原发女性生殖道淋巴瘤11例临床分析

Analysis of 11 Cases with Primary Lymphoma of the Female Genital Tract

目的:探讨原发女性生殖道淋巴瘤(PLFGT)的临床特征、治疗及预后。方法:收集11例PLFGT患者的临床病理资料。结果:(1)临床特征及辅助检查:患者中位年龄66岁(49~77岁),临床症状包括盆腔包块(6例)、绝经后阴道流血(5例)及腹痛(2例)等。所有患者血清乳酸脱氢酶(LDH)均升高,伴血清肿瘤糖类抗原125(CA125)升高(6例)。影像学检查附件区/子宫肿物均呈实性占位,且多为大病灶,可伴丰富血流(6例),腹水少见(2例)。原发卵巢淋巴瘤4例,原发子宫/子宫颈淋巴瘤4例,卵巢与子宫同时受累3例。临床分期:ⅠE期2例,ⅡE期1例,Ⅳ期8例。(2)病理特征:所有患者病理检查均为弥漫性大B细胞淋巴瘤。(3)治疗:行手术探查8例,其中行全子宫+双侧附件切除术±减瘤术7例,行右侧附件切除+腹膜活检1例;诊断性刮宫2例;子宫颈活检1例。术后化疗9例,未化疗2例。(4)预后:无瘤生存7例,死亡4例,中位生存时间32个月(1~81个月)。结论:PLFGT较少见,常以妇科相关症状就诊,多表现为盆腔较大实性肿物,可伴血清LDH及CA125升高,手术的目的主要为明确诊断,治疗上以化疗为主。

Objective:To investigate the clinical characteristics, treatment strategy and prognosis of patients with primary female genital lymphoma(PLFGT).Methods:The clinical and pathological data were retrospectively collected and analysed from 11 patients diagnosed with PLFGT.Results:(1)The median age of included patients was 66 years(49-77 years),clinical manifestation included pelvic mass(6 cases),abnormal uterine bleeding(5 cases) and abdominal pain(2 cases).The levels of serum lactate dehydrogenase(LDH) were raised in all patients, and the levels of serum CA125 were elevated in 6 patients.The imaging examination indictated tumors of ovarian or uterine were solid masses, and ascites(2 cases) were rare.Four cases were primary ovarian lymphoma and 4 cases were primary uterine/cervical lymphoma.Ovaries and uterus were invaded simultaneously in 3 cases.Two cases were at stage ⅠE,1 case at stage ⅡE and 8 cases at stage Ⅳ.(2)The histological type of all patients were diffuse large B cell lymphoma.(3)Eight patients underwent surgical exploration, and 7 cases underwent total hysterectomy and bilateral salpingooophorectomy with or without cytoreductive surgery, 1 case performed right salpingooophorectomy.One patient received diagnostic curettage.One patient performed cervical biopsy.Nine patients received postoperative chemotherapy, 2 cases without chemotherapy.(4)For the prognosis, 7 cases received tumor-free survival, and 4 cases died.The median survival was 32 months(1-81 months).Conclusions:PLFGT is rare.This histological type usually presents as gynecological symptoms and large solid masses in pelvis, and may accompany with elevated levels of serum LDH and CA125.The main purpose of surgery is to make a definite diagnosis, and chemotherapy is the main treatment for PLFGT.