口腔颌面颈部恶性淋巴瘤46例临床分析

The clinical analysis of malignant lymphoma in oral and maxillofacial region and neck.

目的:回顾性分析口腔颌面颈部恶性淋巴瘤的流行病学状况、临床特点、常见误诊原因以及提高临床早期诊断的要点。方法:对46例经病理确诊的口腔颌面颈部恶性淋巴瘤的临床资料进行回顾性分析。结果:46例恶性淋巴瘤中非霍奇金淋巴瘤39例(84.8%),霍奇金淋巴瘤7例(15.2%)。首发症状依次为无痛性包块、疼痛性包块、感染、溃疡。首发部位依次为颈部、颌下、颏下、口腔、腮腺区。不伴发全身症状者40例(87%)。首诊诊断不明者38例(82.6%)。1次病理诊断的确诊率为84.8%。治疗主要为手术+化疗。患者5年生存率58%。结论:结外型恶性淋巴瘤的临床表现呈多样化,容易被临床误诊。应提高对其认识,对高度怀疑为该病的患者应反复多次病检加免疫组化检查以明确诊断。

Objective： To study retrospectively the epidemiologyical state , clinical characteristics and common reasons of clinical misdiagnosis of malignant lymphoma （ML） and to summarize the key points of clinical early diagnosis of ML in oral and maxillofacial region and neck. Method：46 clinical data with ML in oral and maxillofacial region and neck, which were proved by pathologic diagnosis, were analyed retrospectively. Result： Among 46 patients with ML, 39 cases were Non Hodgkin lymphoma （NHL） and 7 cases were Hodgkin lymphoma （HL） .The sequence of the first symptom were painless tumeur, pain tumeur, infection and ulcer respectively. The sequence of the first region were neck, submaxillary region, sub-mental region, oral and parotid region respectively.There were 40 cases without constitutional symptom. The first diagnosis of 38 patients was indefinable. The rate of first pathological diagnosis was 84.8% .The main treatments were muhimodal therapy （chemotherapy and operations）. The five-year survival rates were 58%. Conclusion： The clinical manifestation of extranodal malignant lymphoma was variform, which could be misdiagnosed frequently. Doctors should raise cognitions to the malignant lymphoma.The case, which was considered as malignant lymphoma, should be finally diagnosed by biopsy repeatedly and immunohistochemistry.