46例移植后淋巴组织增殖性疾病的临床和病理特点分析

Post-transplant lymphoproliferative disorders:a clinicopathologic study of 46 cases

目的通过分析46例移植后淋巴组织增殖性疾病(PTLD)的临床和病理特点提高医生对本病的诊治水平。方法收集我院诊治的PTLD患者资料,复习其临床和病理特点。结果入组男女比例1∶1。实体器官移植(SOT)40例,异基因干细胞移植(HSCT)6例。中位年龄3岁,移植后至确诊中位时间12.5个月,HSCT患者发病明显早于SOT患者且差异有统计学意义(Z=-2.714,P=0.005)。最常见的首发症状为淋巴结肿大。23例为非结构破坏性,10例为多形性,12例为单形性,1例为经典霍奇金淋巴瘤型。EBER检测阳性41例,阴性5例。结论PTLD是SOT或HSCT严重的并发症,多于移植后早期发生,HSCT患者术后发病明显早于SOT患者。对PTLD早期发现、早期治疗,可改善预后。

Objective To improve the diagnosis and treatment level of post-transplant lymphoproliferative disorders(PTLD).Methods The data of PTLD patients diagnosed and treated in our hospital were collected.Results The ratio of males and females was 1∶1.There were 40 cases of solid organ transplantation(SOT)and 6 cases of hematopoietic stem-cell transplant.The median age was 3 years old,and the median diagnosis time was 12.5 months,and the difference of postoperative onset time between SOT group and HSCT group was statistically significant(Z=-2.714,P=0.005).The most common initial symptom was enlarged lymph nodes.23 cases were non-destructive PTLD,10 cases were polymorphic PTLD,12 cases were monomorphic PTLD,and 1 case was classic Hodgkin lymphoma PTLD.The result of EBER showed that 41 cases were positive and 5 cases were negative.Conclusion PTLD is a serious complication of SOT or HSCT.The onset of HSCT patients was significantly earlier than that of SOT patients.Early diagnosis and treatment of PTLD could improve the prognosis of patients.