原发性乳腺恶性淋巴瘤的发病特征和诊疗分析

目的 探讨原发性乳腺恶性淋巴瘤(PBL)的发病率、高发年龄和发病趋势、影像学特点、转移规律及不同治疗方法对预后的影响.方法 总结1960年1月至2007年8月收治的49例PBL患者的资料,收集性别、年龄、病理类型、乳腺钼靶X线及B超检查、转移部位等资料并分析治疗与预后的相关性.结果 1960年至2007年间天津市平均人121数中PBL的发病率为59/1000万,高发年龄30～59岁;自1960年至2007年每10年间该病的发病率分别为2/1000万、3/1000万、0、13/1000万和32/1000万,非霍奇金淋巴瘤占绝大部分(48例),乳腺钼靶X线、B超、冰冻病理检查不典型,随访显示脏器受累以骨髓(9/49)、肺(7/49)、脑膜(4/49)和卵巢(4/49)多见,5年总体生存率仅为6.1%.根治术+化疗组患者预后均优于单纯肿物切除术+化疗组和全乳或区段切除术+化疗组(5年存活率分别为21.4%、0、0).结论 PBL是一组罕见的结外淋巴瘤,发病率逐年增加,临床及影像学表现不典型,易累及骨髓、肺、脑膜、卵巢,治疗方案以根治术联合化疗及局部放疗为佳,但预后不良.

Clinical characteristics and treatment analysis of primary breast lymphoma:49 cases report

Objective To explore the morbidity , clinical characteristics, diagnosis, metastasis, treatment and prognosis of primary breast lymphoma ( PBL). Methods From January 1960 to August 2007, 49 cases with PBL were treated among 22811 cases of breast malignancy and 7337 cases of malignant lymphoma. The clinical data of these 49 patients, included gender, age, pathologic type, breast X ray and B ultrasound examination results, involved lymph nodes and organs, treatment, survival time, were retrospectively analyzed. Results From 1960 to 2007, the incidence rate of PBL in Tianjin Municipality was 59/10 millions; in details, the incidence rate of PBL for every 10 years was 2/10 millions, 3/10 millions, 0, 13/10 millions and 32/10 millions, respectively. According to circle graph of age, PBL occurred frequently in female aged 30 to 59 years. Most of this group of PBL was non-Hodgkin lymphoma(48 cases). No typical characteristics was found with the examination of breast X ray, B ultrasound and frozen section pathology. Bone marrow(9 cases), lung(7 cases), meninges(4 cases) and ovary(4 cases) were frequently involved organs. The overall 5-year survival rate was 6. 1% for the group. The prognosis in patients with radical mastectomy combined chemotherapy was much better than that in patient received super to local mastectomy plus chemotherapy or simple tumor resection plus chemotherapy (5-year survival rates were 21. 4% ,0,0, respectively). Conclusions PBL is a kind of rare lymphoma with incidence increasing sharply in the past few decades. The clinical manifestation is atypical. Diagnosis of PBL should adopt histological examinatioa Radical mastectomy combined chemotherapy could bring better prognosis, but the prognosis is still poor.