儿童淋巴瘤的误诊分析

Analysis of Misdiagnosis in children with lymphoma

目的通过对133例患儿临床特点和误诊原因的分析,提高临床医师对儿童淋巴瘤的认识,减少早期误诊。方法收集我院2003年至2008年收治的227例淋巴瘤患儿资料,分别按照其首发症状、误诊原因进行回顾和分析。结果227例患儿中有误诊史的133例,占58.6%。按病理类型分组统计,以大细胞间变性淋巴瘤误诊率最高约占91.2%。误诊原因:1)淋巴瘤首发症状多种多样,结外侵犯多见,临床医师对本病认识不足,造成误诊共58例,占43.6%;2)病理科医生对本病的组织学特点缺乏足够的认识,病理取材不够完整或处置不当以致影响病理结果判断的共33例,占24.8%;3)患儿家长不配合检查延误诊断的共17例,占12.8%;4)盲目使用激素,掩盖病情,造成误诊的共13例,占9.8%;5)临床表现特殊而误诊12例,占9.0%。结论儿童淋巴瘤的临床表现多样化,发热及结外病灶多见,对本病缺乏认识、盲目使用激素是误诊的首要原因。病理科医生对本病细胞形态学的多样性认识不足、处置不当或缺少免疫组化和基因学检测是造成误诊的第二位因素。患儿家长不配合检查及患儿临床表现特殊也是误诊的常见原因。

Objective To make clinical doctors have better understandings of lymphoma and reduce the misdiagnosis of the disease in early stage, by the analysis of 133 patients＇clinical manifestations and misdiagnosis reasons. Methods Retrospective analysis of clinical features, in 227patients with lymphoma from 2003 to 2008. The misdiagnosis reasons and the initial symptoms are analyzed and reviewed. Results 133 out of 227 patients had been misdiagnosised as other disease at first. The patients are divide into different groups by pathological study, and we find that Anaplastic Large Cell Lymphoma （ALCL） ＇ s clinical misdiagnosis rate is the highest, nearly reach up to 93. 3%. The misdiagnosis reasons are： 1） The fact that extra-nodal involvement present and the various initial symptoms make clinical doctors do not have enough understandings of lymphoma. There are about 58 cases （43.6%） , who were misdiagnosisd due to this reason. 2） Because pathologists do not have enough understandings of lymphoma, and some samples are not integrated or incorrect disposal, there are nearly 33 cases （24. 8% ）were misdiagnosis. 3）As some parents of patients are noncompliance, about 17 cases（ 12.8% ） were delayed to be diagnosised. 4） The fact that impropriate usage of steroid before diagnose,make 13cases（9. 8% ） were misdiagnosised. 5）There are 12 cases （9%） were misdiagnosised because of the especial clinical manifestations. Conclusion The chief reasons of misdiagnosis are that lymphoma shows diversified clinical symptoms, fever, and the extra-nodal involvement. With the same time,dotters are often short of cognitions with the disease, and use steroid before diagnose. The next reasons are that pathologists did not pay much attention to morphological variety of lymphoma, they made incorrect disposal or choose inappropriate immunohistiochemical stain markers and genic detection. Some parents of patients are noncompliance, and the especial clinical manifestations are also one of the reasons.