原发睾丸淋巴瘤16例临床分析

Primary testicular lymphoma: a clinical analysis of 16 cases

目的 探讨原发睾丸淋巴瘤(PTL)的临床特征及治疗.方法 收集2005年1月至2015年12月江苏省人民医院收治的16例PTL患者的临床资料,回顾性分析患者临床病理特征,采用Kaplan-Meier法进行生存分析.结果 16例患者中位发病年龄63岁(33~81岁),按Ann Arbor分期标准,ⅠE期8例,ⅡE期2例,Ⅲ~Ⅳ期6例.首发症状主要为睾丸无痛性肿大(9例),其次为疼痛(3例)和胀痛(1例),患者均无全身症状.病理类型均为弥漫大B细胞淋巴瘤,其中生发中心(GCB)型2例,非GCB型14例.所有患者均接受睾丸切除术,其中14例患者术后接受了单纯化疗,2例患者接受了化疗和放疗. 14例患者有完整的随访资料,中位随访时间为23.5个月(1.0~97.0个月). 14例患者中, 11例完全缓解,1例部分缓解,1例无应答,1例治疗中. 11例完全缓解患者中,5例复发,复发部位为中枢神经系统(3例)、右下肢皮肤(1例)及对侧睾丸(1例),中位无进展生存(PFS)时间为19.0个月(14.0~95.0个月).结论 PTL大多数为原发睾丸弥漫大B细胞淋巴瘤,主要采取以手术为主的综合治疗,术后联合化疗或放、化疗有助于减少复发.

Objective To study the clinicopathological features and therapeutic regimens of primary testicular lymphoma (PTL). Methods The clinical data of 16 patients diagnosed with PTL from January 2005 to December 2015 in Jiangsu Province Hospital were collected, and the clinicopathological characteristics were retrospectively analyzed. Kaplan-Meier method was used to make the survival analysis. Results The median onset age of 16 patients was 63 years old (33-81 years old). According to Ann Arbor stage, there were 8 cases of stage ⅠE, 2 cases of stage ⅡE, 6 cases of stage Ⅲ-Ⅳ. The initial symptoms included painless solid enlargement of the testis (9 cases), painful testis (3 cases), distending pain of testis (1 case), and the patients had no other systemic symptoms. The pathological type was diffuse large B-cell lymphoma (DLBCL), of which 2 patients were germinal center B-cell (GCB) type and the other 14 patients were non-GCB type. All the patients received the orchiectomy, of which 14 received chemotherapy alone after the operation, 2 received chemotherapy and radiotherapy. Complete follow-up data were available for 14 patients, and the median follow-up time was 23.5 months (1.0-97.0 months). Among 14 patients, complete remission was achieved in 11 patients, partial remission in 1 patient, no response in 1 patient, and 1 patient was undergoing treatment. Among 11 patients with complete remission, 5 patients relapsed, and the recurrence occurred at the central nervous system (3 cases), skin of right lower extremity (1 case), and contralateral testis (1 case). The mean progression-free survival (PFS) time was 19.0 months (14.0-95.0 months). Conclusions Most PTL is primary testis DLBCL, and the comprehensive treatment based on surgery is the main therapy of PTL. Postoperative chemotherapy with or without radiotherapy is recommended to prevent relapse.