原发性胰腺淋巴瘤临床特征分析

Clinical characteristics analysis of primary pancreatic lymphoma

目的分析原发性胰腺淋巴瘤(PPL)患者的临床特征。方法回顾性收集2002年1月至2023年5月间北京协和医院收治的22例PPL患者的临床资料,分析患者的临床特征。结果22例患者年龄(56.4±13.3)岁,平均起病至诊断时间1.0(1.0,3.0)个月。临床主要表现为腹痛(15/22)、体重下降(14/22)、黄疸(10/22)。15例患者(15/20,75%)血清乳酸脱氢酶升高,仅2例(2/9,22.2%)CA19-9升高,2例(2/9,22.2%)CEA升高。肿瘤长径5.0(3.8,6.9)cm,增强CT多表现为低强化病灶,罕见主胰管扩张(4/20)。15例患者获得胰腺病理学确诊,其中8例通过外科手术,4例通过CT或超声引导下经皮穿刺活检术,3例通过EUS-FNA。主要病理类型为弥漫大B细胞淋巴瘤(14/22)。19例患者接受化疗,中位随访时间5.0(1.5,35.5)个月,6例患者死亡。结论PPL较为罕见,易造成误诊。乳酸脱氢酶水平升高、肿瘤标志物正常、主胰管不扩张是重要的诊断线索。通过EUS-FNA等方法获取病理标本对明确诊断至关重要。

Objective To analyze clinical characteristics of primary pancreatic lymphoma(PPL)patients.Methods Clinical features of 22 patients diagnosed as PPL admitted to Peking Union Medical College Hospital from January 2002 to May 2023 were analyzed retrospectively.Results The median age was 56.4±13.3 years.The median time from onset to diagnosis was 1.0(1.0,3.0)months.The main clinical manifestations were abdominal pain(15/22),weight loss(14/22)and jaundice(10/22).Elevated lactate dehydrogenase(LDH)was observed in 15/20(75%)patients.Only 2(2/9,22.2%)patients had increased CA199 levels and 2(2/9,22.2%)patients had increased CEA levels.The maximum tumor diameter was 5.0(3.8,6.9)cm.Contrast-enhanced CT mostly showed low enhancement lesions.Major pancreatic duct dilatation were rare on CT scan(4/20).Fifteen patients were confirmed by pancreatic pathology,of which 8 were obtained by surgery,4 were obtained by CT or ultrasound-guided percutaneous biopsy,and 3 were obtained by EUS-FNA.The main pathological type was diffuse large B-cell lymphoma(14/22).19 patients received chemotherapy,and 6 patients died with a median follow-up of 5.0(1.5,35.5)months.Conclusions PPL is rare and easy to be misdiagnosed.Elevated LDH levels,normal tumor markers,and non-dilatation of main pancreatic duct are important diagnostic clues.It is important to obtain pathology by EUS-FNA and other methods for definite diagnosis.