肺黏膜相关淋巴组织型淋巴瘤的临床诊断与分析

The clinical diagnosis and analysis of pulmonary mucosa associated lymphoid tissue lymphoma

目的提高对肺黏膜相关淋巴组织型淋巴瘤(PMALT 型淋巴瘤)的临床诊断水平。方法 1998年6月至2006年6月经气管镜、经皮胸腔镜肺、胸膜及开胸肺活检证实的 PMALT 型淋巴瘤13例,对其临床表现、影像学等资料进行分析,并结合文献复习。结果 13例中男9例,女4例;病程1.5～108个月,平均14个月;平均年龄55岁;临床症状相对较轻且缺乏特异性,部分病例仅在体检时发现,临床症状包括咳嗽、胸痛、胸闷、血痰、发热、体重减轻等;胸部影像学表现为多发性病变,以双侧多见(7/13);病变形态多样,表现为块状影(2/13)及结节状影(2/13),致密的实变影内可见支气管充气征(9/13),可伴胸腔积液(4/13),气管镜下可见支气管狭窄和炎症(6/13)。结论 PMALT 型淋巴瘤发病率低,好发于中、老年男性,病情发展相对缓慢,临床症状相对较轻且缺乏特异性,胸部 CT示致密的实变影,可见支气管充气征,尤其双侧病变,气管镜下可见支气管狭窄和炎症。经抗感染治疗后病灶未见吸收者应警惕本病的可能,尽可能行组织病理学检查。

Objective To improve the diagnosis of pulmonary mucosa associated lymphoid tissue （PMALT） lymphoma. Method The clinical and radiographic data of 13 cases of pathology confirmed PMALT lymphoma admitted from June 1998 to June 2006 were respectively analyzed. Results There were 9 males and 4 females, with an average age of 55 years. The course of the disease was 1.5 - 108 months （average 14 months）. Clinical features were nonspecific, with mild symptoms including cough, chest pain, breathlessness, hemoptysis, fever, and weight loss. Some cases were suspected in the routine physical examination. Chest radiography showed multiple lesions, commonly bilateral （7/13）. The lesions were of varied manifestations, including masses （2/13） , nodules （ 2/13 ）, increased airspace consolidation with air brochagram （9/13） and pleural fluid （4/13）. Bronchial stenosis and inflammation （6/13） were present under broncoecopy. Conclusions PMALT is not common, and tends to affect middle aged and older males. The disease progresses slowly and the clinical features are nonspecific.