原发性睾丸弥漫大B细胞淋巴瘤15例临床分析

Clinical analysis of 15 cases of primary testicular diffuse large B-cell lymphoma

目的通过分析原发性睾丸弥漫大B细胞淋巴瘤(PT-DLBCL)患者的诊疗过程,提高对该疾病的临床认识。方法回顾性分析郑州大学第一附属医院2011年5月-2021年5月收治的15例原发性弥漫大B细胞淋巴瘤患者的临床资料。平均年龄(61±15)(34~79)岁,均以发现睾丸无痛性肿大就诊。3例表现B症状(发热、盗汗、体重减轻),8例血清乳酸脱氢酶(LDH)及3例β2-微球蛋白(β2-MG)高于正常值。彩超提示睾丸内条纹状低回声并血流信号丰富。14例行睾丸切除术,术后11例接受CHOP或R-CHOP方案化疗,4例接受健侧睾丸预防性放疗,6例接受鞘内注射。1例双侧病变者行穿刺活检获得病理后行CHOP化疗。结果术后病理为弥漫大B细胞淋巴瘤;Ann Arbor分期:Ⅰ~Ⅱ期9例,Ⅲ~Ⅳ期6例;国际预后指数(IPI)评分:0~2分10例,≥3分5例。术后随访3~79个月,中位时间12个月。6例随访期间死亡,6例存活。结论PT-DLBCL罕见,侵袭性强,预后差,最常累及中枢神经及对侧睾丸。手术切除联合放化疗及免疫治疗可改善预后。

Objective To improve the clinical understanding of primary testicular diffuse large B-cell lymphoma(PT-DLBCL)by analyzing the treatment process.Methods The clinical data of 15 patients with primary diffuse large B-cell lymphoma treated in the First Affiliated Hospital of Zhengzhou University during May 2011 to May 2021 were analyzed retrospectively.The average age was(61±15)(34-79)years.Three patients showed B symptoms.Eight patients serum lactate dehydrogenase(LDH)andβ2 microglobulin(β2-MG)were higher than normal.Color Doppler ultrasound showed striated hypoechoic and abundant blood flow signals in testis.Fourteen patients underwent orchiectomy.After operation,eleven patients received CHOP or R-CHOP chemotherapy,4 received prophylactic radiotherapy for contralateral testis,and 6 received intrathecal injection of chemotherapeutic drugs.One patient with bilateral lesions underwent biopsy and CHOP chemotherapy after pathology.Results The postoperative pathology was diffuse large B-cell lymphoma.Ann Arbor stage:stageⅠ-Ⅱin 9 nine patients and stageⅢ-Ⅳin 6 patients.International prognostic index(IPI)score:0-2 points in 10 patients,≥3 points in 5 patients.During the follow-up of 3-79 months(the median time 12 months),6 patients survived while 6 died.Conclusion PT-DLBCL is rare and invasive with poor prognosis.It most often involves the central nervous system and contralateral testis.Surgical resection combined with chemotherapy,radiotherapy and immunotherapy can improve the prognosis.