睾丸原发性弥漫性大B细胞淋巴瘤临床病理学分析

Primary testicular diffuse large B-cell lymphoma: A clinicopathological analysis

目的:探讨睾丸原发性弥漫性大B细胞淋巴瘤(DLBCL)的临床病理特征、免疫表型及治疗方法。方法:回顾性分析23例睾丸DLBCL的病理形态学及免疫组化标记,结合文献对其临床病理学特点进行分析。23例患者年龄48～76岁,平均61.4岁,82.6%患者超过50岁。病变部位左侧睾丸9例,右侧14例,均为单侧发病。临床主要表现为睾丸无痛性进行性肿大。结果:组织学主要表现为肿瘤细胞弥漫浸润于睾丸实质,细胞体积较大,异型性明显,核分裂易见。免疫表型均表达B细胞标志物。5例获得随访资料,4例截止随访时均存活,随访时间2～32个月,1例随访9个月后死亡。结论:睾丸DLBCL少见,多发于老年男性患者,具有侵袭性生物学行为。诊断时极易误诊或漏诊,其确诊依赖组织病理学,免疫组化标记对明确诊断及鉴别诊断有一定价值。

Objective: To investigate the clinicopathological features, immunophenotype and treatment of primary testicular diffuse large B-cell lymphoma(DLBCL). Methods: We retrospectively analyzed the pathomorphological characteristics and immunohistochemical markers of 23 cases of primary testicular DLBCL as well as their clinicopathological features with a review of the relevant literature. The patients were aged 48-76(mean 61.4) years, 82.6% over 50 years, and all clinically presented with painless progressive unilateral testicular swelling, 9 cases in the left and the other 14 in the right testis. Results: Histologically, the lymphomas were composed of large atypical cells with prominent karyokinesis and diffusely infiltrated the testicular parenchyma. The neoplastic cells were positive for B-cell markers. Five of the patients were followed up for 2 to 32 months, of whom 4 survived and 1 died at 9 months. Conclusion: Primary testicular DLBCL is a rare tumor with an invasive biological behavior, mostly found in elderly males and easily misdiagnosed or missed in diagnosis. Histopathology plays a key role and immunohistochemical markers are of high value in the definite diagnosis and differential diagnosis of the tumor.