原发性乳腺弥漫大B细胞性淋巴瘤3例报告及文献复习

摘要

目的:探讨原发性乳腺弥漫大B细胞性淋巴瘤(PB-DLBCL)的临床特点、诊断和治疗方案,为其临床治疗提供依据.方法:对3例诊断为PB-DLBCL患者行影像学、病理和骨髓细胞学检查,追踪观察治疗效果,并复习相关文献.结果:3例PB-DLBCL患者均为女性,且具有与乳腺癌相似的临床表现(无痛性乳腺肿块)及影像学表现,1例患者行乳腺肿块切除明确诊断,后给予R-CHOP×4+CHOP×4周期+1次预防性鞘内注射治疗,现治疗结束1年余,随访无复发.另2例近期收治,通过空心针穿刺活检确诊,经CHOP×2周期、CHOP×1周期方案化疗,分别获得非常好的部分缓解(VGPR)和完全缓解(CR),此2例仍在化疗中,过程顺利.结论:对于以无痛性乳腺肿块为首发症状的患者,应结合其临床资料,若高度怀疑为原发性乳腺淋巴瘤(PBL),可以行空心针穿刺活检及免疫组织化学进行确诊.R-CHOP/CHOP方案化疗可取得较好的疗效,在早期治疗中行中枢神经系统(CNS)预防可能会改善预后.%Objective:To investigate the clinical features,diagnosis and treatments of primary breast diffuse large B-cell lymphoma (PB-DLBCL),and to provide the basis for its clinical treatmemt.Methods:Three patients with PB-DLBCL were examined by imaging,pathology and bone marrow cytology.The curative effect was observed,while the related literatures were also reviewed.Results:Three patients with PB-DLBCL were female and had the clinical manifestations (painless breast mass) and their imaging findings were similar to breast cancer.the 3 patients,one patient underwent excisional biopsy in the assessment of breast nodules,followed by chemotherapy with 4 cycles of R-CHOP +4 cycles of CHOP+ 1 prophylactic intrathecal injection treatment,no recurrence was found in 1 year's follow-up;the other 2 patients were diagnosed by core needle biopsy,receiving 2 cycles of CHOP and 1 cycle of CHOP,respectively,getting very good partial remission (VGPR) and complete remission (CR);they still received chemotherapy,and the process was smooth.Conclusion:Core needle biospy along with immunohistochemical method combined with clinical data is an effective technique for the diagnosis in the patients with when unilateral painless mass as the first symptom and highly suspected as PBL.The elementary role of chemotherapy of R-CHOP / CHOP is preferred for the patients.Central nervous system (CNS) prophylaxis may improve the prognosis in the early treatment.