原发性骨恶性淋巴瘤36例报告

Clinical Review of 36 Cases of Primary Malignant Lymphoma of Bone

目的 探讨原发性骨恶性淋巴瘤的诊断标准、治疗方法和预后的关系。方法回顾性分析此瘤３６例，均无特殊的临床与影像学表现，原发于骨骼而无任何其他组织起源的证据。均经病检。特别是免疫组化检测，确诊为原发性骨恶性淋巴瘤。Ｂ细胞源性２４例（核裂细胞型１１例，无核裂细胞型８例，混合型５例），Ｔ细胞源性１２例（多形Ｔ细胞型６例，淋巴母细胞型３例，透明Ｔ细胞型３例）。结果 手术治疗１９例，术后放疗９例，化疗６例。诊断性活检术１７例，确诊后单用放疗６例，单用化疗６例，放、化疗４例，住院期间死亡１例。出院后随访２－１４年，获得随访结果３１例，２年内死亡１２例，现存活１９例，五年与１０年生存率分别为３７．５％（１２／３２）与１５．６％（５／３２）。结论病检和免疫组化是确诊与分型的重要手段。治疗以放、化疗为主，辅以手术，可根据免疫表型选择不同的化疗方案。

Objective Study on diagnostic criterion and the relationship between treatment andprognosis of primary malignant lymphoma of bone to improve the level of diagnosis and treatment. MethodsThirty-six cases of primary lymphoma of bone were reviewed. All were confirmed by histological examinationand immunohistochemical staining: They were of B-cell origin in 24 cases (cleaved cell in 11, noncleaved cellin 8, mixed type in 5), T-cell origin in 12 cases (multimorphologic T-cell in 6, lymphoblast in 3, and clearT-cell type in 3). Results Surgery was performed in 19 cases (after operation, radiotherapy 9, chemotherapy6), biopsy 17 (among them, radiotherapy 6, chemotherapy 6, radiotherapy plus chemotherapy 4, One died inhospital) . Follow-up was available in 31 cases (death within two years 12 cases, survival 19 cases) . The 5year and 10 year survival rates were, 37. 5% (12/32) and 15. 6% (5/32), respectively. ConclusionsHistological examination and immunohistochemical staining are important in diagnosis and subclassification ofprimary malignant lymphoma of bone. Radiotherapy and chemotherapy are main treatment for this tumor, andsurgery is an adjutant measure. Different protocols of chemotherapy could be chosen according to differentimmunotypes.