原发性肺非霍奇金淋巴瘤的诊断和治疗--综合国内94例分析

Clinical analysis of 94 cases of primary pulmonary non-Hodgkin’s lymphoma:a report of eight cases and review of domestic literatures published in the past twenty years

目的:提高对原发性肺非霍奇金淋巴瘤(primarypulmonarynon-Hodgkin’slymphoma,PPNHL)的认识和诊断水平。方法:确诊为PPNHL的新病例8例,结合1980～2004年国内报道的PPNHL病例共94例,对临床表现、影像学及病理学特征、诊断及治疗方法进行汇总分析。结果:PPNHL临床表现缺乏特异性,主要症状依次为咳嗽咳痰(60.6%)、发热(30.9%)、胸痛(29.8%)、咯血(18.1%)、呼吸困难(13.8%)和体质量下降(7.4%)。影像学表现以边缘模糊的单发或多发肿块影、实变影(89.4%)最为常见,部分病灶内(22.3%)含充气支气管影。病理学表现以B细胞淋巴瘤(75.5%)多见。最终确诊主要由手术(63.8%)和CT定位下经皮肺穿刺切割活检(24.5%)而获得病理依据。主要治疗手段为手术、化疗或术后合并化疗。结论:PPNHL临床表现无特异性;影像学表现具有一定的特征,有助于诊断;经皮肺穿刺切割活检是一种较为理想的检查手段,可有效地获得病理结果。

OBJECTIVE： To improve the understanding and diagnosis of primary pulmonary non-Hodgkin＇ s lymphoma （PPNHL） by the comprehensive review of domestic literatures in the past twenty years. METHODS： Eight new cases with PPNHL were reported and integrated with other 86 cases reported domestically in the past twenty years for analysis of their clinical manifestations, computed tomography （CT） features, pathological characteristics, diagnosis and treatment. RESULTS.. The clinical manifestations of PPNHL were nonspecific, and the most common symptoms were cough （60. 6 %）, fever （30. 9%）, chest pain （29.8%）, haemoptysis （18. 1%）, dyspnoea （13.8%）, and weight loss （7. 4%）. The CT features were characterized with solitary or multiple pneumonia-like consolidations and alveolar masses （89.4 %）, with air-bronchogram presented in 21 cases （22.3%）, the margins of the opacities were often ill-defined. The pathological features showed a large predominance of B cell lymphomas （75.5%）. Definite diagnosis was confirmed by pathological examinations of the lung tissue which was obtained through surgical resection （63.8%） or CT-guided percutaneous needle lung biopsy （24.5%）. The treatment modalities included surgical resection, chemotherapy or both. CONCLUSION： PPNHL is lack of specific clinical manifestations, and some specific imaging findings are helpful in the diagnosis of PPNHL, and a specific diagnosis can be obtained by means of CT-guided percutaneous needle lung biopsy.