以呼吸系统症状为首发表现的恶性淋巴瘤79例分析

Analysis of lymphoma presenting with pulmonary symptoms： report of 79 cases

目的 分析以呼吸系统症状为首发表现的恶性淋巴瘤的临床特点,提高早期诊断率.方法 回顾性分析广州呼吸疾病研究所2007年1月至2014年1月确诊的以呼吸系统症状为首发表现的恶性淋巴瘤79例,其中男46例,女33例,年龄16～88岁,中位年龄51岁.对其临床资料进行分析.结果 79例患者的临床表现为：咳嗽（66例,84％）、咳痰（55例,70％）、消瘦（37例,47％）、发热（37例,47％）、气促（34例,43％）、浅表淋巴结肿大（24例,30％）及双肺湿性哕音（20例,25％）.实验室检查：29例乳酸脱氢酶（LDH）升高,40例ESR增快,39例癌抗原125增高.影像学表现为双肺病变49例（62％）,单肺病变23例（29％）,纵隔占位病变11例（14％）,包括结节肿块、实变、混合病变、磨玻璃或网格状影及胸腔积液等.50例有2种及以上影像学表现.21例胸腔积液患者行胸腔积液检查,其中20例为渗出液.胸腔积液／血清LDH＞ 3.5者1例,胸腔积液/血清癌胚抗原＞1者4例,胸腔积液中癌抗原125增高5例,癌胚抗原增高1例,LDH中位数为224 U/L,腺苷脱氨酶中位数为21 U/L.79例中经支气管镜活检确诊40例,外周淋巴结活检确诊21例,经皮肺穿刺活检确诊8例,经胸腔镜肿物切除确诊3例,经胃镜黏膜活检及经肠镜黏膜活检确诊各1例,胸膜前肿物、胸骨后肿物、头皮肿物、乳腺及咽部活检确诊各1例.病理诊断霍奇金淋巴瘤8例,非霍奇金淋巴瘤71例.中位误诊时间为3个月.结论 以呼吸系统症状为首发表现的淋巴瘤患者症状及影像学表现缺乏特异性,应提高诊断意识,尽早行病理活检,以免漏诊.

Objective To study the clinical characteristics and diagnostic methods of lymphoma with pulmonary symptoms as the initial manifestations.Methods Seventy-nine patients with lymphoma presenting with pulmonary symptoms were retrospectively analyzed.These cases were all diagnosed in The First Affiliated Hospital of Guangzhou Medical University during 2007 to 2014.The data were collected,including general features,clinical manifestations,blood examinations,CT scan,diagnostic methods,pathologic diagnosis,misdiagnosis and the reasons.Results The median age of the 79 patients was 51 years.Cough （66 cases,84%）,expectoration （55 cases,70%）,weight loss （37 cases,47 %）,fever （37cases,47%）,shortness of breath（34 cases,43%）,enlargement of the peripheral lymph nodes （24 cases,30%）,and rales in both sides of the lungs（20 cases,25%）.Erythrocyte sedimentation rate（ESR）,serum lactate dehydrogenase（LDH） and CA125 levels were increased in 51%,37%,and 49% of the patients respectively.Chest CT scan showed bilateral involvement in 49 cases（62%）,unilateral involvement in 23 cases（29%）,and mediastinum occupying lesions in 11 cases （14%）.The lesions included nodules and masses,infiltration and pulmonary consolidation,diffuse ground-glass shadows or reticular changes,and pleural effusion.Fifty patients had at least 2 kinds of these radiological changes.The pleural effusion of 21 patients were examined,and 20 of them were exudates.Pleural effusion LDH/serum LDH 〉 3.5,pleural effusion CEA/serum CEA 〉 1,and pleural effusion CA125 increase were present in 1,4,and 5 patients respectively.The median value of the pleural effusion LDH and ADA were 224 U/L and 21 U/L.Several methods were used for diagnosis,including transbronchial biopsy（40 cases）,peripheral lymph node biopsy （21 cases）,percutaneous lung biopsy （8 cases）,video-assisted thoracoscopic surgery （3 cases）,gastroscopic biopsy （1 case）,enteroscopic biopsy （1 cases）,pleural mass biopsy （1 case）,sternal mass biopsy（1 case）,scalp mass biopsy（1 case）,mammary glands biopsy（1 case） and pharyngeal biopsy （1 case）.The pathological study showed that 8 cases were Hodgkin＇ s lymphoma,and 71 cases were nonHodgkin＇s lymphoma.The median misdiagnosis time was 3 months.Conclusions The clinical symptoms and radiological features were diverse and nonspecific in patients with lymphoma presented by pulmonary symptoms.Pathological biopsy should be considered early to avoid delay in diagnosis.