肺鳞癌并发嗜酸粒细胞型类白血病反应1例并文献复习

A case report of squamous cell lung cancer with eosinphil leukemoid reaction and literature review

目的 提高临床医师对肺癌伴类白血病反应（leukemoid reaction,LR）的认识,减少漏诊、误诊.方法 报道中南大学湘雅二医院呼吸内科2011年10月收治的1例肺癌并嗜酸粒细胞型LR,对国内外文献共报道的55例肺癌伴LR的临床症状、外周血象、骨髓学特征、治疗及预后进行分析.结果 国内共报道了16例肺癌伴LR,国外近10年共统计和报道了39例肺癌伴LR.55例LR中仅3例为嗜酸粒细胞型,50例为中性粒细胞型,2例未报道具体类型.以“肺癌”和“类白血病反应”为主题词检索中国期刊网全文数据库,结果有相关文献12篇,共报道16例肺癌合并LR,有13例取得肺癌病理组织类型,14例行骨髓学检查.以“lung cancer”和“leukemoid reaction”加时间限制“10 years”在Pubmed里可检索到6篇相关文献,共统计39例肺癌并LR,均取得肺癌病理类型及骨髓学结果.以“lung cancer”和“eosinphil”为主题词检索Pubmed,无相关报道.结论 肺癌合并嗜酸粒细胞型LR尚属罕见.LR一般发生在肿瘤晚期,骨髓检查对其诊断很重要,一旦出现提示疾病预后差,大多在1～6个月内死亡.

Objective To analyze the clinical presentations of lung cancer with leukemoid reaction （LR） arid to improve the clinical doctorsr understanding of lung cancer with LR to reduce misdiagnosis. Methods Clinical symptoms, peripheral blood, treatment, and prognosis of one patient with lung cancer with LR in our department and 55 patients reported in literatures were analyzed. Results Through searching China journal full-text database using ＂lung cancer＂ and ＂leukemoid reaction＂ as subject terms, there were 16 patients of lung cancer with LR reported since 1989. And through searching Pubmed using the same subject terms with restricting of 10 years, there were 39 patients of lung cancer with LR reported. 52 of 55 patients were diagnosed by lung biopsy,and 53 of 55 patients were diagnosed by bone marrow biopsy. There was no literature reported searching Pubmed using ＂lung cancer＂ and ＂eosinphil＂. LR mainly occured in the advanced state of disease. LR should be diagnosed with bone marraw examination. Conclusions LR commonly occurs in later period of cancer,disease prognosis is poor once appears, mostly dying in 1-6 months, especially in patients of lung cancer with LR. Most lung cancer with LR is the type of neutrophils, and lung cancer with eosinophil LR is reported rarely up to now.