原发于乳腺的恶性淋巴瘤8例临床分析

回顾性分析8例原发于乳腺的恶性淋巴瘤（PBL）患者的临床资料，患者均行手术、化疗或（和）放疗，中位生存期47．6个月。结果提示PBL预后与肿瘤大小、病理、临床分期及治疗方式有关。     

原发性骨淋巴瘤1例并文献复习

目的:探讨原发性骨淋巴瘤(PBL)的诊断、治疗及预后。方法:报道1例确诊为PBL患者的临床资料,并结合文献复习,以提高对该病的认识。结果:采用化疗联合放疗治疗,该PBL患者对治疗敏感。结论:PBL为临床少见的结外淋巴瘤,多为弥漫大B细胞性非霍奇金淋巴瘤,预后较好。通常可见溶骨性破坏,影像学检查无特异性,早期明确诊断比较困难,确诊有赖于病理检查及免疫组织化学。治疗以放化疗联合治疗为宜。     

原发性中枢神经系统淋巴瘤23例临床分析

目的 探讨原发性中枢神经系统淋巴瘤(PCNSL)的诊断、合理治疗方案和预后的相关因素.方法 收集天津医科大学肿瘤医院2005年1月至2007年12月经病理证实且随访资料完整的23例免疫功能正常的PCNSL患者,其中男10例,女13例,中位年龄50岁.行腰穿检查者18例,检查出瘤细胞者4例.8例行开颅手术切除,15例行立体定向活检术.4例行全颅放疗,6例行以大剂量甲氨蝶呤为基础的联合化疗,13例行放疗联合化疗.分析其治疗、临床特点与预后之间的联系.结果 Kaplan-Meier分析显示本系列患者中位生存期45.0个月,3年生存率56.5％.Log-Rank检验发现放疗联合化疗组(43.8和30.0个月)与化疗组(39.7和29.7个月)的总生存期及肿瘤无进展生存期明显长于单纯放疗组(25.7和19.8个月,P值均＜0.05);放疗联合化疗组的总生存期长于单纯化疗组(P＜0.05),2组间肿瘤无进展生存期无明显差异(P＞0.05).结论 病理诊断仍是确诊的金标准,脑脊液检查发现瘤细胞者也可确诊.以全颅放疗联合化疗为主的综合治疗优于单纯放疗或化疗.     

原发性骨恶性淋巴瘤4例临床分析并文献复习

目的：探讨原发性骨恶性淋巴瘤(PBL)的特点、治疗及预后。方法：4例PBL均经手术取活检，病理明确诊断，给予放、化疗治疗。结果：4例患者对化疗和放疗敏感，达到完全缓解。结论：PBL多为B细胞性非霍奇金淋巴瘤，可侵犯骨的任何部位，治疗主要是化疗结合局部放疗，是一种预后较好、有可能被治愈的疾病。     

骨源性淋巴瘤伴继发性甲状旁腺机能亢进症1例报告并文献复习

目的：探讨骨源性非霍奇金淋巴瘤(NHL)(弥漫型大B细胞性)伴继发性甲状旁腺机能亢进的诊断及机制。方法：对1例全身骨痛伴昏迷患者进行了骨髓图、骨髓病理及免疫组织化学、血液生化和CT检查，并复习文献就其诊治问题进行讨论。结果：CT显示多部位骨质破坏，血钙及甲状旁腺激素水平显著升高，骨髓病理及免疫组织化学检查证实为骨源性NHL(弥漫型大B细胞性)，最终诊断为骨源性NHL(弥漫型大B细胞性)伴继发性甲状旁腺机能亢进。结论：骨源性NHL的诊断有赖于病理组织学、免疫学和细胞遗传学检查以及CT及核素扫描。淋巴瘤细胞分泌甲状旁腺激素相关蛋白或相关多肽(PTHrP)，细胞因子与PTHrP的释放及溶骨损害是引起高钙血症的原因。     

原发性中枢神经系统淋巴瘤的诊断与治疗

回顾性分析23例原发性中枢神经系统淋巴瘤（PCNSL）的临床资料。术前9例行腰椎穿刺脑脊液离心脱落细胞检查。全部行CT和（或）MR／检查。4例行立体定向活检术。所有病例均经病理证实为非霍奇金氏B细胞型淋巴瘤。手术联合放、化疗19例,平均生存45个月,单纯放疗3例,单纯手术11例,平均生存18个月。术后2a内复发8例。认为PCNSL患者预后差,综合治疗有利于改善患者预后。     

恶性淋巴瘤致急腹症剖腹探查38例临床探讨

目的探讨恶性淋巴瘤致急腹症剖腹探查患者的临床特点、诊治及预后。方法对38例患者的临床资料进行回顾性分析。结果单个部位累及16例,多个脏器累及22例。霍奇金淋巴瘤混合细胞型4例,非霍奇金淋巴瘤34例：弥漫性大B细胞淋巴瘤18例,边缘区淋巴瘤5例,滤泡性淋巴瘤2例,Burkitt淋巴瘤2例,周围性T细胞淋巴瘤6例,血管免疫母细胞性T细胞淋巴瘤1例。16例肿瘤切除及化疗者,2年存活率56．25％,5年存活率43．75％,生存期59～3412天（中位生存期1672天）;6例行姑息手术治疗及化疗者,2年存活率33．33％,5年存活率为0,生存期24～1022天（中位生存期515天）;11单纯手术治疗,仅1例存活26个月。33例追踪随访5年生存率,霍奇金淋巴瘤混合细胞型33．33％,非霍奇金淋巴瘤中以惰性淋巴瘤（滤泡性淋巴瘤、边缘区淋巴瘤）较高,分别为50．00％及40．00％,弥漫性大B细胞淋巴瘤为20％,周围性T细胞淋巴瘤、Burkitt淋巴瘤、血管免疫母细胞性T细胞淋巴瘤无1例长期生存。结论恶性淋巴瘤引起急腹症往往临床表现不典型,病理分型、早期诊断、合理治疗方案的选择是提高疗效与预后的关键。     

粒细胞肉瘤11例临床分析

目的提高对粒细胞肉瘤(GS)的诊断、发病机制、治疗以及预后的认识。方法回顾性分析2003年2月至2008年5月河南省肿瘤医院收治的11例GS患者的误诊原因以及治疗方法对预后的影响。结果7例患者初诊时被误诊,分别被误诊为非霍奇金淋巴瘤2例,腰椎间盘突出症2例,乳腺肿瘤2例,神经母细胞瘤1例。误诊率为63.6%,其中形态学误诊4例(36.4%),医学影像学误诊3例(27.3%)。3例造血干细胞移植(HSCT)后复发者,既往均有AML-M2病史,同时有染色体t(8;21)异常,1例伴有del(11)(q)。8例死亡,中位生存时间20.5个月(6～40个月),其中5例接受常规治疗的患者中位生存期为10个月(6～23个月),3例接受大剂量阿糖胞苷化疗和(或)HSCT的患者中位生存期为35个月(32～40个月),明显优于常规治疗患者。结论GS在临床特征、医学影像学和形态学上容易误诊,免疫组织化学检查为其诊断的重要依据。联合骨髓细胞形态学和染色体核型分析可以帮助诊断。GS复发率高,预后差,高强度的化疗有望延缓复发,提高长期生存率。AML-M2伴有染色体t(8;21)可能为其易患因素。     

原发性中枢神经系统淋巴瘤临床分析

目的:探讨原发性中枢神经系统淋巴瘤(PCNSL)的临床特征.方法:回顾分析10例免疫功能正常的PCNSL患者的临床资料.结果:临床表现为颅内压增高及病灶所致的局部表现.病灶单发7例,多发3例,全经手术切除病灶,病理示B细胞型非霍奇金淋巴瘤.6例术后未行放化疗出院,失访1例,随访5例,平均生存4个月.1例CHOP方案化疗1周期,生存19个月.3例行大剂量甲氨蝶呤化疗+放疗;1例生存13个月,2例至今生存,平均生存24个月,复查无异常.结论:PCNSL预后不良,单纯手术不能延长患者生存期,手术结合放化疗是目前临床首选的治疗方案.     

原发骨淋巴瘤42例临床分析

目的探讨原发骨淋巴瘤(PBL)的临床特点及预后。方法入选西京医院2006年至2014年期间收治的PBL患者42例,男24例,女18例,中位年龄45.6(11~78)岁,收集患者的临床资料,包括性别、年龄、有无全身症状、发病部位、临床分期、病理类型、治疗方案、疗效评价等,进行回顾性分析,通过电话和门诊随访至2015年3月。结果 42例患者均以病变部位疼痛或牵涉性麻木为首发临床表现。病理分型均为非霍奇金淋巴瘤(NHL),50%(21/42)为弥漫大B细胞淋巴瘤(DLBCL)。其中17例患者接受了治疗,5例放化疗联合,12例单纯化疗,两组比较,近期疗效差异无统计学意义(P0.05)。4个疗程后评估近期疗效,年龄、性别、分期、乳酸脱氢酶(LDH)水平、有无全身症状、病理分型、美国东部肿瘤协作组(ECOG)评分、国际预后指数(IPI)评分、是否应用利妥昔单抗治疗、是否联合放疗等对完全缓解率(CR)的影响无统计学意义(P0.05)。中位随访时间13(2~48)个月,无进展生存期3年的4例患者中3例应用了利妥昔单抗。结论 42例PBL患者病理类型主要为DLBCL,治疗以化疗为主,联合放疗未明显提高疗效,应用利妥昔单抗可能会改善预后,尚需扩大样本量进行研究。     

原发性中枢神经系统淋巴瘤18例临床分析

目的探讨原发性中枢神经系统淋巴瘤(PCNSL)的诊断及治疗措施。方法回顾性分析18例PCNSL的临床、影像学特征及治疗效果。结果18例患者均经手术病理确诊;15例患者行手术治疗和(或)术后放疗和(或)常规CHOP方案化疗,生存期为3~18个月;3例患者手术确诊后使用大剂量甲氨蝶呤(MTX)为主的方案化疗及鞘内注射药物等治疗,生存期均大于36个月。结论PCNSL临床症状及影像学无特征性,诊断困难,易误诊;手术治疗、术后放疗及常规CHOP方案化疗的疗效欠佳,采用易通过血脑屏障药物治疗可取得一定的疗效。     

Nodular lymphocyte predominant Hodgkin lymphoma: a Lymphoma Study Association retrospective study

Nodular lymphocyte predominant Hodgkin lymphoma represents a distinct entity from classical Hodgkin lymphoma. We conducted a retrospective study to investigate the management of patients with nodular lymphocyte predominant Hodgkin lymphoma. Clinical characteristics, treatment and outcome of adult patients with nodular lymphocyte predominant Hodgkin lymphoma were collected in Lymphoma Study Association centers. Progression-free survival (PFS) and overall survival (OS) were analyzed, and the competing risks formulation of a Cox regression model was used to control the effect of risk factors on relapse or death as competing events. Among 314 evaluable patients, 82.5% had early stage nodular lymphocyte predominant Hodgkin lymphoma. Initial management consisted in watchful waiting (36.3%), radiotherapy (20.1%), rituximab (8.9%), chemotherapy or immuno-chemotherapy (21.7%), combined modality treatment (12.7%), or radiotherapy plus rituximab (0.3%). With a median follow-up of 55.8 months, the 10-year PFS and OS estimates were 44.2% and 94.9%, respectively. The 4-year PFS estimates were 79.6% after radiotherapy, 77.0% after rituximab alone, 78.8% after chemotherapy or immuno-chemotherapy, and 93.9% after combined modality treatment. For the whole population, early treatment with chemotherapy or radiotherapy, but not rituximab alone (Hazard ratio 0.695 [0.320–1.512], P=0.3593) significantly reduced the risk of progression compared to watchful waiting (HR 0.388 [0.234–0.643], P=0.0002). Early treatment appears more beneficial compared to watchful waiting in terms of progression-free survival, but has no impact on overall survival. Radiotherapy in selected early stage nodular lymphocyte predominant Hodgkin lymphoma, and combined modality treatment, chemotherapy or immuno-chemotherapy for other patients, are the main options to treat adult patients with a curative intent.     

HIV-associated plasmablastic lymphoma: lessons learned from 112 published cases

Plasmablastic lymphoma (PBL) is a distinct subtype of non-Hodgkin B-cell lymphoma, originally described with a strong predilection to the oral cavity of human immunodeficiency virus (HIV)-infected individuals. Data regarding patient age and gender, HIV status, initiation of and response to highly active antiretroviral therapy (HAART), tumor extent, pathology, treatment, and outcome were extracted from 112 cases of PBL identified in the literature. The median age at presentation was 38 years with a male predominance of 7:1, and the median CD4+ count was 178 cells/mm(3). PBL presented on average 5 years after diagnosis of HIV. Common primary sites of presentation included the oral cavity, gastrointestinal tract, and lymph nodes. Most cases presented with either stage I or stage IV disease. There was a variable expression of B-cell markers in tumor cells, but plasma cell markers were expressed in all cases. EBV was detected in 74%. Chemotherapy was used to treat 55% patients and was combined with radiotherapy in 21% cases. Complete response was obtained in 66% of treated cases; the majority of these responses were seen after CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone). The refractory/relapsed disease rate was 54%. Death occurred in 53% of patients, with a median overall survival of 15 months. Sex, CD4+ count, viral load, clinical stage, EBV status, primary site of involvement, and use of CHOP failed to show an association with survival. PBL is an aggressive B-cell lymphoma that presents in both oral and extra-oral sites of chronically HIV-infected immunosuppressed young men.     

Ocular presentation of primary central nervous system lymphoma: diagnosis and treatment

Primary ocular lymphoma (POL), a lymphoma of the globe, is a restricted form of primary central nervous system lymphoma (PCNSL) that often progresses to the brain and meninges; frequently it is misdiagnosed until central nervous system (CNS) lymphoma develops. The optimal treatment has not yet been identified. We retrospectively reviewed the course and the treatment of POL in 31 patients. Seventeen patients were treated for isolated POL (group A) and 14 were treated only after CNS disease was diagnosed (group B). The treatment in both groups consisted of systemic chemotherapy, chemotherapy plus radiotherapy (RT) or RT alone. In group A, nine patients (53%) developed CNS progression and five (29%) had ocular recurrence. In group B, seven (50%) had CNS progression and three (21%) ocular relapse. To control for diagnostic lead time, median survival was calculated from initial ocular symptoms and was 60 months in group A and 35 months in group B (P < 0.05). Ocular lymphoma responds to a variety of therapies but treatment with chemotherapy and/or ocular radiotherapy (ORT) failed to prevent CNS progression. Patients whose ocular disease was identified and treated before CNS progression had a significantly improved survival.     

Primary non-Hodgkin’s lymphoma of the breast: eight-year follow-up experience

The objective of this study is to analyze the clinical characteristics and treatment of patients with primary non-Hodgkin's lymphoma of the breast (PNHLB). Forty-five patients with PNHLB treated in our hospital during a 15-year period were retrospectively analyzed. Forty-four were females and one male, with a median age of 47 years. Forty-two patients were at stage I or II and 82.2% had diffuse large B cell lymphoma (DLBCL). Local control rate was 95.2 and 66.7% for patients with and without radiotherapy, respectively (P = 0.020). Median overall survival and progression-free survival (PFS) of all patients was 6.8 and 4.3 years, respectively. For patients with DLBCL or T cell lymphoma, median PFS was 6.5 years with chemoradiation and 3.9 years with chemotherapy or radiation only (P = 0.029). Patients who used rituximab had not reached median PFS, while those treated without rituximab had a median PFS of 5.1 years (P = 0.301). International prognostic index (IPI) score and bilateral breast involvement were two independent prognostic factors for survival. Chinese patients with PNHLB have early occurrence in lifespan. Radiation confers a better local control. Patients with intermediate or high-grade PNHLB might be treated with chemotherapy, radiotherapy, and for CD-20 positive disease, rituximab. Bilateral disease and IPI are two prognostic factors.     

胰腺转移癌10例诊断及治疗

目的 探讨胰腺转移癌的诊断及治疗方法.方法 对1997年7月至2007年7月中国医科大学附属第一医院收治的10例胰腺转移癌进行回顾性分析.结果 原发肿瘤为肺癌3例、结肠癌2例、胃癌2例、肾癌2例、鼻咽癌1例.胰腺转移距发现原发肿瘤时间间隔平均40个月(0-192个月).10例转移灶均位于胰腺头颈部,单发9例,多发1例,肿瘤最大径平均3.03cm.主要临床表现为腹痛、腹胀、厌食、黄疸等.行胰十二指肠切除术2例.胰动脉灌注化疗1例,经皮经肝胆管内支架置入术1例,全身化疗2例.放疗1例,3例未行进一步治疗.7例获得随访,生存时间2-44个月,平均10.6个月.结论 胰腺转移癌临床少见,表现无特异性,应根据具体情况选择合理的治疗措施,对可切除者应积极手术治疗.     

原发性粒细胞肉瘤1例并文献分析

目的:分析原发性粒细胞肉瘤(GS)的临床特征包括疾病的发病率,诊断流程,预后和治疗策略等。方法:对我院近期内确诊的1例原发于卵巢的GS和近20年MEDLINE文献关于原发性GS的资料87例进行总结分析。结果:分析资料完整的88例患者,其中65例确诊为原发性GS后转化为急性非淋巴细胞白血病(AN-LL),其余23例未发生转化目前仍在随访中。淋巴结,皮肤,泌尿生殖系统和消化系统是GS最常见的髓外发生部位;经典的GS肿瘤细胞形态具有不同阶段髓细胞分化的特点,免疫组化示MPO,NCAE(氯化醋酸AS-D萘酚酯酶),CD43和CD68等阳性;37例患者初诊时被误诊,大多数误诊为恶性淋巴瘤。传统的ANLL化疗方案疗效明显优越于恶性淋巴瘤方案和单独放疗。结论:减少原发性GS向ANLL转化并延长生存期,关键在于早期确诊和早期采用ANLL方案全身化疗。     

骨原发性淋巴瘤继发中枢神经系统浸润1例病例报告及文献复习

目的:探讨骨原发性淋巴瘤(primary bone lymphoma,PBL)继发中枢神经系统(CNS)浸润的主要临床特点、诊断及治疗。方法:分析我科收治的1例弥漫大B细胞性PBL继发CNS浸润患者的临床表现及相关检查结果,治疗方法,并复习相关文献。结果:本例患者为老年男性,主要临床表现为骨痛,经PET/CT、骨髓象、骨组织活检、免疫组化及流式细胞学等检查确诊为弥漫大B细胞性PBL。行R-CHOP化疗方案治疗,化疗后症状缓解,但出现CNS浸润。先后给予6次鞘内注射(Ara-C、MTX、DEX),并同时2次大剂量的甲氨蝶呤(HD-MTX)系统性化疗,10次腰骶部放疗后,症状缓解,但3个月后因肺部感染死亡。结论:本例患者以骨痛为首发表现,PET/CT结合MRI示多发骨损害,经骨髓象及活检、免疫组化染色,流式细胞学检查明确诊断,对PBL应重视CNS侵犯及预防。