cell non-hodgkin's lymphoma:a case report and literature review[J].Am J Case Rep,2017,18:286-290.
[8]Salhan D,Verma P,Naing TW,et al.Primary pulmonary lymphoma presenting with superior vena cava syndrome in a young female[J].Case Rep Pulmonol,2017,2017:1937 107.
[9]Bae HJ,Chon GR,Kim DJ,et al.A case of intravascular large B-cell lymphoma of lung presenting with progressive multiple nodules on chest computed tomog raphy[J].Respir Med Case Rep,2017,21:108-112.
[10]Bai Y,Liang W.CT and PET/CT findings of primary pulmonary diffuse large B-cell lymphoma:one case report and literature review[J].Medicine(Baltimore),2017,96(47):e8876.
[11]高陆,袁钟.原发性肺弥漫大B细胞淋巴瘤一例[J].海南医学,2017,27(8):1364-1366.
[12]Agarwal KK,Dhanapathi H,Nazar AH,et al.Primary pulmonary lymphoma-role of fluoro-deoxy-glucose positron emission tomography-computed tomography in the initial staging and evaluating response to treatment-case reports and review of literature[J].Indian J Nucl Med,2016,31(3):194-197.
[13]Park JH,Yoon DH,Kim DY,et al.The highest prognostic impact of LDH among International Prognostic Indices(IP-Is):an explorative study of five IPI factors among patients with DLBCL in the era of rituximab[J].Ann Hematol,2014,93(10):1755-1764.
[14]Wang L,Liu P,Geng Q,et al.Prognostic significance of neuron-specific enolase in patients with diffuse large B-cell lymphoma treated with rituximab-based immunoc hemotherapy[J].Leuk Lymphoma,2011,52(9):1697-1703.
[15]唐光才.肺淋巴瘤的影像学表现[J].内科急危重症杂志,2015,21(2):92-95.
[16]周国永,刘伟波,张翠禄,等.多层螺旋CT引导下经皮穿刺活检术的临床应用优势分析[J].中国当代医药,2017,24(16):124-127.
[17]Aviles A,Nambo MJ,Huerta-Guzman J,et al.Rituximab in the treatment of diffuse large B-cell lymphoma primary of the lung[J].Hematology,2013,18(2):81-84.
[18]宫子木,杨威.2015年美国国家综合癌症网弥漫大B细胞淋巴瘤诊疗指南解读[J].中国实用内科杂志,2015,35(5):406-410.