原发性肺淋巴瘤的临床特征分析

Clinical features and diagnosis analysis of primary pulmonary lymphoma via endobronchial ultrasound

目的探讨原发性肺淋巴瘤(PPL)的临床诊断要点,以提高对该病的认识。方法收集该院2015年1月-2017年3月经肺活检病理确诊的共11例PPL的临床资料,其中大部分(10例)均经超声支气管镜肺活检确诊,并对有关资料进行回顾性分析。结果 11例PPL患者中,男7例(63.6%),女4例(36.4%),年龄35~72岁,平均(53.2±9.7)岁,以50岁以上(72.7%)多见。临床症状以咳嗽(7例,63.6%)、咯痰(5例,45.5%)、气促(4例,36.4%)多见;无症状者2例(18.2%)。胸部CT表现为四种类型:(1)肺炎型(8例,72.7%);(2)结节(或肿块)型(5例,45.5%);(3)支气管淋巴管型(间质型)(1例,9.1%);(4)粟粒型(1例,9.1%)。72.7%伴支气管充气征,典型者呈枯树枝征。确诊前误诊8例(72.7%),均首诊肺炎或机化性肺炎。结论 PPL的临床表现缺乏特异性,首诊常常容易误诊为肺炎,但影像学改变仍具有一定特征性,如病灶形态多变、多发,伴支气管枯树征等,确诊依赖于病理组织学和免疫组化检测。支气管腔内超声引导下的肺活检阳性率也很高。

Objective To investigate the clinical diagnosis features of primary pulmonary lymphoma （PPL）. Methods 11 cases of primary pulmonary lymphoma, confirmed by pathological examinations from January 2015 to March 2017, were studied. Most of them （10 cases） were diagnosed by endobronchial ultrasound. Results The study group consisted of 7 male （63.6%） and 4 female （36.4%） patients, aged from 35 to 72 years. 8 of 11 cases （72.7%） were more than 50 years old. The clinical symptoms consist of cough （63.6%）, sputum （45.5%）, breathlessness（36.4%）, 2 cases were asymptomatic. The pulmonary imaging manifestation consists of four different patterns： pneumonic （72.7%）; nodular or mass （45.5%）; bronchovascular-lymphangitic （9.1%）; milliary- hematogenous （9.1%）. Air bronchograms （8 cases, 72.7%） were the common accompanying signs, typically taking the shape of withered arborization. Many cases （72.7%） were misdiagnosed, first as pneumonia or organizing pneumonia. Conclusion Primary lymphoma of the lung occurs with nonspecific clinical features, often initial misdiagnosed as pneumonia or organizing pneumonia, but it has some characteristics on radiology, such as multiple lesions, lesions accompanied with air bronchogram taking the shape of withered arborization. Final diagnosis making depended on pathological examinations by lung biopsy. The positive rate of lung biopsy by endobronchial ultrasound is also high.