原发性睾丸弥漫性大B细胞淋巴瘤的诊治体会

Clinic experience of primary testicular diffuse large B-cell lymphoma

目的 探讨原发性睾丸弥漫性大B细胞淋巴瘤的临床特点、诊治方法及预后.方法 回顾性分析2012年4月至2015年4月收治的8例原发性睾丸弥漫性大B细胞淋巴瘤患者的临床资料,年龄43-68岁,平均58岁.术前阴囊彩色多普勒超声检查示睾丸肿瘤直径3.5 -8.0 cm,平均5.5 cm.腹盆腔CT及肿瘤标志物检查未见异常.8例均行根治性睾丸切除术,术中切开鞘膜可见睾丸内肿瘤,质地较硬,与正常睾丸组织无明确界限.结果 8例手术均顺利完成,手术时间25-40 min,平均34 min.术后病理诊断均为睾丸弥漫性大B细胞淋巴瘤,免疫组化染色检查：CD20（＋）、BCL-6（＋）、CD3（-）、CD1o（-）、CK（-）.术后1周均接受环磷酰胺750 mg/m^2＋阿霉素50 mg/m^2＋长春新碱1.4 mg/m^2＋泼尼松60 mg/m^2＋利妥昔单抗375 mg/m^2 （RCHOP）方案化疗,每3周1次,共6次.术后随访6-36个月,平均17个月,8例均存活,未见肿瘤复发和转移.结论 原发性睾丸弥漫性大B细胞淋巴瘤临床罕见,应尽早行根治性睾丸切除术,术后1周行RCHOP方案化疗,近期疗效满意,远期疗效有待进一步研究。

Objective To investigate the clinical features, diagnosis, treatment and prognosis of primary testicular diffuse large B-cell lymphoma.Methods 8 patients with primary testicular diffuse large B-cell lymphoma were reviewed from April, 2012 to April, 2015.The mean age was 58 years old, ranging 43-68 years old.Color Doppler echocardiography examination showed that there were round or oval regular tumors in the scrotum, which the diameter ranged from 3.5 to 8.0 cm, mean 5.5 cm.There was no abnormal changes among abdomen and pelvic cavity in CT scan and tumor markers examination.The radical orchiectomy were performed in all patients.After opening the tunica vaginalis, a hard texture tumor could be found, which has the vague border line with normal tissue.All patients were diagnosed according to the combination of morpbologic and immunohistochemical examination after operating.Results All patients accepted operation successfully.The mean operation time was 34 minutes, ranging 25-40 minutes.8 cases were diagnosed as primary testicular diffuse large B-cell lymphoma after operating.Immunohistochemical analysis showed that CD20, BCL-6 were positive.CD3, CD10, CK were negative.All patients received adjuvant chemotherapy with RCHOP（cytoxan 750 mg/m^2, adriamycin 50mg/m^2, leurocnstine 1.4 mg/m^2, prednisone 60 mg/m^2 ,rituximab 375 mg/m^2） regimen over 6 cycles, which was conducted once every three weeks, one week post-operatively.The follow up duration ranged from 6 to 36 months, mean 17 months.All patients survived at the end of this study with no sign of recurrence and metastasis.Conclusions The patients with primary testicular diffuse large B-cell lymphoma are rare.The radical orchiectomy is recommended.And RCHOP chemotherapy should be considered one week post-operatively.The short term outcome of the treatment is satisfactory.But the long term outcome should be further studied.