原发性睾丸淋巴瘤17例的诊治体会

Diagnosis and treatment of 17 primary testicular lymphoma cases

目的总结原发性睾丸淋巴瘤的诊疗要点及预后，以提高对该病的临床认识。方法1995—2010年，首都医科大学附属北京友谊医院泌尿外科共收治原发性睾丸淋巴瘤17例，回顾性分析其临床特点、诊疗经过及预后。结果17例患者平均年龄68岁，以睾丸实性肿物为首发症状，肿物平均直径4．7cm，均接受患侧睾丸高位切除术，病理均为非霍奇金淋巴瘤，弥漫大B性15例，间变大细胞性2例，临床分期均为IE期。长期随访14例，失访3例，平均随访时间37．8月，术后所有患者均接受CHOP化疗，部分患者合并行利妥昔单抗及预防性低剂量盆腔放疗。共5例患者死于其他内科慢性合并症，对侧睾丸转移1例再次行手术治疗，目前9例患者均无瘤生存。结论原发性睾丸淋巴瘤较为少见，多见于老年男性，术后病理诊断为金标准，治疗以综合性全身治疗为主，需根据患者具体情况制定个体化治疗方案。

Objective Concluding the clinical feature and prognosis of primary testicular lymphoma to improve the understanding of this disease. Methods During 1995 and 2010, 17 cases of primary testicular lymphoma treated in Beijing Friendship Hospital of Capital Medical University were retrospectively analyzed of its clinical features, diagnosis, treatment and prognosis. Results Seventeen patients with a mean age of 68 years complained the testicular solid mass as their first symptoms. The mean tumor diameter was 4.7 cm, and all patients underwent orchidectomy, and testicular non-Hodgkin＇s lymphoma was confirmed by pathologic examination. Fourteen cases were diffuse large B cell type and 3 cases were anaplastic large cell type. The clinical stage of all the patients was IE. Fourteen cases were fol- lowed up （3 cases were lost）with mean follow-up time of 37.8 months by outpatient interview and telephone, all pa- tients were treated with CHOP chemotherapy, and some of them were combined with rituximab and preventive lowdose pelvic radiotherapy. Five cases died of other chronic medical complications, 1 case with contralateral testicular metastasis received surgery again. There were 9 tumor free survival cases in total. Conclusion Primary testicular lymphoma is rare and more common in older men. Postoperative pathologic diagnosis is gold standard. The systemic treatment and individual therapy is the first choice for primary testicular lymphoma.