原发性肺淋巴瘤三例

目的：提高原发性肺淋巴瘤的诊治水平。方法：通过3例病理证的实原发性肺淋巴瘤的病例分析，结合文献，对原发性肺淋巴瘤的临床病理学特点，诊断，鉴别诊断，治疗及预后进行分析。结果：低度恶性、小B细胞型、支气管粘膜关淋巴组织淋巴瘤，进展缓慢，预后好，高度恶性、B细胞型，进展迅速，治疗效果差，预后差，结论：原发性肺淋巴瘤临床少见，常易漏诊，误诊，目前缺少非创伤性检查方法。     

原发性肺淋巴瘤22例临床与病理学相关特征分析

目的探讨并分析原发性肺淋巴瘤患者临床表现、病理学特征。方法回顾经病理组织诊断为原发性肺淋巴瘤的患者22例相关资料,分析其临床表现、影像学表现、病理检查结果以及随访相关资料。结果 22例原发性肺淋巴瘤患者临床表现主要为:20例咳嗽(90.91%)、18例(81.82%)发热、15例(68.18%)胸部疼痛、12例(54.55%)体重减轻;CT影像学表现主要为实变影、肿块影、结节影;病理检查可见B淋巴细胞大量浸润,B淋巴细胞相关抗原阳性表达;大部分患者预后较好,少数患者预后较差。结论原发性肺淋巴瘤临床表现以及影像学表现无特异性,其诊断主要依靠病理检查,T细胞淋巴瘤患者恶性程度高,预后差,其余患者预后较好。     

原发性肺结外鼻型NK/T细胞淋巴瘤一例临床分析

目的报道国内第一例肺部原发性结外鼻型NK/T淋巴瘤,分析原发性肺鼻型NK/T淋巴瘤的临床特点和诊断治疗。方法通过1例病理证实的原发性肺结外鼻型淋巴瘤的病例分析,结合文献,对原发性肺NK/T淋巴瘤的免疫表型、发病机制、临床特点、影像学表现、诊断、治疗及预后进行分析。结果NK/T细胞淋巴瘤是一种新近认识的恶性淋巴瘤,原发于肺部的比较罕见,具有特殊的免疫表型与临床病理特点,EB病毒在其发病中扮演重要角色。此瘤恶性程度很高,疾病进展快,治疗效果及预后差。结论原发性肺结外鼻型NK/T淋巴瘤临床罕见,诊断难度大,预后差,目前缺少有效的治疗方法。     

以急性呼吸窘迫症为表现的原发性肺NK/T细胞淋巴瘤1例临床分析

目的报道1例以急性呼吸窘迫症为表现的原发性肺NK/T细胞淋巴瘤,分析NK/T细胞淋巴瘤的临床特点和诊断治疗。方法通过1例骨髓病理证实的原发性NK/T淋巴瘤的病例分析,结合文献,对原发性NK/T淋巴瘤的发病机制、临床特点、诊断、治疗及预后进行分析。结果 NK/T细胞淋巴瘤原发于肺部且以急性呼吸窘迫为表现比较罕见,具有特殊的免疫表型和临床症状特点,此病恶性程度高,疾病进展快,治疗效果及预后差。结论原发性肺NK/T淋巴瘤临床罕见,诊断难度大,预后差,目前缺少有效治疗方法。     

钡灌肠及CT检查对原发性结肠淋巴瘤的诊断价值

研究显示，钡灌肠及CT检查对原发性胃肠道淋巴瘤的诊断及分期有重要作用。现根据10例原发性结肠淋巴瘤的钡灌肠及CT表现，结合有关文献，分析并探讨钡灌肠及CT对原发性结肠淋巴瘤的诊断价值。     

原发性肠淋巴瘤与克罗恩病的鉴别诊断

背景：原发性肠淋巴瘤的发病率较低，临床表现缺乏特异性，易误诊为其他胃肠道疾病，特别是与克罗恩病（CD）的鉴别诊断较困难。目的：通过分析原发性肠淋巴瘤和CD患者的临床资料，提高原发性肠淋巴瘤与CD的鉴别诊断水平。方法：回顾性分析原发性肠淋巴瘤和CD患者的临床特点、内镜表现和病理检查结果。结果：原发性肠淋巴瘤患者的平均年龄为50岁，CD为35岁。5例（12.2％）CD发生肛周病变，4例（9.8％）内瘘，3例（7.3％）有肠外表现，但仅1例（5.9％）原发性肠淋巴瘤曾有肛瘘。内镜下原发性肠淋巴瘤以回盲部受累多见（41.7％），CD以小肠和结肠均受累多见（48，8％）；原发性肠淋巴瘤以肿块型较多见（41.7％），CD则主要表现为溃疡和铺路石样改变，其中18例伴肠腔狭窄，4例瘘管形成。B细胞性原发性肠淋巴瘤13例，T细胞性4例。12例CD表现为非干酪样坏死性肉芽肿。结论：临床上原发性肠淋巴瘤与CD的鉴别诊断较困难，需综合各种检查手段，特别是内镜检查和内镜下对病变部位多点取活检，以提高诊断率。     

肺原发性支气管相关淋巴组织淋巴瘤临床分析

目的 探讨肺原发性支气管相关淋巴组织（BALT）淋巴瘤的临床诊断及治疗,提高对BALT淋巴瘤的认识.方法 分析肺原发性BALT淋巴瘤的临床特点、影像学表现、病理特征、临床诊断,并复习文献.结果 患者以反复咳嗽、咳痰伴胸闷、气促为其特点;胸部CT检查显示：双肺多发大片实变影,右侧胸腔积液;CT引导下经皮肺穿刺活检病理检查结果：黏膜相关淋巴组织结外边缘带小B淋巴细胞淋巴瘤,免疫表型：CD20、BCL-2、ki-67、PAX-5均阳性;CD3、CD5、CD10、CD23、CD43、cyclin-D1、MPO等表达均阴性.结论 BALT淋巴瘤临床罕见,属于低度恶性B细胞淋巴瘤,依靠组织细胞学病理、免疫表型与临床、影像学相结合可明确诊断.     

原发于肺的淋巴瘤六例临床分析并文献复习

目的：探讨原发于肺的淋巴瘤的临床特点、诊断、治疗方法，以提高其诊断率。方法：回顾性地总结算1989年－2000年收住北京协和医院的原发于肺的淋巴瘤6例，并结合文献对其临床表现、影像学特点、支气管镜下表现、诊断及治疗方法进行分析。结果：原发于肺的淋巴瘤为少见的淋巴瘤，临床表现不特异，很难确诊。原发于肺的淋巴瘤主要症状为咳嗽（4／6）、发热（2／6）等。影像学可表现为单发或多发的结节或团块影、实变影等，早期无肺门和纵隔淋巴结肿大。支气管镜检查可见支气管狭窄，慢性炎症或大致正常。最终确诊需通过开胸手术、胸腔镜及经皮肺穿获取病灶组织，并结合病理及免疫组化检查。主要治疗手段为手术切除辅以放化疗。预后取决于淋巴瘤的恶性程度。结论：原发于肺的淋巴瘤临床表现不典型，易误诊，及时行必要的有创检查获取组织病理标本有利于早期诊断。     

肺原发性黏膜相关淋巴组织淋巴瘤12例诊断与治疗

目的探讨肺原发性黏膜相关淋巴组织淋巴瘤的临床诊断与治疗方法。方法对1992年8月至2005年5月收集的12例肺原发性黏膜相关淋巴组织淋巴瘤（MALT lymphoma）患者的临床资料、治疗、随访结果进行总结。结果随访6～164个月（平均70．3个月），12例目前均存活。手术治疗6例，术后化疗4例。单纯化疗4例，2例为完全缓解，2例为部分缓解。临床观察2例，带病生存。1例术后12．7年复发，随访8个月生存良好。结论肺原发性黏膜相关淋巴组织淋巴瘤临床表现无特异性，但其胸部放射线检查较为特异，表现为边缘模糊，内有充气支气管征的肿块。该病主要依靠病理组织学及免疫组化诊断。手术治疗结合化疗或者单纯化疗，疗效均较满意，是一种预后相对良好的恶性肿瘤。     

69例肺淋巴瘤临床、CT表现及病理特征分析

目的 探讨肺淋巴瘤的CT表现、临床病理特征，评价其在诊断中的应用价值。方法 回顾性分析2012-2021年就诊于南京脑科医院(胸科院区)的69例肺淋巴瘤患者的临床特征、CT表现和病理类型。结果 肺淋巴瘤以男性多发(69.6%),B细胞来源居多(66.7%)。继发性肺淋巴瘤出现临床症状的比例较原发性肺淋巴瘤高(85.7%vs 60.0%)。粘膜相关淋巴瘤(MALT)是原发性肺淋巴瘤的主要病理类型。病理类型为MALT的淋巴瘤中，PPL多为单侧病灶分布，支气管充气征、血管造影征是最常见的CT征象，胸腔积液少见；SPL病灶侧别则无明显倾向性，跨叶分布亦较少；支气管充气征及血管造影征比例较PPL低，胸腔积液比例升高；两组的CT征象均以结节肿块型为主，其次为肺炎肺泡型。结论 HRCT对肺淋巴瘤诊断的确立及分型有指导意义，结节/肿块病灶伴支气管充气征、血管造影征、胸腔积液应注意鉴别淋巴瘤。     

肺原发性间变性大细胞淋巴瘤1例及文献复习

目的 探讨肺原发性间变性大细胞淋巴瘤(anaplastic large cell lymphoma,ALCL)临床病理特点、免疫组化特点、鉴别诊断、治疗和诊断技术,以提高对肺原发性ALCL的认识。方法 通过本病例及复习相关的文献资料,回顾性分析病例的临床特征、组织细胞形态学和免疫组化特点。结果 肺原发性ALCL的临床特...     

Clonality analysis of alveolar B lymphocytes contributes to the diagnostic strategy in clinical suspicion of pulmonary lymphoma

The diagnostic procedure of chronic pulmonary opacities may envisage the search for non-Hodgkin lymphoma (NHL). Previous retrospective studies have shown that clonality analysis of bronchoalveolar B lymphocytes could reflect the clonality of pulmonary lymphocytes. Our objective was to define the diagnostic usefulness of bronchoalveolar lavage (BAL) B-lymphocyte clonality analysis in the setting of a clinical suspicion of both primary and secondary pulmonary lymphoma. A prospective BAL fluid B-cell clonality analysis was performed by polymerase chain reaction (PCR) in 106 consecutive patients presenting with a clinical suspicion of pulmonary NHL. Diagnosis was pulmonary B-cell lymphoma for 22 patients (13 primary and 9 secondary). When compared, pulmonary biopsy and BAL fluid have clonal identity. The detection of a strong B-cell clonal population in BAL fluid was associated with the diagnosis of pulmonary NHL (P <.0001), with a 97% specificity and a 95% negative predictive value. Thus, the absence of a dominant B-cell clone detection in BAL fluid could help to dismiss invasive investigations of pulmonary lesions. The detection of a dominant B-cell clone would lead to the performance of a pulmonary biopsy to get histologic diagnosis in primary pulmonary lymphoma and, by contrast, would avoid the need for biopsy in the setting of a secondary pulmonary lymphoma.     

Three cases of primary pulmonary malignant lymphoma]

Primary pulmonary malignant lymphoma is a rare disease that is thought to belong to a category of malignant lymphomas arising from mucosa- or bronchus-associated lymphoid tissue (MALT or BALT). We encountered 3 cases of primary pulmonary malignant lymphoma, Case 1: In a 51-year-old male, an abnormal shadow was detected in chest radiography in the right S9 after an operation for thyroid carcinoma. A right lower lobectomy was performed. The diagnosis was malignant lymphoma (marginal zone B-cell lymphoma). Immunohistochemical staining for IgM gave a positive result. Case 2: Multiple nodular shadows were noted in both lungs of a 55-year-old man after a bout of pneumonia. Video-assisted thoracoscopic surgery was performed, and the diagnosis was malignant lymphoma (marginal zone B-cell lymphoma). Gene analysis revealed rearrangement of a heavy chain gene. Case 3: An abnormal shadow was seen in the chest radiograph of a 60-year-old man. He was treated by right upper and middle lobectomy. The diagnosis was Hodgkin's disease, nodular sclerosing type. Chemotherapy was given after surgery and the patient is now alive without recurrence. As the pulmonary malignant lymphoma was difficult to diagnosepreoperatively, it was necessary to resect the mass for diagnostic purposes. The prognosis of a resected solitary lesion in the lobe was good. Therefore lobectomy was performed as the treatment of choice. Systemic chemotherapy is performed for the diffuse type of pulmonary lymphoma.     

Primary pulmonary lymphoma

The authors report 2 cases of primary pulmonary lymphoma. The first case was a 65 year old woman with a diagnosis of lymphocytic lymphoma confirmed by surgical biopsy, after being suspected on the basis of bronchoscopic biopsies and bronchiolo-alveolar aspiration. Twenty one months after the beginning of treatment with chemotherapy and six months after this treatment was completed, the patient was in complete remission. The second patient was a 52 year old man who underwent left inferior lobectomy for a lympho-plasmacytic lymphoma, which was only diagnosed definitively on the operative specimen. The authors discuss the clinical and radiological features and the histological and immunological criteria of primary pulmonary lymphomas (PPL). There are a number of related diseases with varying degrees of malignancy: interstitial lymphocytic pneumonitis (ILP), pseudo-lymphoma, which corresponds to a localised form of ILP, lymphomatoid granulomatosis (LYG) and pulmonary lymphoma, which usually has a lymphocytic or lympho-plasmocytic cell type.     

原发性肺黏膜相关淋巴组织淋巴瘤4例临床病例分析

目的 总结原发性肺黏膜相关淋巴组织(MALT)淋巴瘤的临床表现、影像学特点、诊断手段、治疗方法及预后,提高临床诊治水平.方法 回顾性分析4例经病理确诊的原发性肺MALT淋巴瘤的临床资料并随诊分析预后.结果 4例原发性肺MALT淋巴瘤患者均为老年女性,为原发性肺非霍奇金淋巴瘤的最常见类型.其中3例为查体发现,1例因咳嗽、咳痰和痰中带血就诊.发病时间为7个月至5年.肺部体征无特异性.血炎症指标和肿瘤相关指标多为正常.影像学以肿块影和结节为主要表现.患者肺通气和弥散功能正常.经胸腔镜、CT引导下肺穿刺、开胸手术获取病变组织而确诊.病理表现为弥漫浸润生长的小淋巴细胞,可见淋巴上皮增生.治疗主要是化疗和手术.随访1～8.8年,1例随访4.5年时可疑复发,其余3例均病情稳定.结论 肺原发性MALT淋巴瘤为少见病,好发于老年女性,起病隐匿,临床表现不典型.诊断须靠有经验的病理专家作出.治疗尚无指南,无症状者可采取“观察等待”策略,待肿瘤进展或出现症状时,首选苯丁酸氮芥化疗,联合利妥昔单抗与否均可.预后良好,但复发率高.     

原发性肺淋巴瘤18例临床和影像及病理特点

目的 探讨原发性肺淋巴瘤(PPL)的临床表现、病理和影像学特点、诊断及治疗方法,提高其诊断率.方法 回顾性分析1989年1月至2007年2月北京协和医院住院的原发性肺淋巴瘤18例,总结其临床表现、病理和影像学特点、诊断手段、治疗方法及预后.生存时间按月记录,以手术日至患者最后一次就诊时间为准.计量资料采用秩和检验,计数资料采用卡方检验.使用SPSS 10.0统计软件进行数据分析.结果 18例中男6例,女12例,年龄17～71岁,中位年龄47.5岁.外科肺活检确诊15例(其中1例曾行经支气管镜活检发现肿瘤细胞,但未能明确病理类型),经皮肺活检确诊1例(1/6),经皮肺活检及经支气管镜活检标本共同确诊1例,经支气管镜活检确诊l例(1/10).病理结果为霍奇金淋巴瘤2例,其中混合细胞型和结节硬化型各1例;黏膜相关淋巴组织淋巴瘤9例,滤泡性淋巴瘤1例,弥漫性大B细胞淋巴瘤2例,间变性大细胞淋巴瘤2例,2例外院切片我院会诊后诊断为非霍奇金淋巴瘤.主要症状为咳嗽(11/18)和发热(6/18).18例中影像学表现为肺内结节或团块影14例,片状浸润影11例,实变影5例.胸腔积液和肺不张各5例,肺门或纵隔淋巴结肿大7例,空洞病变1例,病灶内液化1例.11例曾被误诊.3例手术完全切除病灶,8例单纯化疗,6例在肺叶切除术后化疗,1例放疗及化疗.中位随访时间为11个月(10 d至205个月),目前存活13例,失访4例,死亡1例.非霍奇金淋巴瘤患者白细胞异常升高与疾病进展(预后不良)相关,预后不良组中位数为25.1×109/L(18.1～39.1)×109/L,预后良好组中位数为6.7×109/L(5.48～8.41)×109/L,u=0.000,P＜0.05.结论 PPL临床表现不典型,易误诊;及时行外科肺活检获取组织病理标本有利于早期诊断.     

Pulmonary mucosa-associated lymphoid tissue lymphoma in a patient with common variable immunodeficiency syndrome

Common variable immunodeficiency syndrome (CVID) is a primary immunodeficiency typically presenting with recurrent sinopulmonary infections. Non-Hodgkin's lymphoma and other secondary cancers are typical late complications of CVID. We report on a patient suffering from CVID with a history of recurrent sinopulmonary infections, interstitial pulmonary changes and hepatic granulomas. Despite treatment with intravenous immunoglobulin followed by a reduction in the number of pulmonary infections, reticular and nodular lung changes progressed. Video-assisted thoracoscopic lung biopsy showed a low-grade B cell lymphoma of the mucosa-associated lymphoid tissue (MALT) of the bronchus without evidence of pulmonary infection. In conclusion, MALT lymphoma of the lung should be considered in the differential diagnosis of progressive lung disease in CVID.