原发于肺的淋巴瘤六例临床分析并文献复习

Primary pulmonary lymphoma: analysis of cases and review of the literature

目的 探讨原发于肺的淋巴瘤的临床特点、诊断、治疗方法 ,以提高其诊断率。方法 回顾性地总结自 1 989年～ 2 0 0 0年收住北京协和医院的原发于肺的淋巴瘤 6例 ,并结合文献对其临床表现、影像学特点、支气管镜下表现、诊断及治疗方法进行分析。结果 原发于肺的淋巴瘤为少见的淋巴瘤 ,临床表现不特异 ,很难确诊。原发于肺的淋巴瘤主要症状为咳嗽 (4/6)、发热 (2 /6)等。影像学可表现为单发或多发的结节或团块影、实变影等 ,早期无肺门和纵隔淋巴结肿大。支气管镜检查可见支气管狭窄 ,慢性炎症或大致正常。最终确诊需通过开胸手术、胸腔镜及经皮肺穿获取病灶组织 ,并结合病理及免疫组化检查。主要治疗手段为手术切除辅以放化疗。预后取决于淋巴瘤的恶性程度。结论 原发于肺的淋巴瘤临床表现不典型 ,易误诊 。

Objective To study the clinical characteristics, diagnosis and treatment of primary pulmonary lymphoma. Methods Six cases of primary pulmonary lymphoma diagnosed from 1989 to 2000 were retrospectively analyzed , and the literature was reviewed with regard to its clinical manifestations, X ray features, bronchoscopic findings, diagnosis and treatment. Results Primary pulmonary lymphoma was a rare form of lymphoma. Its diagnosis was difficult because of the lack of specific characteristics. The most common symptoms were cough (4/6) and fever(2/6). X ray features included solitary or multiple nodules and consolidation. Hilar or mediastinal lymphadenopathy might be absent in the early stage. Bronchoscopic examination revealed bronchial constriction, chronic mucosal inflammation or nearly normal bronchi. Definite diagnosis was made by pathologic and immunohistochemical examinations of the lung tissue obtained through surgical operation, pleuroscopy, or percutaneous needle lung biopsy. Treatment modalities included surgical resection, radiotherapy and chemotherapy. The prognosis was associated with the malignancy of lymphoma. Conclusions The clinical manifestations of primary pulmonary lymphoma are nonspecific. Misdiagnosis is common. Appropriate invasive biopsy procedures are necessary for early diagnosis.