CAJ | 학술논문

目的探讨原发性及继发性肺淋巴瘤的临床、病理、治疗和预后,以提高早期诊治水平.方法回顾性分析2003 2013年解放军总医院经肺活检或手术肺组织病理确诊的40例原发性及继发性肺淋巴瘤患者的临床资料.结果 40例中,原发性肺淋巴瘤(PPL)10例,继发性肺淋巴瘤(SPL)30例,男24例,女16例,年龄15～ 84岁.PPL的特点以咳嗽、胸痛症状最为多见,4例患者无症状;胸部CT示8例肿块影,3例斑片实变影.氟代脱氧葡萄糖(13F-FDG)正电子发射计算机断层扫描/计算机断层扫描(PET/CT)检查病灶仅限于肺组织内,肺病灶最大标准化摄取值(SUVmax)为3.96～6.70,中位SUVmax为4.50;所有PPL病理类型均为非霍奇金淋巴瘤;3例单纯手术,4例手术联合化疗.SPL的特点以咳嗽、浅表无压痛淋巴结肿大及发热最多见,8例无症状;胸部CT示20例胸膜受累,14例纵隔及肺门淋巴结肿大,13例斑片实变影,6例多发结节;全身PET/CT检查除肺部病变外,还累及颈部淋巴结、甲状腺、胃及胰腺等,肺病灶SUVmax为2.40～ 19.60,中位SUVmax为5.70;SPL病理类型示21例非霍奇金淋巴瘤,9例霍奇金淋巴瘤;14例单纯化疗,8例化疗联合放疗,2例手术联合化疗.PPL的1年生存率为100.0％(10例),SPL的1年生存率为93％(28例).PPL最短生存时间为13个月,SPL最短生存时间为2个月.结论原发性与继发性肺淋巴瘤的影像学、病理类型及治疗方法有所不同.PPL以肿块影多见,而SPL多有胸膜受累及纵隔和肺门淋巴结肿大.PPL病理均为非霍奇金淋巴瘤,而SPL除非霍奇金淋巴瘤外,部分为霍奇金淋巴瘤.PPL多以手术治疗为主,SPL多以化疗为主.全身PET/CT检查对协助肺淋巴瘤诊断及分期具有重要价值.肺淋巴瘤误诊率较高,确诊必须依靠肺组织病理活检及免疫组织化学染色.与PPL比较,SPL预后较差.
목적 탐토원발성급계발성폐림파류적림상、병리、치료화예후,이제고조기진치수평.방법 회고성분석2003 2013년해방군총의원경폐활검혹수술폐조직병리학진적40례원발성급계발성폐림파류환자적림상자료.결과 40례중,원발성폐림파류(PPL)10례,계발성폐림파류(SPL)30례,남24례,녀16례,년령15～ 84세.PPL적특점이해수、흉통증상최위다견,4례환자무증상;흉부CT시8례종괴영,3례반편실변영.불대탈양포도당(13F-FDG)정전자발사계산궤단층소묘/계산궤단층소묘(PET/CT)검사병조부한우폐조직내,폐병조최대표준화섭취치(SUVmax)위3.96～6.70,중위SUVmax위4.50;소유PPL병리류형균위비곽기금림파류;3례단순수술,4례수술연합화료.SPL적특점이해수、천표무압통림파결종대급발열최다견,8례무증상;흉부CT시20례흉막수루,14례종격급폐문림파결종대,13례반편실변영,6례다발결절;전신PET/CT검사제폐부병변외,환루급경부림파결、갑상선、위급이선등,폐병조SUVmax위2.40～ 19.60,중위SUVmax위5.70;SPL병리류형시21례비곽기금림파류,9례곽기금림파류;14례단순화료,8례화료연합방료,2례수술연합화료.PPL적1년생존솔위100.0％(10례),SPL적1년생존솔위93％(28례).PPL최단생존시간위13개월,SPL최단생존시간위2개월.결론 원발성여계발성폐림파류적영상학、병리류형급치료방법유소불동.PPL이종괴영다견,이SPL다유흉막수루급종격화폐문림파결종대.PPL병리균위비곽기금림파류,이SPL제비곽기금림파류외,부분위곽기금림파류.PPL다이수술치료위주,SPL다이화료위주.전신PET/CT검사대협조폐림파류진단급분기구유중요개치.폐림파류오진솔교고,학진필수의고폐조직병리활검급면역조직화학염색.여PPL비교,SPL예후교차.
Objective To investigate the clinical manifestations,pathological types,treatment and prognosis of primary pulmonary lymphoma (PPL) and secondary pulmonary lymphoma (SPL).Methods The clinical data of 40 cases of PPL or SPL diagnosed from 2003 to 2013 in the Chinese PLA General Hospital were retrospectively analyzed.All cases were diagnosed via lung biopsy or surgical biopsy.Results There were 24 male and 16 female patients,aging from 15 to 84 years,including 10 patients with PPL and 30 with SPL.The main clinical manifestations of PPL were cough and chest pain,but 4 patients were asymptomatic.Chest CT showed lung mass in 8 patients and patchy opacities in 3.18F-FDG PET/CT showed that the SUV of lung lesions was 3.96-6.70 with a median value of 4.50.The pathological types of all PPL cases were non-Hodgkin lymphoma (NHL),and 4 patients were treated with surgery combined with chemotherapy,and 3 patients were treated with surgery alone.The main clinical manifestations of SPL were cough,superficial lymph node enlargement and fever,but 8 patients were asymptomatic.The chest CT revealed pleural effusions in 20,mediastinal and hilar lymph node enlargement in 14,patch opacities in 13 and multiple nodules in 6 patients.In addition to pulmonary involvement,PET/CT examination confirmed that cervical lymph nodes,thyroid,stomach and pancreas were also involved.The SUVmax was from 2.40 to 19.60,with a median value of 5.70.Twenty-one cases of SPL were NHL and 9 were Hodgkin lymphomas (HL).Of these patients with SPL,14 were treated with chemotherapy alone,8 chemotherapy combined with radiotherapy,and 2 surgery combined with chemotherapy.The one-year survival rate of PPL was 100％,compared with 93.3％ of SPL.The shortest survival time of PPL was 13 months,compared with 2 months of SPL.Conclusions There were differences in the radiological features,pathological types and treatment between PPL and SPL.The chest CT manifestations of PPL were mainly lung masses,while those of SPL were mainly pleural involvement and mediastinal and hilar lymph node enlargement.The pathological type of PPL was all NHL while that of 9 cases of SPL was HL.Patients with PPL were mainly treated with surgical therapy,but SPL mainly with chemotherapy.PET/CT examination may be helpful for the diagnosis and staging of lung lymphoma.Since the misdiagnosis rate of pulmonary lymphoma was high,diagnosis must rely on lung tissue biopsy and immunohistochemistry.Compared with PPL,the prognosis of SPL is poorer.