睾丸原发非霍奇金淋巴瘤

Primary testicular non-Hodgkin＇s lymphoma

目的分析睾丸原发非霍奇金淋巴瘤的临床表现、病理特征和治疗情况。方法睾丸原发淋巴瘤患者12例。年龄36～78岁，平均62岁。首诊症状：单纯睾丸增大8例；睾丸增大伴阴囊胀痛3例，伴发热1例；阴囊下坠1例。单侧11例，双侧1例。病程15d～6个月。12例超声检查均有睾丸实质性肿块。10例行CT检查发现腹膜后淋巴结肿大3例。AnnArbor分期IE9例、ⅡE2例、ⅢE1例。12例均行根治性睾丸切除术，10例术后接受CHOP方案（环磷酰胺，阿霉素，长春新碱，泼尼松）化疗4～8个疗程。5例在化疗后行放射治疗，放疗剂量25～50Gy。结果12例术后病理报告均为非霍奇金淋巴瘤，高度恶性3例、中度恶性9例。免疫分型：B细胞型8例，T细胞型2例，分类不明确2例。随访1～9年，失访1例，术后2年非癌死亡1例。1、3、5年生存率分别为82％（9／11），40%（4／10），20％（2／10）。肿瘤复发转移部位包括对侧睾丸3例，中枢神经系统3例，肝转移1例，腹膜后广泛转移1例。结论睾丸原发非霍奇金淋巴瘤生存率低，应采取综合治疗。IE、ⅡE期患者应给予手术加放射治疗加化疗，对侧睾丸应预防性照射。ⅡE期以上患者术后应先行化疗，然后根据病情辅以放射治疗。

Objective To summarize the clinical presentation, pathology features, and treatment principle for primary testicular non-Hodgkin＇s lymphoma. Methods Twelve patients were diagnosed with primary testicular lymphoma. The mean age was 62 years （36--78）. Of the patients, unilateral primary testicular tumors were found in 11 cases and bilateral tumors were found in 1 case. All cases had swollen testes, 3 cases had mild pain and 1 had low-grade fever. Ultrasonic examination detected solid mass in all 12 cases. CT scan revealed retroperitoneal enlarged lymph nodes in 3 cases. Nine patients were diagnosed with disease of stage I E, 2 of stage Ⅱ E, and 1 of stage Ⅲ E. All of the patients underwent radical orchiectomies. Postoperative treatment included： CHOP chemotherapy for 10 cases, radiotherapy after chemotherapy for 5 cases, and surgery alone for 9. cases. Results Post- operative pathology results were non-Hodgkin＇s lymphoma in all cases. One patient lost in follow up, one died within 2 years because of other disease. The 1, 3 and 5 year actual survival rates were 82%（9/11） ,40%（4/10）,20%（2/10）, respectively. The relapsed organs included contralateral testis（3/ 11）, central nervous system（3/11）, liver（1/11）and retroperitoneal lymph node（1/11）. Conclusions The prognosis of the primary testicular non-Hodgkin＇s lymphoma is very poor. Chemotherapy must be used after surgery for any stage. Stage I E and 11 E patient should be treated by surgery combined with radiotherapy and chemotherapy. Contralateral testis should be irradiated prophylactically. Patients beyond stage II E should accept chemotherapy after surgery and radiotherapy according to the patients status.