妊娠期淋巴瘤21例临床病理特征分析

Clinicopathological features and outcomes： analysis of 21 cases of lymphoma in pregnancy

目的探讨妊娠期淋巴瘤的临床病理特征及预后。方法回顾性分析中国医学科学院肿瘤医院1999年1月至2012年1月收治的21例妊娠期淋巴瘤患者的临床病理资料，并进行生存随访。结果霍奇金淋巴瘤（HL）11例，其中结节硬化型经典型霍奇金淋巴瘤（NSCHL）10例；非霍奇金淋巴瘤（NHL）10例，其中弥漫大B细胞淋巴瘤6例，介于弥漫大B细胞淋巴瘤和伯基特淋巴瘤之间的不能分类的B细胞淋巴瘤1例，小淋巴细胞淋巴瘤1例，间变淋巴瘤激酶阳性的间变大细胞淋巴瘤1例，T淋巴母细胞淋巴瘤1例。中位年龄26岁（22—35岁）。以浅表淋巴结肿大为主要症状的HL多于NHL（10／11比3／10，P=0．008）。诊断时，NHL大肿块及淋巴结外病变的发生率均高于HL（8／10比2／11，P=0．009；7／10比2／11，P=0．030）。所有患者均接受联合化疗，早期患者联合放疗，10例HL和6例NHL达完全缓解。HL中位随访90个月，5年无进展生存（PFS）及总生存（OS）率分别为87．5％及100％；NHL中位随访31个月，2年PFS及OS率分别为66．7％及77．8％。NHL的PFS及OS均有劣于HL的趋势，但差异无统计学意义（P=0．073、0．066）。1例HL和1例NHL于妊娠中后期接受产前联合方案化疗，母婴结局良好。结论NSCHL是最常见的妊娠期HL亚型；NHL中B细胞淋巴瘤多于T细胞淋巴瘤，以侵袭性亚型为主。妊娠期NHL较HL不良因素多、预后差。

Objective To evaluate the elinieopathological features and outcomes of lymphoma in pregnancy. Methods A total of 21 patients with lymphoma in pregnancy were diagnosed and treated at our hospital between January 1999 and January 2012. The efinicopathological data were analyzed retrospectively. Results There were 11 cases of Hodgkin＇s lymphoma （HL） and 10 cases of nodular sclerosis classical Hodgkin＇s lymphoma （NSCHL）. And, among 10 cases of non-Hodgkin＇s lymphomas （ NHL）, there were diffuse large B cell lymphoma （ n = 6 ）, B-cell lymphoma, non-classifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma （n = 1 ）, small lymphocytic lymphoma （ n = 1 ）, anaplastic large cell lymphoma with anaplastie lymphoma kinase（ ALK ） positive （ n = 1 ） and T-cell lymphoblastic lymphoma （ n = 1 ） . The median age was 26 （ 22 - 35 ） years. Superficial lymphadeuopathy was more common in HL than in NHL （ 10/11 vs 3/10,P = 0. 008 ）. At diagnosis,bulky disease and extranodal involvement were more prevalent in NHL than in HL （ 8/10 vs 2/11, P = O. 009 ; 7/10 vs 2/11 ,P = O. 030）. All patients received chemotherapy and those with early stages also had combined radiotherapy. Ten patients with HL and 6 patients with NHL achieved complete remission. During a median follow-up of 90 months for HL, the 5-year progression-free survival （ PFS ） and overall survival （ OS ） rates were 87.5% and 100% respectively. And during a median follow-up of 31 months for NHL,the 2-year PFS and OS rates were 66. 7% and 77.8% respectively. The values of PFS and OS of NHL were inferior to those of HL （P = 0. 073 and P = 0. 066 respectively）. One case of HL and 1 case of NHL received chemotherapy in the second trimester. The patients and their children experienced good outcomes. Conclusions NSCHL is the most prevalent subtype of HL during pregnancy. B cell lymphoma and aggressive subtypes are most common for NHL during pregnancy. The outcomes of NHL are inferior to those of HL during pregnancy.