骨原发性恶性淋巴瘤的临床特征与疗效分析

Clinical features and treatment of primary skeletal lymphoma

目的探讨骨原发性恶性淋巴瘤的临床特征及其治疗效果。方法回顾性分析我院1995年4月至2003年10月收治的经病理检查证实的11例骨原发性恶性淋巴瘤的病例资料,其中骨盆3例,胸椎和腰椎各2例,颅骨、左肱骨上端、左尺骨近端和左股骨转子部各1例。疼痛为共同表现,1例腰椎病变者有神经根受损症状。X线片示主要为溶骨性改变。病理类型主要为弥漫性大B细胞性淋巴瘤。治疗主要采用局部放疗和全身化疗,1例腰椎病理性压缩性骨折者行经皮穿刺椎体成形术,1例左股骨转子部病变者行瘤段切除人工髋关节置换术。结果随访1～8年,平均2.5年,1年、3年、5年生存率分别为100%(11/11)、66.7%(2/3)、50.0%(1/2),1例腰椎弥漫性大B细胞型Ⅲ期患者1年后出现全身多处转移死亡,且随着临床分期增高,3、5年生存率降低。结论骨原发性恶性淋巴瘤临床少见,治疗应以放、化疗等综合治疗为主,原发灶若为主要负重骨应辅以手术治疗预防病理性骨折的发生。

Objective To explore clinical features and treatment outcome of primary skeletal lymphoma. Methods 11 primary skeletal lymphoma cases who admitted from April 1995 to October 2003 were studied retrospectively. The histological diagnose was reconfirmed. The primary sites are ilium（3 ） and thoracic （2） and lumbar （2） and cranium （ 1 ） and ulna （ 1 ） and femur（ 1 ）. The most often presenting symptom was pain. The lumbar lymphoma had nervous dysfunction. X - ray showed osteolysis and erosion of the bone. Most of histological types were diffuse B -cell lymphoma. Local radiotherapy combined with chemotherapy was conducted. The lumbar patient with pathological fracture and received percutaneous vertebroplasty and one hip patient had local resection and prosthesis replacement. Results The follow - up ranges from one to eight years and the average is 2.5 years. The 1-year ,3 - years and 5 -years survival rates were 100% （11/11）,66.7% （2/3） and 50.0% （1/2） respectively. The lumbar lymphoma patient died of mediastinum metastasis. The survival rates decreased with the progression of the clinical stages. Conclusions Primary skeletal lymphoma is a rare malignant bone tumor. Combination therapy including radiotherapy and chemotherapy are the main treatment and surgery is an adjuvant procedure to treat or prevent pathologic fractures.