原发性肺淋巴瘤9例临床分析并文献复习

摘要

目的 探讨原发性肺淋巴瘤的临床特征和诊断.方法 回顾性分析苏州大学附属第一医院2000年1月至2011年4月诊治的9例原发性肺淋巴瘤的临床资料,对其临床表现、影像学特点、确诊手段、分期进行分析.结果 霍奇金琳巴瘤1例,非霍奇金琳巴瘤8例,其中黏膜相关淋巴组织型(MALT)淋巴瘤2例,弥漫性大B细胞淋巴瘤2例,浆细胞样琳巴瘤1例,周围性T细胞淋巴瘤2例,未能进一步明确分类1例.临床以咳嗽、发热常见,2例无症状因体检发现.CT多表现为结节肿块、肺部实变,实变影中常见支气管充气征.6例行肺穿的患者仅1例明确诊断.8例经开胸肺组织活检病理检查明确.9例患者琳巴结外琳巴瘤临床分期IE期7例,II 1E期1例,II 2E期1例.结论原发性肺琳巴瘤的临床表现及影像学表现无特征性,因而易误诊,手术组织活检是其主要诊断方法,预后相对较好.%Objective To study the clinical characteristics and diagnosis of primary pulmonary lymphoma (PPL). Methods A retrospective review was performed based on the clinical records of 9 PPL cases treated at the First Affiliated Hospital of Soochow University from Jan 2000 to Apr 2011. The clinical manifestations, imaging features, diagnosis approaches and staging of 9 patients were analyzed. Results Hodgkin lymphoma was one case, non-Hodgkin lymphoma was eight cases. There were two patients with mucosa-associated lymphoid tissue(MALT) lymphoma. Two patients with diffuse large B cell lymphoma, one patient with lymphoplasmacytic lymphoma, two patients with peripheral T-cell lymphoma,one patient failed to further classification. The main common symptoms were cough and fever. The PPL in two patients with non specific symptoms were diagnosed during physical examination. Multiple nodules and pulmonary consolidation shadows were the main findings on CT scans. Air bronchogram was often seen in the consolidation imaging. Six patients underwent percutaneous needle biopsy but PPL was confirmed in only one patient. The diagnosis was confirmed in eight patients by open lung biopsy. According to the staging classification of extranodal lymphomas, there were seven cases in stage I E.one case in stage D IE,one case in stage II 2E. Conclusion PPL is easy to be misdiagnosed due to non specific clinical and imaging manifestations. The invasive biopsy is the main diagnostic method. The prognosis is relatively better.