误诊为肺炎的肺NK/T细胞淋巴瘤的临床特征

Clinical characteristics of lung NK/T cell lymphoma misdiagnosed as pneumonia

目的探讨肺自然杀伤(NK)/T细胞淋巴瘤的临床特征。方法搜集郑州大学第一附属医院2013年6月至2019年1月因肺部阴影收住院,初期按肺炎治疗,后经病理证实为肺NK/T细胞淋巴瘤患者的相关临床资料。回顾性分析患者的临床表现、实验室检查、胸部CT表现、治疗过程、转归及误诊情况。结果15例患者中原发性肺NK/T细胞淋巴瘤5例,继发性肺NK/T细胞淋巴瘤10例。男8例,女7例,年龄20~76岁。发热14例,呼吸困难4例,咳嗽伴咳痰2例。白细胞减少12例,单核细胞百分比增高10例,肝功能异常10例,血清乳酸脱氢酶升高13例,2例原发性肺NK/T细胞淋巴瘤胸腔积液乳酸脱氢酶及腺苷脱氨酶升高。5例原发性肺NK/T细胞淋巴瘤均为双肺多发病变,以弥漫多发实变影、磨玻璃影及斑片影为主,部分可伴结节影;10例继发性肺NK/T细胞淋巴瘤均表现为结节肿块影,部分伴有斑片影,多为双肺多发散在病变。15例患者早期均误诊为肺炎,后经肺穿刺或支气管镜活检病理确诊。6例行化疗,其中1例临床缓解,4例正在随访中,1例因呼吸衰竭死亡;5例诊断后因呼吸衰竭死亡,4例自动出院,均在半年内死亡。结论肺部NK/T细胞淋巴瘤临床少见,其临床表现及肺部影像学表现与肺部炎性病变不易区分,易误诊为肺炎,尽早行CT引导下肺穿刺或支气管镜活检病理可提高诊断率。

Objective To investigate the clinical features of lung natural killer(NK)/T cell lymphoma.Methods The clinical data of patients with lung NK/T-cell lymphoma confirmed by pathology who were hospitalized due to lung shadow and initially treated as pneumonia from the First Affiliated Hospital of Zhengzhou University was collected from June 2013 to January 2019.The clinical manifestations,laboratory tests,chest CT findings,treatment procedures,outcomes,and misdiagnosis were retrospectively analyzed.Results Among the 15 enrolled patients with lung NK/T-cell lymphoma,5 were primary and the other 10 were secondary.There were 8 males and 7 females,aged 20-76 years.Fever presented in 14 cases,dyspnea was observed in 4 cases and 2 cases had cough.A total of 12 cases had leukopenia,10 cases had mononuclear cell increase,10 cases had liver dysfunction,13 cases had elevated serum lactate dehydrogenase(LDH),and 2 cases of primary lung NK/T-cell lymphoma had increased pleural LDH and adenosine deaminase.Five cases of primary lung NK/T-cell lymphoma had multiple lung lesions,with diffuse multiple solid shadows,ground glass and patchy shadows,some with nodules;10 cases of secondary lung NK/T-cell lymphoma showed nodular masses,some were accompanied by patchy shadows,and most patients had multiple lesions scattering in the lung.All the fifteen patients were misdiagnosed as pneumonia in the early stage,and then were diagnosed by percutaneous lung biopsy or transbronchial biopsy.Six patients underwent chemotherapy,of which 1 achieved complete response,4 were in follow-up and 1 died of respiratory failure;5 patients died of respiratory failure after diagnosis and 4 patients discharged and died within half a year.Conclusions The lung NK/T-cell lymphoma are rare.The clinical manifestations and pulmonary imaging findings are indistinguishable from pulmonary inflammatory lesions.They are easily misdiagnosed as pneumonia.Early CT-guided percutaneous lung biopsy or transbronchial biopsy can improve the diagnostic accuracy.