1例原发睾丸淋巴瘤的临床特点与诊治分析

A case study of primary testicular lymphoma: diagnosis and treatment strategies

睾丸淋巴瘤发病率占睾丸肿瘤1%～9%,全部非霍奇金淋巴瘤(NHL)的1%～2%。病理以弥漫大B细胞淋巴瘤最常见。临床主要表现为单侧睾丸无痛性肿大,呈进行性加重,有发热、盗汗、体重减轻的B症状者占25%～41%。局部阴囊部位多受累,中枢神经系统复发常见。治疗多采用以R-CHOP联合预防性鞘注化疗及对侧睾丸放疗治疗为主的综合治疗模式,可明显改善患者的无进展生存期及总生存期。现介绍天津医科大学附属肿瘤医院淋巴瘤科收治的1例睾丸原发的恶性淋巴瘤及其诊治的多学科综合讨论供大家参考。

Primary testicular lymphoma comprises 1% to 9% of testicular neoplasms and represents 1% to 2% of all non-Hodg-kin lymphomas. Histologically, the majority of the tumor consists of diffuse large B-cell non-Hodgkin lymphomas that are of intermedi-ate- or high-grade neoplasm. Clinically, the disease typically presents as a painless testicular swelling that develops over a span of weeks to months. B symptoms such as fever, weight loss, and anorexia are present in 25% to 41% of the patients. This tumor is an ag-gressive type, with frequent invasion of the epididymis, spermatic cord, and scrotum, as well as a marked tendency to relapse, especial-ly in the CNS. The treatment is mainly based on orchiectomy （mostly in stages ⅠE and ⅡE） regardless of its association with prophy-lactic irradiation of the scrotum and administration of intrathecal chemotherapy, cyclophosphamide, doxorubicin, vincristine, and pred-nisone regimen chemotherapy plus rituximab （R-CHOP） （stages ⅢE and ⅣE） and radiotherapy. The multi-modality treatment marked-ly improved progression-free and overall survival. We introduce as reference one case that received a multidisciplinary comprehensive discussion in the Department Lymphoma, Tianjin Medical University Cancer Hospital.