原发性肺黏膜相关淋巴组织淋巴瘤1例报告并文献复习

Pulmonary Primary Small B-Cell Lymphoma of Mucosa-Associated with Lymphoid Tissues:A Case Report and Literature Reviwe

目的:探讨原发性肺黏膜相关淋巴瘤的临床特征、诊断、鉴别诊断及治疗。方法:报告1例肺黏膜相关淋巴瘤患者的临床资料、影像学表现、实验室检查和治疗、随访情况,复习国内外相关文献5篇。结果:原发性肺黏膜相关性淋巴组织淋巴瘤是抗原长期刺激,发生免疫应答及局部炎症,从无到有产生淋巴组织、淋巴细胞免疫性增殖,从良性转化为恶性,出现异常克隆而导致黏膜相关淋巴组织淋巴瘤,属于结外非霍奇金淋巴瘤。病理免疫组化特点:若κ和λ两种轻链同时染色,为多克隆性,通常提示病变的组织为良性反应性增生;若病灶细胞的免疫球蛋白仅有一种轻链(κ或λ)染色阳性,即单克隆性,则见于原发性肺低度恶性B细胞淋巴瘤。肺黏膜相关淋巴组织淋巴瘤CD20(+)。结论:原发性肺黏膜相关淋巴瘤大多属低度恶性,发展缓慢,早期不易浸润至远处部位,手术切除彻底,术后化疗效果好。需与肺的恶性肿瘤、淋巴细胞间质肺炎、淋巴瘤样肉芽肿、隐球菌性肺炎等相鉴别。

Objective：To investigate the clinical features and diagnosis of MALT lymphoma and its differential diagnosis. Methods ：The clinical data,imaging feature,Lab and the character of treatment and follow-up,and 5 literatures were reviewed. Result：Mucosa associated lymphoid tissue lymphoma was caused by antigenic stimulus,leading immune response and region inflammation. And it could lead to develop the lymphatic tissue and increasing the lymphocyte immu nity,and changed the benign tumor to cancer,and appearanced abnormal clone and lead to mueosa associated lymphoid tissue lymphoma. It belonged to non-Hodgkin＇s lymphoma. The Immunohistochemistry showed that if the light chain,k and λ,were simultaneous stained,that meaned multiclonieity. Iit meaned pathological changes issue wss innocence reactive hyperplasia. And if one of the light chain were stained,that was monoclonicity. It meaned it was pulmonary primary small B-cell lymphoma of mucosa-associated with lymphoid tissues. It was CD20 （＋）. Conclusion ：Most of pulmonary primary small B-cell lymphoma of mucosa-associated with lymphoid tissues are low potential malignancy. It develop slowly. And in earlier period it is very difficult to infiltrate distant place. Thoroughly exairesis and then chems can lead a good result. And it must be identified with pneumonic cancer,lymphocyticinterstitial pneumonia,lymphomatoid granulomatosis and pulmonary cryptococcosis.