以肺部病变首诊的淋巴瘤6例临床特点分析

Clinical characteristics analysis of lymphoma firstly presenting with pulmonary symptoms: report of 6 cases

目的分析总结以肺部病变首诊的的淋巴瘤病例的临床特征,提高诊断能力。方法回顾性分析2013年3月至2016年4月收治的6例以肺部病变首诊的淋巴瘤患者的临床资料,分析和总结其临床特点、影像学特点、病理特点、误诊情况。结果 6例淋巴瘤患者中,男女比例为1︰2。5例患者既往合并有风湿免疫性疾病、慢性肺部炎症性疾病或吸烟等病史。主要症状为咳嗽、咳痰、发热、胸疼、憋气、咯血。主要体征为浅表淋巴结肿大,呼吸音减低及肺部干湿性啰音等。实验室检查提示血常规正常,红细胞沉降率及C反应蛋白可升高,贫血较常见,肿瘤标记物中神经元烯醇化酶升高,5例患者表现为血脂减低。影像学表现为肺部磨玻璃密度影、结节影、软组织密度影、肺实变、肺不张、胸腔积液等多种病变形态。2例患者经淋巴结穿刺确诊,2例患者经经皮肺穿刺活检确诊,1例患者经支气管镜下黏膜活检确诊,1例患者经骨髓穿刺活检确诊。6例患者病理类型均为非霍奇金淋巴瘤,其中黏膜相关淋巴组织结外边缘区B细胞淋巴瘤2例,弥漫大B细胞淋巴瘤4例。6例患者主要误诊为肺炎、肺结核、结节病、肺部肿瘤、嗜酸细胞性肺炎、慢性阻塞性肺疾病急性加重。结论表现为肺部症状的淋巴瘤缺乏特异性的临床特点,当诊断与治疗不相符时,应尽快完善病理检查确诊,避免误诊误治。

Objective To analyze the clinical features of the lymphoma presenting with pulmonary symptoms, in order to improve the ability of diagnosis. Methods Retrospectively analyzed the clinical data of the six patients with lylnpholna presenting with puhnonary symptoms who were in our hospital during 2013 to 2016, including clinical manifestation, imaging character, pathological character, lnisdiagnosis. Results In six patients, male and female proportion was 1：2. Five patients with rheumatic autoilnmune diseases, chronic inflammatory lung diseases, history of smoking. The main symptoms of patients were cough, sputum, fever, chest pain, breath, helnoptysis. Main signs were superficial lymph node enlargement, decreased breath sounds and rales in both sides of the lungs, etc. Laboratory tests showed normal routine blood, erythrocyte sedimentation rate and C - reactive protein can rise, anemia was common, tumor marker of neuronal enolization enzyme increases, 5 patients of blood lipid reduction. Imaging findings demonstrated lung ground glass density, nodular shadows, soft tissue density, consolidation of the lung, atelectasis, pleural effusion, and other lesions. Two patients were diagnosed by the lymph node biopsy, two patients were diagnosed by percutaneous lung biopsy, one patient was confirmed by bronchoscopy mucosa biopsy, one patient was confirmed by bone marrow biopsy. All the six patients were diagnosed as non - hodgking lymphoma, two eases were the mucosa associated lymphoid tissue B cell lymphoma, and other four eases were diffuse large B cell lylnpholna. All six patients were misdiagnosed as pneumonia, tuberculosis, sarcoidosis, lung tumor, acidophil pneumonia, acute exacerbation chronic obstructive puhnonary diseases. Conclusion Lympholna presenting with pulmonary symptoms were often lack of specific clinical manifestation. When the diagnosis and treatment is not consistent, pathological biopsy should be considered as early as possible to avoid delay of diagnosis and treatment.