目的 探讨原发性和继发性膀胱黏膜相关淋巴瘤(mucosal-associated lymphoid tissue,MALT)的临床病理特点和治疗方法. 方法 回顾性分析1996年6月至2011年9月收治的8例膀胱淋巴瘤患者的资料,5例为原发性膀胱淋巴瘤,男2例,女3例,年龄57 ～78岁,平均68岁;3例为继发性膀胱淋巴瘤,男1例,女2例,年龄41 ～81岁,平均61岁.泌尿系CT检查示膀胱壁有圆形或椭圆形、不规则占位,突向膀胱腔内,直径1 ～4 cm,边缘较光滑,密度均匀,相应膀胱壁外缘较毛糙,增强后病灶强化较明显、均匀.膀胱镜检查:7例为菜花状肿瘤、中央为坏死钙化区域;1例为多发型,1个较大的肿瘤直径3.5 cm,伴3个小的卫星病灶.7例采用TURBt加CHOP方案化疗、放疗,1例放弃手术治疗.术后2周开始CHOP方案化疗:环磷酰胺750 mg/m2,第1天;表柔比星90 mg/m2、长春新碱1.4mg/m2,第1～5天;口服泼尼松100 mg或甲泼尼龙80 mg,1次/d.每4周1个疗程,共3个疗程.3例继发性膀胱淋巴瘤患者辅以三维适型放疗:400 cGy/次,连续3次,休息2d,共6000 cGy.结果 病理诊断5例为原发性膀胱MALT,其中3例为外周带区域膀胱MALT,2例为弥散大B细胞淋巴瘤;3例为继发性膀胱MALT,其中2例为弥散大B细胞淋巴瘤,1例为全身滤泡囊中央淋巴瘤,属于结节硬化型霍奇金淋巴瘤.免疫组化染色检查:3例低级别MALT CD20、CD21、CD43(+),5例高级别MALT CD3、CD20、CD31(+).本组随访3～ 44个月,3例继发淋巴瘤患者于确诊3～13个月死亡;5例原发性MALT患者均生存,其中1例术后14个月复发,膀胱镜检查见原位菜花状新生物,再次行TURBt及CHOP方案化疗,病理检查示肿瘤由外周带区域MALT转化为弥散大B细胞淋巴瘤,术后随访无复发. 结论 弥散大B细胞淋巴瘤是MALT最常见的类型;原发和继发性弥散大B细胞淋巴瘤在组织学上存在相似性,但前者预后好于后者,TURBt配合放化疗是较好的治疗方法.
目的 探討原髮性和繼髮性膀胱黏膜相關淋巴瘤(mucosal-associated lymphoid tissue,MALT)的臨床病理特點和治療方法. 方法 迴顧性分析1996年6月至2011年9月收治的8例膀胱淋巴瘤患者的資料,5例為原髮性膀胱淋巴瘤,男2例,女3例,年齡57 ～78歲,平均68歲;3例為繼髮性膀胱淋巴瘤,男1例,女2例,年齡41 ～81歲,平均61歲.泌尿繫CT檢查示膀胱壁有圓形或橢圓形、不規則佔位,突嚮膀胱腔內,直徑1 ～4 cm,邊緣較光滑,密度均勻,相應膀胱壁外緣較毛糙,增彊後病竈彊化較明顯、均勻.膀胱鏡檢查:7例為菜花狀腫瘤、中央為壞死鈣化區域;1例為多髮型,1箇較大的腫瘤直徑3.5 cm,伴3箇小的衛星病竈.7例採用TURBt加CHOP方案化療、放療,1例放棄手術治療.術後2週開始CHOP方案化療:環燐酰胺750 mg/m2,第1天;錶柔比星90 mg/m2、長春新堿1.4mg/m2,第1～5天;口服潑尼鬆100 mg或甲潑尼龍80 mg,1次/d.每4週1箇療程,共3箇療程.3例繼髮性膀胱淋巴瘤患者輔以三維適型放療:400 cGy/次,連續3次,休息2d,共6000 cGy.結果 病理診斷5例為原髮性膀胱MALT,其中3例為外週帶區域膀胱MALT,2例為瀰散大B細胞淋巴瘤;3例為繼髮性膀胱MALT,其中2例為瀰散大B細胞淋巴瘤,1例為全身濾泡囊中央淋巴瘤,屬于結節硬化型霍奇金淋巴瘤.免疫組化染色檢查:3例低級彆MALT CD20、CD21、CD43(+),5例高級彆MALT CD3、CD20、CD31(+).本組隨訪3～ 44箇月,3例繼髮淋巴瘤患者于確診3～13箇月死亡;5例原髮性MALT患者均生存,其中1例術後14箇月複髮,膀胱鏡檢查見原位菜花狀新生物,再次行TURBt及CHOP方案化療,病理檢查示腫瘤由外週帶區域MALT轉化為瀰散大B細胞淋巴瘤,術後隨訪無複髮. 結論 瀰散大B細胞淋巴瘤是MALT最常見的類型;原髮和繼髮性瀰散大B細胞淋巴瘤在組織學上存在相似性,但前者預後好于後者,TURBt配閤放化療是較好的治療方法.
목적 탐토원발성화계발성방광점막상관림파류(mucosal-associated lymphoid tissue,MALT)적림상병리특점화치료방법. 방법 회고성분석1996년6월지2011년9월수치적8례방광림파류환자적자료,5례위원발성방광림파류,남2례,녀3례,년령57 ～78세,평균68세;3례위계발성방광림파류,남1례,녀2례,년령41 ～81세,평균61세.비뇨계CT검사시방광벽유원형혹타원형、불규칙점위,돌향방광강내,직경1 ～4 cm,변연교광활,밀도균균,상응방광벽외연교모조,증강후병조강화교명현、균균.방광경검사:7례위채화상종류、중앙위배사개화구역;1례위다발형,1개교대적종류직경3.5 cm,반3개소적위성병조.7례채용TURBt가CHOP방안화료、방료,1례방기수술치료.술후2주개시CHOP방안화료:배린선알750 mg/m2,제1천;표유비성90 mg/m2、장춘신감1.4mg/m2,제1～5천;구복발니송100 mg혹갑발니룡80 mg,1차/d.매4주1개료정,공3개료정.3례계발성방광림파류환자보이삼유괄형방료:400 cGy/차,련속3차,휴식2d,공6000 cGy.결과 병리진단5례위원발성방광MALT,기중3례위외주대구역방광MALT,2례위미산대B세포림파류;3례위계발성방광MALT,기중2례위미산대B세포림파류,1례위전신려포낭중앙림파류,속우결절경화형곽기금림파류.면역조화염색검사:3례저급별MALT CD20、CD21、CD43(+),5례고급별MALT CD3、CD20、CD31(+).본조수방3～ 44개월,3례계발림파류환자우학진3～13개월사망;5례원발성MALT환자균생존,기중1례술후14개월복발,방광경검사견원위채화상신생물,재차행TURBt급CHOP방안화료,병리검사시종류유외주대구역MALT전화위미산대B세포림파류,술후수방무복발. 결론 미산대B세포림파류시MALT최상견적류형;원발화계발성미산대B세포림파류재조직학상존재상사성,단전자예후호우후자,TURBt배합방화료시교호적치료방법.
Objective To analyze the clinicopathologic characteristics and treatment of primary and secondary bladder mucosa lymphoma. Methods From June 1996 to September 2011,8 cases of bladder mucosa lymphoma patients including primary bladder mucosa lymphoma patients (2 males and 3 females)and secondary bladder mucosa lymphoma patients ( 1 male and 2 females) were treated in our institute.The patient's mean age was 68 years (ranged from 57 to 78 years),and the other 3 secondary bladder mucosa lymphoma patient's mean age was 61 years (ranged from 41 to 81 years).7 of 8 patients accepted transurethral resection of bladder tumor combined with CHOP chemotherapy and radiotherapy,and 1 patient abandoned treatment.CHOP chemotherapy and radiotherapy were performed at 2 weeks post-operatively.Secondary bladder mucosa lymphoma patients accepted 3-dimensional conformal 6000 cGy radiotherapy.Urinary CT examination showed that there were round or oval irregular tumors in the wall of urinary bladder,whose diameters were 1 to 4 cm.Tumor edges were glossy and tumor density were uniform.In addition,the bladder wall with tumor was uneven.In contrasted CT,the tumors appeared obviously enhanced.7 cases had cauliflower-like tumors found by cystoscope,and there were necrosis-calcification area in the center of tumors.1case appeared multiple tumors,which consisted of one big tumor and three smaller ones. Results There were 5 cases of primary bladder mucosa lymphoma, including 3 bladder mucosa associated lymphoma (MAL) cases and 2 diffuse large B cell lymphoma cases.There were 3 secondary bladder mucosa lymphoma cases including 2 diffuse large B cell lymphoma cases and 1 generalized follicular cystic central lymphoma case,which belongs to the tuberous sclerosis Hodgkin lymphoma.Immunohistochemical analysis showed that CD20,CD21,CD43 staining were positive in low grade MAL (3 cases).However,CD3,CD20,CD31 staining were positivein high grade MAL (5 cases). All patients were followed up 3 to 44 months.3 cases of secondary malignant lymphoma patients died after diagnosed after 3 to 13 months.5 cases of primary malignant lymphoma patients were all survived. 1 case recurred 14 months after surgery and accepted TURBT and CHOP chemotherapy again.Pathologic diagnosis showed the transformation from peripheral zone of bladder mucosa associated lymphoma to diffuse large B cell lymphoma.The patient was free of recurrence. Conclusions MAL and diffuse large B cell lymphoma are the most common type of bladder mucosa lymphoma.Primary and secondary diffuse large B cell lymphoma have similarities in histological analysis,but the former prognosis is better than the latter's. Transurethral resection of bladder tumor combined with chemotherapy and radiotherapy can prevent the relapse of MAL in short term and long term with good tolerance,and can be used as ideal treatment of MALT.
