耳鼻咽喉部及头颈部非霍奇金淋巴瘤──附45例临床分析

Clinical analysis of 45cases with non-Hodgkin lymphoma in otorhinolary ngologic region and in head and neck.

目的:探讨耳鼻咽喉部及头颈部非霍奇金淋巴瘤(NHL)的临床特点、诊断及预后。方法:对45例耳鼻咽喉-头颈部NHL患者的临床资料作回顾性分析。结果:45例中T细胞淋巴瘤18例;B细胞淋巴瘤23例,未定型4例;其中10例曾被误诊。NHL的临床表现复杂,局部表现以发病部位的功能损害为主,有鼻塞、涕血、嗅觉下降、咽痛、咽异常感觉、颈部肿块、面瘫(双侧)、听力下降、腭部溃疡、头痛、抽搐、胸痛、腹痛等。发热、盗汗及体重下降为主要的全身症状。发病部位以鼻腔鼻窦居首位(40%),其次是扁桃体及颈部,分别占22%、16%。10例患者有3个或以上病灶。确诊主要靠病理检查或加免疫组织化学检查。本组3年、5年及10年的生存率分别为76%、51%及38%。T细胞淋巴瘤、有全身症状、临床分期高及恶性程度高者预后不良。结论:NHL的临床表现无固定特征,诊断应采用病理活组织检查及免疫组织化学检查相结合,其预后与病理类型、有无全身症状、临床分期、恶性程度等有关。

Objective:To study the clinical feature,diagnosis and prognosis of non-Hodgkin lymphoma (NHL),which are primary in the otorhinolaryngologic region and in head and neck.Methods :Forty five cases with NHL in otorhinolaryngologic region and in head and neck were analyzed retrospectively.Results:Among 45patients with NHL 18cases we re T-lymphoma ,23cases were B-lymphoma ,4cases were unclassified.10cases h ad been misdiagnosed.The manifesta tion of these NHL were complicated.The local manifestations mainly pre sented as the dysfunction of the path ogenic regions,such as nasal obstruction,nasal discharge and nosebleed,hyposmia,pharyngalgia,pharyngeal paraesthesia,mass of neck,facial paralysis(bilateral),hypoacusis,ulcer of palate,headache,convulsion,chest pain,abdominal pain and so on.The predomi nant general symptoms were fever,night sweat and loss of body weight.The commonly involved regions were nasal cavity /paranasal sinuses(40%),tonsil(22%)and neck(16%).There were ten patients with at least three foci.Definite diagnosis was predominantly depended on patholog ical examination and /or immunohistochemistry.The t hree,five and ten-year survival rates were 76%,51%and 38%respectively.Poor progn osis was found in patients with T-lymphom a,with the above-mentioned general sy mptoms ,or at stageⅢandⅣand in high malignancy as well.Conclusion:There are no characteristic feature s in NHL.Pathological biopsy combin ed with immunohistochemitry must be used in the diagnosis of NHL.The prognosis is related to pathological typ e,with or without the general symptoms ,malignant degree and tumor stage.[