以淋巴水肿为首发表现的淋巴瘤的临床分析

Clinical analysis of lymphoma with lymphedema as the first manifestation

目的探讨首发症状为淋巴水肿的淋巴瘤患者的临床特征。方法选择2010年8月至2022年2月于首都医科大学附属北京世纪坛医院淋巴外科收治的12例以淋巴水肿为首发表现的淋巴瘤患者作为观察组,选择同期于首都医科大学附属北京世纪坛医院淋巴外科收治的20例妇科肿瘤术后的下肢继发性淋巴水肿患者作为对照组。收集2组患者的临床特点,分析以淋巴水肿为首发表现的淋巴瘤患者的临床特征。结果12例由淋巴瘤引起或加重的淋巴水肿,其中上肢水肿1例、下肢水肿10例、全身性水肿1例。这些患者常伴有虚弱、消瘦、疼痛、肿块、淋巴结肿大等临床症状,肿瘤标志物异常患者比例为6/8,贫血患病率为6/12,超声、电子计算机断层扫描和磁共振成像的阳性率分别为8/8、8/8和3/3,行病理诊断及免疫组织化学检测确诊。2组患者的病程、主要症状及伴随症状、既往史、肿瘤标志物、贫血、影像学检查差异均有统计学意义(P<0.01)。结论淋巴瘤相关的恶性淋巴水肿少见,发病隐匿。为了避免延误淋巴瘤诊断和治疗,应在随访期间积极寻找淋巴水肿的病因。

Objective To investigate the clinical features of lymphoma patients with the first symptom of lymphedema.Methods From August 2010 to February 2022,12 patients with lymphoma who presentied with lymphedema as the first manifestation were selected as the observation group,and 20 patients with secondary lymphedema of the lower limbs after gynecological tumor surgery were selected as the control group.We collected the clinical characteristics of two groups of patients and analyze the clinical characteristics of lymphoma patients with lymphedema as the first manifestation.Results There were 12 cases with lymphoedema caused or aggravated by lymphoma,including 1 case with upper limb edema,10 cases with lower limb edema,and 1 case with systemic edema.These patients are often accompanied by clinical symptoms such as weakness,emaciation,pain,lumps,and enlarged lymph nodes.The proportion of patients with abnormal tumor markers is 6/8,and the prevalence of anemia is 6/12.The positive rates of ultrasound,computed tomography(CT),and magnetic resonance imaging(MRI)are 8/8,8/8,and 3/3,respectively.The patients are diagnosed by pathological diagnosis and immunohistochemistry.There were significant differences between the two groups in course of disease,main and concomitant symptoms,past history,tumor markers,anemia,and imaging examinations(P<0.01).Conclusion Lymphoma associated malignant lymphedema is rare and the incidence is insidious.In order to avoid misdiagnosis and delayed treatment of lymphoma,we should actively identify cause of lymphedema during follow-up.