巨大淋巴结增生43例临床资料分析

Clinical data analysis on 43 cases of the giant lymph node hyperplasia

目的总结巨大淋巴结增生的临床特点、治疗方法及预后。方法回顾性分析我院自1999至2006年43例巨大淋巴结增生患者临床资料，单中心型肿瘤分布：颈部10例，胸部20例，腹部9例；多中心型4例。结果皆通过手术或手术配合放化疗，术后病理证实为巨大淋巴结增生，其中浆细胞型16例，占37．2％，透明血管型26例，占60．5％，混合型1例，占2．3％；单中心39例，占90．7％，多中心4例，占9．3％。单中心39例经手术切除后38例无复发，皆存活，1例失随访；多中心4例经手术＋放或化疗后，3例复发，其中2例死亡，1例带瘤存活至今，1例无瘤存活。结论巨大淋巴结增生病较为罕见，术前易误诊为其他疾病，诊断主要依靠术后病理；单中心患者手术切除为最彻底治疗，术后无复发，预后好；多中心患者手术切除后常有复发，疾病呈进行性发展，预后差，尚无较好治疗手段。

Objective To summarize the clinical features, treatment and prognosis of giant lymph node hyperplasia（ Castleman＇s disease, CD）. Methods The clinical data of 43 CD patients with the tumor located in neck （n = 10）, chest （n = 20）, abdomen （n = 9） and multi-centers （n = 4） were analyzed. Results All the patients underwent surgical resection of tumor or lymph and the patients of multicentric disease underwent adjuvant chemotherapy or radiotherapy. All the diagnoses of CD were confirmed by pathological examination. Among all the cases, 26 patients were hyaline vascular subtype （HV）, 16 patients plasma cell subtype （PC） and 1 patient mixed subtype. All 39 patients of unicentrie disease survived without disease evidence. 2 patients of multicentric disease died at 18 months and 54 months after surgery; 1 patient survived with disease; 1 patient sm＇vived with no evidence of disease. Conclusion Giant lymph node hyperplasia is a rare disease. The diagnosis depends mainly on the pathological examination. Surgery is the best choice for unicentric disease with an excellent prognosis. Patients with muhicentric disease may benefit from surgery, adjuvant chemotherapy or radiotherapy, but the prognosis remains grim.