原发性骨淋巴瘤1例及文献复习

Primary Non-Hodgkin's Lymphoma of Bone:Case Report and Literature Review

目的:为加强对原发性骨恶性淋巴瘤(PLB)的临床诊断和治疗的认识,了解其临床表现的多样性、病因及预后,加深对其病理、影像学表现特点的认识,以期得到早期诊断及积极治疗以改善预后。方法:报道分析了一例以左小腿局部胀痛为首发症状的原发性骨恶性淋巴瘤,并复习国内外相关文献。结果:通过综合病史、临床及影像学检查、局部组织活检加病理可明确诊断。早期诊断及积极治疗可改善疾病的预后。结论:PLB是少见的结外淋巴瘤,以弥漫大B细胞性非霍奇金淋巴瘤多见,通常为溶骨性破坏,PLB病情发展迅速,局部症状重而全身症状轻,实验室检查及影像学表现无特异性,造成早期准确诊断非常困难,容易发生误诊,目前确诊主要依靠病理及免疫组化。应采取综合的临床诊断手段,加以鉴别诊断,尽早明确诊断,积极系统的治疗以改善预后。

Objective： To intensify the diagnosis and treatment of primary Non - Hodgkin＇s lymphoma of bone （PLB）, understand it＇s complexity of clinical characteristics and reinforce the impression of it＇s features of pathology and imaging, a case of PLB with the first symptom of pain of the local left leg was reported. The results indicated the combinations of the medical history, the clinical features, imaging features, characteristics of clinicopathology and immunohistochemical stain can lead to the diagnosis and active treatmeant can improve the prognosis. Conclusions： PLB are uncommon malignancies. Patients with PLB commonly present with local bone pain, soft tissue swelhng, and a mass or a pathological fracture. Most cases of PLB are classified as diffuse large B - cell lymphomas （DLBCL） in the WHO classification of hematological malignancies. Comprehensive immunohistochemical studies are required to establish an accurate histological diagnosis of PLB. Early diagnosis and the differentiation from other disease and active treatmeant should be performed. Combination therapy including radiotherapy and chemotherapy is the optimal treatment for PLB.