口腔颌面部淋巴瘤临床误诊原因探析

Cause Analysis of Clinical Misdiagnosis of Oral and Maxillofacial Lymphoma

目的分析口腔颌面部淋巴瘤临床误诊原因及防范误诊措施,以提高临床诊治水平。方法回顾分析2023年4月至2024年4月收治1例误诊为口腔溃疡和1例误诊为鼻息肉-鼻窦炎的口腔颌面部淋巴瘤患者的临床资料。结果1例因左硬腭反复溃疡11个月,反复发热、左硬腭溃疡加重2个月入院,根据病史及专科检查考虑复发性口腔溃疡。给予补充维生素及对症处理,未见好转,后经口腔溃疡组织病理检查确诊为口腔弥漫大B细胞淋巴瘤,非生发中心来源型。误诊时间11个月。予以CHOP方案化疗,未出现严重不良反应,病情得到控制,目前随访中。1例因双侧鼻塞、流脓涕伴头痛4周入院,根据头颅和鼻窦CT考虑鼻息肉-鼻窦炎,经磁共振成像、病理及免疫组化检查确诊为上颌窦恶性淋巴瘤,弥漫大B细胞性。误诊时间14 d。采用R-CHOP方案化疗,化疗期间出现骨髓抑制,病情未得到控制,患者出现新病灶,1个月后死亡。结论口腔颌面部淋巴瘤早期缺乏特异性临床特征,易误诊、漏诊,尽早行影像学检查,对可疑患者行病理及免疫组化检查是防止口腔颌面部淋巴瘤误诊的关键。

Objective To analyze the causes of clinical misdiagnosis and preventive measures of oral and maxillofacial lymphoma and to improve the level of clinical diagnosis and treatment.Methods From April 2023 to April 2024,the clinical data of 1 patient with oral and maxillofacial lymphoma initially misdiagnosed with oral ulcer and 1 patient initially misdiagnosed with nasal polyps and sinusitis were retrospectively analyzed.Results One patient was admitted to hospital due to recurrent ulcer of the left hard palate for 11 months,and recurrent fever and aggravation of the left hard palate ulcer for 2 months.According to the medical history and specialist examination,recurrent oral ulcer was considered.Vitamin supplementation and symptomatic treatment were given,but no improvement was found.After histopathological examination of the oral ulcer,it was confirmed as oral diffuse large B-cell lymphoma of non-germinal central origin.The misdiagnosis lasted 11 months.After treatment with CHOP chemotherapy regimen,no serious adverse reactions occurred and the disease was controlled.Currently,the patients was being followed up.A patient was admitted to hospital due to bilateral nasal congestion,runny nose and headache for 4 weeks.According to head and sinus CT,nasal polyps and sinusitis were considered,and magnetic resonance imaging,pathological examination and immunohistochemical examination confirmed malignant diffuse large B-cel l lymphoma of maxillary sinus.The misdiagnosis lasted 14 d.R-CHOP regimen was used for chemotherapy.Bone marrow suppression occurred during chemotherapy,and the disease was not controlled.The patient developed new lesions and died 1 month later.Conclusion The lack of specific clinical features in the early stage of oral and maxillofacial lymphoma is likely to lead to misdiagnosis or missed diagnosis.The key to prevent misdiagnosis of oral and maxillofacial lymphoma is to perform imaging examination as soon as possible and pathological and immunohistochemical examination of suspected patients.