肺黏膜相关淋巴组织淋巴瘤的临床特征与诊疗分析

Clinical Characteristics,Diagnosis and Treatments of Pulmonary Mucosa-Associated Lymphoid Tissue-Derived Lymphoma

目的探讨肺黏膜相关淋巴组织结外边缘区B细胞(MALT)淋巴瘤的临床特征和诊疗思路。方法收集郑州大学第一附属医院2011年10月至2021年3月收治的48例经病理确诊为原发性肺MALT淋巴瘤患者的临床资料,回顾性分析其一般状况、临床症状、胸部影像学资料、气管镜资料、临床分期、诊疗方式及随访结局等。结果肺MALT淋巴瘤患者共48例,男23例,女25例,年龄(59.29±10.75)岁。常见临床特征为咳嗽(45.83%)、咳痰(39.58%)、胸闷/气喘(35.42%)及胸痛(10.42%)。所有患者均行胸部影像学检查,其中44例(91.67%)双肺病变,40例(83.30%)病变边缘欠规整/模糊,38例(79.17%)呈片状实变,34例(70.83%)呈毛玻璃或结节影,30例(62.50%)空气支气管征。26例(54.17%)患者行支气管镜检查,其中14例(53.85%)发现异常,包括10例(38.46%)气管壁多发结节样新生物,8例(30.77%)管腔狭窄。按Ann Arbor分期,共有Ⅰ/Ⅱ期20例(41.67%),Ⅲ/Ⅳ期28例(58.33%)。死亡患者有7例,其中5例保守治疗,2例仅接受化疗。本研究中肺MALT淋巴瘤1 a生存率达到95.74%。结论肺MALT淋巴瘤常见于中老年患者,临床以咳嗽、咳痰、胸闷为主要表现,胸部影像多见双肺病变、片状实变、毛玻璃影及空气支气管征,部分患者支气管壁可见多发结节样新生物。但是上述特征无法明显与临床其他呼吸系统疾病相区别,因此怀疑该病时应采取组织病理检查以明确诊断。

Objective To explore the clinical characteristics,diagnosis and treatments of lung extranodal marginal zone B cell of mucosa-associated lymphoid tissue-derived(MALT)lymphoma.Methods The clinical data of 48 patients with pathologically confirmed primary lung MALT lymphoma admitted to the First Affiliated Hospital of Zhengzhou University from October 2011 to March 2021 were collected.These were analyzed retrospectively of the general conditions,clinical symptoms,chest imaging data,tracheoscopy data,clinical staging,diagnosis and treatment methods,follow-up results.Results There were 48 cases with lung MALT lymphoma,including 23 males and 25 females,aged(59.29±10.75)years.The common clinical features included cough(45.83%),expectoration(39.58%),chest congestion and asthma(35.42%),chest pain(10.42%).Chest imaging was performed in all patients,the result showed that 44 cases(91.67%)had double lung lesions,40 cases(83.30%)had lesions with irregular and blurred margins,38 cases(79.17%)had patchy consolidation,34 cases(70.83%)had frosted glass or nodular shadow and 30 cases(62.50%)had air bronchial sign.Twenty-six cases(54.17%)underwent bronchoscopy and 14 cases(53.85%)found the results abnormal,included 10 cases(38.46%)with multiple nodular neoorganisms in the air duct wall and 8 cases(30.77%)with tracheobronchial stenosisl.There were 20 cases with stageⅠ/Ⅱand 28 cases with stageⅢ/Ⅳaccording to Ann Arbor stage.There were seven patients with death,of which five cases received conservative treatment,two cases only received chemotherapy.One year survival rate reached 95.74%for lung MALT lymphoma.Conclusion Lung MALT lymphoma was common in elderly patients.The main clinic signs were cough,sputum,chest tightness.The main chest imaging were double lung lesion,patchy consolidation,ground-glass opacity and air bronchogram.Multiple nodular neoorganisms were observed in the bronchial wall of some patients.But these characteristics cannot be clearly distinguished from other clinical respiratory diseases.Therefore histopathological examination should be performed to confirm the diagnosis when the disease is suspected.