肺黏膜相关淋巴组织淋巴瘤的临床特征与诊断

Clinical characteristics and diagnosis of pulmonary mucosa-associated lymphoid tissue-derived （MALT） lymphoma： a restrospective analysis of 29 cases

目的探讨肺黏膜相关淋巴组织（MALT）淋巴瘤的临床特征和影像学特点，以及影响患者预后的因素。方法回顾性分析同济大学附属上海市肺科医院2002年1月至2010年6月收治的、经病理确诊的肺MALT淋巴瘤的临床、影像学和生存资料。结果29例肺MALT淋巴瘤患者中，男性19例（65．5％），女性10例（34．5％）；年龄27～73岁，中位年龄53岁。（1）常见的临床表现：咳嗽15例（51．7％），发热6例（20．7％），胸闷5例（17．2％），胸痛5例（17．2％），乏力4例（13．8％），体重下降4例（13．8％），无症状患者9例（31．O％）。（2）胸部CT表现：浸润或实变影22例（75．9％），团块或结节影7例（24．1％）；单侧病灶15例（51．7％），双侧病灶14例（48．3％）。诊断时间为0．5～96个月。（3）确诊方法：手术18例（62．1％），其中开胸活检15例（51．7％），电视胸腔镜3例（10．3％）；经皮肺穿刺活检4例（13．8％），气管镜活检5例（17．2％），外周淋巴结活检2例（6．9％）。治疗方法包括单纯手术、联合化疗、放疗以及中药治疗。29例患者1、3年生存率分别为92．3％和87．4％。结论肺MALT淋巴瘤临床表现和影像学表现不典型，易于误诊，诊断主要依靠病理活检。早期肺MALT淋巴瘤患者以手术治疗为主，复发或晚期患者以联合化疗为主，总体预后较佳。

Objective To study the clinical manifestations and radiological characteristics, diagnostic methods and outcomes of pulmonary mucosa-associated lymphoid tissue-derived （MALT） lymphoma. Methods A retrospective review of clinical, radiological and follow-up data of 29 pulmonary MALT lymphoma cases at Shanghai Pulmonary Hospital affiliated to Tong Ji University from January 2002 to June 2010 was performed. Results Among these patients, there were 19（65.5% ） males and 10 （34.5%） females aged from 27 to 73 （ median 53） years old. Common clinical manifestations were cough （51.7%）, fever （20.7%）, apnea （ 17.2% ）, chest pain （ 17.2% ）, fatigue （ 13.8% ） and weight loss （ 13.8% ）, while 9（31.0% ） cases had no symptoms at diagnosis. The characteristics of the chest CT showed that 22 （ 75.9% ） of the cases had patch infiltration or consolidation of the lung, 7 （24.1% ） of the cases had mass, and 15 （51.7%） unilateral and 14（48.3% ） bilateral lesions. Their diagnosis duration varied between 0.5 and 96 months. 18（62.1% ） cases were confirmed by surgery （15 open lung and 7 video-assisted thoracic surgery, VAST ）, 4（ 13.8% ） by percutaneous lung biopsy, 5（ 17.2% ） by bronchoscopic biopsy, and 2（6. 9% ） by peripheral lymph node biopsy. The treatment methods included surgery, combined chemotherapy, radiotherapy and Chinese herbal medicine. The 1- and 3-year-survival rates were 92. 3% and 87.4%, respectively. Conclusions Pulmonary MALT lymphoma is atypical in clinical manifestations and radiological characteristics, and easy to be misdiagnosed. Local diseases are mainly treated by operation while extensive diseases receive combined chemotherapy. A proper diagnosis is mainly based on pathological biopsy. Patients with MALT lymphoma have a favorable outcome. Poor prognosis may be connected with poor performance status and long diagnosis duration.