如何认识恶性肉芽肿与恶性淋巴瘤的关系

RELATIONSHIP BETWEEN MALIGNANT GRANULOMA AND MALIGNANT LYMPHOMA

根据发病情况、首发症状、原发部位、病变范围、治疗方法及疗效等方面对 1 0 4例中线恶性淋巴瘤与 6 9例恶性肉芽肿进行比较。两组性别、中数年龄大致相同 ;首发症状有半数以上为鼻堵、鼻衄、流涕等症状 ;两组均有 6 0 %以上原发部位在鼻腔。由于采用AnnArbor分期评价疗效对这类病变不是很合适 ,作者采用将病变侵及区域范围进行比较。治疗手段 :中线恶性淋巴瘤 74 %采用放、化疗 ,恶性肉芽肿 2 7%采用化疗 ,肿瘤量前者为 4 5～ 5 5Gy ,后者为 5 0～ 6 0Gy。 5年生存率受侵 1区两组均在 90 .0 %以上 ;受侵 2区为 87.8%与 6 8.0 % ;3区为 5 2 .3%与 6 1 .5 % ;≥ 4区为 2 6 .6 %与 2 9.0 %。治疗失败除局部未控外 ,常出现皮下结节、胸腹腔、骨髓等结外器官受侵。作者初步认为这两组病是一类病变。

This study was to compare 104 cases of malignant midline lymphoma with 69 cases of malignant granuloma in their clinical course, initial symptoms, location of lesion, extension of disease, treatment and prognosis. The two groups were similar in sex and median age. As regard to the initial symptoms such as nasal obstruction, epistaxis and nasal discharge, they were present in more than half of the patients in both groups. The primary location of lesions was in the nose (60% in both groups). As the Ann Arbor staging system is unsuitable for this disease, we compared the treatment results by area of involvement. Treatment: 74% of malignant midline lymphoma was treated by radiation and chemotherapy. 27% of malignant granuloma was treated by chemotherapy. The radiation of the two groups were 45～55Gy and 50～60Gy, respectively. The 5-year survival rates were over 90% in both groups, for those of lesion with one area involvement, 87.8% and 68% for lesions with two area involvement. 52.3% and 51.5% for three area involvement, 26.6% and 29% for four area involvement patients. Besides local uncontrol, the failure was extra-nodal invasion, such as subcutaneous nodules, pleura-peritoneal or bone marrow extensions. The authors believe that these two groups of lesions actually belong to one disease entity.