以呼吸系统症状首诊的继发性肺淋巴瘤临床特征研究

Clinical analysis of secondary pulmonary lymphoma first diagnosed with respiratory symptoms:A retrospective study

目的:分析探究继发性肺淋巴瘤(SPL)临床资料,以期减少误诊。方法:回顾性分析首诊于呼吸与危重症医学科并经肺部病理确诊的共12例SPL患者的临床资料。分析临床表现、血清指标、胸部CT表现、微创肺活检、病理特点。结果:12例SPL患者,男7例,女5例,平均年龄50.08岁。临床症状以气短(7例)、胸闷(5例)、干咳(5例)、高热(4例)、咳痰(4例)多见。胸部CT均表现为多发病灶,好发于双肺(5例)及右下肺(4例),以单发肿块(6例)、多发肺结节(6例)、实变影(5例)多见,超过一半患者(7例,58.33%)合并胸腔积液,仅2例伴纵隔淋巴结肿大。血清乳酸脱氢酶、铁蛋白、β_(2)微球蛋白多有升高(7~8例),12例患者均通过微创肺活检确诊为淋巴瘤。结论:SPL临床表现缺乏特异性,胸部CT示单发肿块、多发肺结节、实变影,伴血清乳酸脱氢酶、铁蛋白、β_(2)微球蛋白升高,抗感染或其他治疗无效,应考虑SPL可能。多次肺组织活检、充足的肺组织标本及免疫组化、基因重排技术有助于SPL的诊断。

Objective:To analyze the clinical data of secondary pulmonary lymphoma(SPL)in order to reduce misdiagnosis.Methods:The clinical data of 12 SPL patients first diagnosed and confirmed by pulmonary pathology were retrospectively analyzed.Clinical manifestations,serum indexes,chest CT findings,minimally invasive lung biopsy and pathological features were analyzed.Results:There were 12 SPL patients,7 males and 5 females,with a mean age of 50.08 years.The clinical symptoms were dyspnea(7 cases),chest tightness(5 cases),dry cough(5 cases),hyperpyrexia(4 cases)and expectoration(4 cases).Chest CT showed multiple lesions,mostly in bilateral lungs(5 cases)and right lower lobe(4 cases).Single mass(6 cases),multiple pulmonary nodules(6 cases)and consolidation shadow(5 cases)were more common.More than half of patients(7 cases,58.33%)had pleural effusion,and only 2 cases had mediastinal lymph node enlargement.Serum lactate dehydrogenase,ferritin and β_(2) microglobulin were mostly elevated(7-8 cases).All 12 patients were diagnosed with lymphoma by minimally invasive lung biopsy.Conclusion:The clinical manifestations of SPL are untypical.As Chest CT shows single mass,multiple pulmonary nodules,consolidation shadow,with elevated serum lactate dehydrogenase,ferritin and β_(2) microglobulin,anti-infection or other treatments are ineffective,the possibility of SPL should be considered.Multiple lung biopsies,adequate lung tissue samples,immunohistochemistry and gene rearrangement techniques are helpful for the diagnosis of SPL.