以妇科肿瘤为临床表现的非霍奇金淋巴瘤六例临床分析

Clinical analysis for 6 cases of primary extra-nodal Non-Hodgkin lymphoma with manifestation as gynecologic neoplasm

目的为了提高对妇科恶性肿瘤鉴别诊断的能力,回顾性分析6例以妇科肿瘤为临床表现的非霍奇金淋巴瘤的临床和病理特点,了解诊断和治疗方法,预后因素。方法收集2008年至2016年在妇科诊治的6例非霍奇金淋巴瘤临床资料。结果平均发病年龄57.8岁。主要临床表现为盆腔肿物、腹痛和阴道排液;5/6例伴有血清CA125升高,4/6例有血清LDH升高。4例接受开腹手术,手术探查证实肿瘤来自回肠1例,来自卵巢1例,来自结肠系膜1例,以及来自直肠与子宫宫颈卵巢融合的大肿瘤1例。另外2例接受了宫颈活检和阴道肿瘤活检。病理诊断,6例患者均为NHL弥漫大B细胞淋巴瘤。免疫组化染色对CD20（＋）,CD3（-）,ki67（＋）60%~90%。6例患者接受了以R-CHOP方案为主的化疗,4-10疗程。除1例死亡以外,5例达到完全缓解和部分缓解。平均生存50个月（4~112个月）,其中3例无瘤生存5年以上。结论对于表现为妇科恶性肿瘤的病人实施肿瘤切除或者活检,是获得病理诊断的重要方法。R-CHOP方案是治疗结外NHL DLBCL的有效方法。

Objective To improve the ability of differential diagnosis of gynecologic malignancy,analyze the clinicopathology dates of 6 cases Non-Hodgkin lymphoma（NHL）,with the clinical manifestations as gynecologic malignancy.Methods The medical records of 6 patients with diagnosis non-Hodgkin lymphoma of the pelvic masses from 2008 to 2016 at Peking University People＇s Hospital were reviewed respectively.Results The mean age of 6 patients at presentation was 57.8 years（range 50 to 66 years）.The main clinical manifestations were pelvic mass,lower abdominal pain and vaginal discharge.Serum CA125 was elevated at 5/6 patients and serum LDH increased at 4/6 patients.4 cases underwent laparotomy,the surgical exploration confirmed that the tumors derived from ileum,right ovary,mesocolon and a big rectum tumor fused with uterus cervix and ovary,respectively.The other 2 patients received tumor biopsy on cervix and vagina respectively.Pathological diagnosis of all patients were Primary extranodal NHL with subtype of diffuse large B cell lymphoma（DLBCL）.The immunohistochemisty on all tumors presented as CD20（＋）,CD3（-）,ki67（＋）60% ~ 90%.Combination chemotherapy with R-CHOP regime was used in all patients.The overall median survival from the diagnosis of NHL was 50 months（4 ~ 112 months）,with 1 case died because of disease and 3 cases living more than 5-year.Conclusion Gynecologic surgery or biopsy on the suspicious pelvic malignancy was the way to obtain the pathologic diagnosis.Combination Chemotherapy is the efficient therapy to treat on the patients with NHL.