26例睾丸非霍奇金淋巴瘤的临床病理及其免疫表型

目的观察睾丸非霍奇金淋巴瘤的临床病理表现及免疫表型，探讨对该肿瘤的病理诊断及鉴别诊断。方法对26例睾丸非霍奇金淋巴瘤作回顾性临床病理研究，形态学分型按新版WHO（2001）关于淋巴造血组织肿瘤的分类进行。SP法免疫组织化学染色及EBER原位杂交检测。结果患者的中位年龄为64岁，单侧睾丸肿大是常见的临床表现，少数病例还累及对侧睾丸、附睾、精索及淋巴结等；组织学分型：22例（84．6％）为弥漫大B细胞淋巴瘤，3例（11．6％）为继发鼻型NK／T细胞淋巴瘤，1例（3．8％）为非特指外周T细胞淋巴瘤。几乎所有病例肿瘤细胞都有很高的增殖活性，部分肿瘤细胞表达bcl-2蛋白。结论老年患者出现无痛性、进行性睾丸肿大。应考虑到淋巴瘤的可能。该肿瘤的确诊依赖于病理活检，免疫表型检测及原位杂交对肿瘤的诊断和鉴别诊断有重要作用。     

儿童原发性结外淋巴瘤37例分析

目的：探讨儿童原发性结外淋巴瘤的临床及病理特点。方法对郑州大学第一附属医院小儿血液与肿瘤内科自2010年1月至2013年9月所收治的37例儿童原发性结外淋巴瘤（ PENL）的临床特点及病理类型进行分析。结果37例儿童PENL确诊时平均年龄7.8岁,男26例,女11例,男女比例为2.3：1,约占同期儿科收治儿童淋巴瘤患者的15%。病理分型：弥漫大B细胞性淋巴瘤及Burkitt淋巴瘤各7例（各18.9%）,T淋巴母细胞淋巴瘤6例（16.2%）,B淋巴母细胞淋巴瘤5例（13.5%）,未定型B系非霍奇金淋巴瘤4例（10.8%）,未定型T系非霍奇金淋巴瘤及种痘水疱病样T细胞淋巴瘤各3例（8.1%）,间变大B细胞淋巴瘤2例（5.4%）。原发部位多见于肠道、头颈部及胸腔内。确诊时最常见分期为Ⅲ期（48.6%）。约30%PENL患儿在确诊前有反复肺部感染或不明原因发热史。结论儿童PENL在原发部位、病理类型上具有特殊性,好发于儿童的不同病理类型的淋巴瘤在一定程度上决定着PENL的原发部位。     

脾脏原发性非霍奇金氏淋巴瘤的临床病理分析

目的：回顾性观察脾脏原发性非霍奇金氏淋巴瘤（NHL）的临床病理及免疫组化特点，为临床诊治提供依据。方法：收集10例脾脏原发性非霍奇金氏淋巴瘤（NHL）手术切除标本病例，总结其临床资料及病理组织学特点，采用HE染色、免疫组化CD45、CD45RO、CD30、CD34、CD68和EMA抗体标记。结果：10例脾脏原发性NHL临床上主要表现为脾脏肿大伴左上腹隐痛，临床分期为Ⅰ期者7例（7/10）、Ⅱ期3例（3/10）。大体分型：均匀弥漫型3例、粟粒结节型2例、巨块型2例、多肿块型3例。组织学形态：弥漫型淋巴瘤7例（其中中心母细胞性1例，中心母细胞/中心细胞性3例，中心细胞性1例，小细胞性2例）、滤泡型淋巴瘤2例均为中心/中心母细胞性淋巴瘤、中小多型T淋巴细胞性淋巴瘤1例；免疫组化CD45、CD20、CD45RO标记阳性表达率分别为100％、90％、10％，余CD30、CD34、CD68和EMA标记均为阴性。结论：脾脏原发性非霍奇金氏淋巴瘤较少见，临床常表现为脾脏肿大伴左上腹隐痛，手术前不易确诊，组织学以B细胞源性多见，治疗以外科手术为主；患者预后与病期及化疗有关。     

淋巴瘤误诊1例

恶性淋巴瘤是原发于淋巴结和淋巴组织的肿瘤,按病理形态学特征可分为霍奇金淋巴瘤和非霍奇金淋巴瘤两大类,组织学可见淋巴细胞和（或）组织细胞的肿瘤性增生。但该病有时会被误诊,现将我院误诊的1例该病患者临床资料报告如下。     

间变性大细胞淋巴瘤的临床病理分析

目的探讨间变性大细胞淋巴瘤的临床病理特点、免疫表型及鉴别诊断。方法对8例淋巴结及皮肤的间变性大细胞淋巴瘤组织学观察及免疫组化染色（ABC法），并复习相关临床资料。结果8例间变性大细胞淋巴瘤患者男性5例，女性3例，年龄12—53（平均34）岁。6例发生于淋巴结，2例发生于皮肤。组织学特征：部分或全部淋巴结受累，瘤细胞有成巢或沿淋巴窦内生长现象，发生于皮肤者肿瘤组织弥漫成片分布，瘤细胞高度异型、多形，核分裂象多见。免疫表型：8例瘤细胞均表达CD30，6例表达CD3或CD45RO，而CD15和CD20均阴性。结论间变性大细胞淋巴瘤是一种形态学高度异形、免疫表型特异，而临床预后相对较好的淋巴瘤。组织学上需与转移癌、恶性黑色素瘤及霍奇金淋巴瘤相鉴别。CD30免疫组织化学标记在鉴别诊断中具有重要价值。     

原发性睾丸淋巴瘤33例临床病理分析

目的探讨原发性睾丸淋巴瘤（PTL）的临床病理特征,以提高对该疾病的诊治水平。方法收集PTL存档资料33例,进行石蜡切片,常规HE染色,Envision二步法免疫组织化学标记,根据2008年版WHO淋巴与造血组织肿瘤病理学分类标准进行临床病理学分析。结果 PTL占同期睾丸恶性肿瘤的8.3%（33/397）。临床Ⅰ～Ⅱ期28例（85%）,Ⅲ～Ⅳ期5例（14%）。组织学分型：33例PTL中弥漫性大B细胞淋巴瘤25例（76%）,黏膜相关（MALT）淋巴瘤3例（9%）,B淋巴母细胞淋巴瘤1例（3%）,外周T细胞淋巴瘤2例（6%）,鼻型NK/T细胞淋巴瘤2例（6%）。所有患者均行患侧睾丸根治性切除术。术后随访6～120个月,生存时间6～80个月,平均生存28个月。结论 PTL类型多样,以弥漫性大B细胞淋巴瘤最多见。PTL确诊依赖于病理学检查。正确的病理诊断,明确免疫表型,进而制定相应的放化疗方案,可有效改善预后。     

血管免疫母细胞性T细胞淋巴瘤的临床病理观察

血管免疫母细胞性T细胞淋巴瘤（angioimmunoblastic T-cell lymphoma,AITL）是一种具有独特临床病理特征的外周T细胞淋巴瘤（peripheral T-cell lymphoma,PTCL）,发病率占非霍奇金淋巴瘤（NHL）的2%,占PTCL的15%～20%,仅次于非特指型PTCL[1]。     

淋巴瘤与多原发肿瘤的关系

目的 探讨淋巴瘤患者中多原发肿瘤的发病特点。方法检索1999年1月至2008年6月多原发肿瘤患者的病例。分析其中包含淋巴瘤病理诊断的病例资料。结果在2668例多原发肿瘤病例中,共检索出32例在多原发肿瘤中包括非霍奇金淋巴瘤或霍奇金淋巴瘤病例。其中30例为双原发肿瘤,2例为三原发或四原发肿瘤。男女比例为1：1。32例患者中,以淋巴瘤作为第1原发肿瘤7例,同时双原发癌5例．淋巴瘤（全部为非霍奇金淋巴瘤）作为第2、3、4原发肿瘤20例。第1和第2原发肿瘤的平均发病年龄分别为（50．4±14．7）岁和（58．4±12-2）岁,同时多原发肿瘤患者的平均年龄为（60．0±14．5）岁。非霍奇金淋巴瘤在第2、3、4原发癌中占绝对优势,比例为92．6％（25／27）。第2原发肿瘤为非霍奇金淋巴瘤病例中,B细胞来源占84％（21／25）,结外器官起源占60％（15,25）。结论在以淋巴瘤作为多原发肿瘤之一的患者中。非霍奇金淋巴瘤是最主要的第2原发肿瘤,多为B细胞来源,常见结外器官起源或受侵．平均发病年龄较大。     

原发性胃肠道非霍奇金淋巴瘤预后因素分析

目的：探讨原发性胃肠道非霍奇金淋巴瘤临床特征和生存率的关系。 方法：对1980-1997年本院收治均经病理证实的66例原发于胃肠道的非霍奇金淋巴瘤患者的临床资料进行回顾性分析。对患者年龄、性别、有无B症状、确诊前病程、临床分期、病理类型、免疫分型、肿块大小、浸润深度、有无淋巴结和（或）脏器转移、骨髓浸润、原发部位、治疗措施等13个变量进行单因素及Cox多因素分析,并采用Kaplan-Meier法及Log-rank检验进行生存情况统计。 结果：单因素分析表明年龄、性别、确诊前病程、原发部位与预后无明显相关性(P>0.05);无B症状组、临床分期为Ⅰ_E～Ⅱ_E期及Ⅰ_E～Ⅱ₁E期组、低中度恶性组、B细胞型、肿瘤未突破浆膜层组、瘤体直径小于10 cm组、无淋巴结和（或）脏器转移组、无骨髓浸润组、行手术+化疗组5年生存率预后均较佳（P<0.05）;Cox分析表明肿瘤直径<10 cm与≥10 cm组、临床分期为Ⅰ_E～Ⅱ_E期与Ⅲ_E～Ⅳ_E期组、免疫分型为B细胞与T细胞组及手术+化疗与单纯手术组5年生存率比较,差异均具有显著性（P<0.05）。结论：肿瘤大小、临床分期、免疫分型、治疗措施为影响原发性胃肠道非霍奇金淋巴瘤预后的重要因素。     

原发性乳腺弥漫性大B细胞淋巴瘤临床病理分析并文献复习

<正>原发性乳腺淋巴瘤(primary breast lymphoma,PBL)少见。PBL主要为非霍奇金淋巴瘤(NHL),以弥漫大B细胞淋巴瘤(DLBCL)最多,而霍奇金淋巴瘤(HL)则罕见。PBL的诊断标准日趋完善并被广泛接受,为了更加全面地认识原发性乳腺DLBCL的临床病理特征并更好地掌握其诊断标准,本研究对1例原发性乳腺DLBCL进行了临床病理观察、免疫表型检测和长期随访、预后分析并复习文献讨论该类肿瘤的临床病理     

Primary testicular non-Hodgkin's lymphoma--a review article.

Primary testicular non-Hodgkin's lymphoma was first described as a clinical entity in 1866. It is a rare disease and accounts for 1% of all non-Hodgkin's lymphoma, 2% of all extranodal lymphomas and 5% of all testicular neoplasms. It is the most common testicular tumor in males between sixty and eighty years of age. Testicular non-Hodgkin's lymphoma is unique in its high incidence of bilateral involvement (8-38%), and it is also the most common bilateral testicular tumor. Testicular non-Hodgkin's lymphoma has a predilection for spreading to non-contiguous extranodal sites, especially the central nervous system. Advanced-stage disease is usually managed with doxorubicin-based chemotherapy. For early-stage disease, opinion is divided regarding systemic chemotherapy following orchidectomy. The high incidence of spreading, especially to the central nervous system, leads to advocacy of the use of central nervous system prophylaxis with intrathecal chemotherapy. Prospective multicenter trials incorporating a large number of patients may lead to better guidelines for optimal management of this subtype of non-Hodgkin's lymphoma.     

颌面颈部恶性淋巴瘤临床分析

目的：总结口腔颌面颈部恶性淋巴瘤(ML)的诊断方法及治疗措施。方法：回顾性分析收治的ML患者38例的临床资料。结果：霍奇金病(HD)5例，非霍奇金淋巴瘤(NHL)33例，31例采用综合治疗，7例采用单纯化疗，38例1，3，5a生存者分别为5，14，12例，存活患者中以临床Ⅰ，Ⅱ期者占绝大多数，死亡患者中以Ⅳ期为多。结论：早期明确ML的诊断并早期治疗效果较好，综合治疗是最有效的治疗手段，临床分期对预后有重要参考价值。     

腹部恶性淋巴瘤的CT诊断报告

目的:探讨腹部恶性淋巴瘤的CT影像诊断特点,及时作出诊断及鉴别诊断。方法:搜集经手术或病理证实的腹部恶性淋巴瘤4 3例,其中何杰金病(HD) 4例,非何杰金淋巴瘤(NHL ) 39例,全部进行CT增强扫描。结果:累及腹部淋巴结的39例,75 .0 %HD和82 .1 %NHL淋巴结增大呈普遍均匀强化密度,2 5 .0 %HD和1 7.9%NHL呈均匀强化合并坏死密度。HD和NHL 累及小网膜(30 .2 %)、肠系膜(2 5 .6 %)、胰腺周围(5 1 .2 %)、腹主动脉周围(79.1 %)。7例胃肠恶性淋巴瘤均示胃肠壁不规则增厚,3例伴淋巴结增大。NHL 中1 8例脾增大,1 5例呈均匀密度增大,3例有占位征象。结论:CT检查能较好显示腹部恶性淋巴瘤淋巴结及结外器官病理改变、病变范围,对恶性淋巴瘤的诊断及其临床的分期及疗效的判定有较高价值。     

Primary spinal epidural non-Hodgkin's lymphoma in a child

Non-Hodgkin's lymphoma usually involves the central nervous system by metastatic disease. Primary spinal epidural non-Hodgkin's lymphoma (PSENL) is a relatively rare cause of spinal cord compression. It mainly occurs in adults past the 4th or 5th decades. This entity is even rarer in children. The proper treatment modalities are controversial in adults with PSENL. Radiotherapy is the main strategy after surgery; the role of chemotherapy is uncertain. Therapeutic experience in childhood PSENL is extremely limited. We report a 10-year-old boy presenting with backache and bilateral lower leg weakness after minor trauma. Small non-cleaved cell non-Hodgkin's lymphoma of the epidural space was proven after subtotal tumor removal. Other investigations including computed tomography of the chest and abdomen, bone scan, gallium scan, bone marrow aspiration, and cerebrospinal fluid study were all negative for occult disease. The patient received combined therapy with irradiation and chemotherapy after surgery. Esophageal stricture resulting from radiotherapy developed during treatment and colon interposition was performed. He has remained disease free 42 months after the diagnosis with normal functional status.     

原发性甲状腺非霍奇金淋巴瘤8例并文献复习

目的 探讨原发性甲状腺非霍奇金淋巴瘤的临床特点,诊断及综合治疗方法,以提高其诊治水平.方法 回顾性总结我院2001年～2005年收治的原发性甲状腺非霍奇金淋巴瘤8例,并结合文献对其临床表现、病理特征、诊断及治疗方法进行分析.结果 8例均因无痛性颈部肿块人院.其中5例女性,平均年龄66.3岁(56岁-79岁).均通过手术确诊,均为B细胞性.主要治疗手段为手术辅以化疗、放疗.结论 原发性甲状腺非霍奇金淋巴瘤好发于老年女性,多为B细胞性,主要表现为无痛性甲状腺肿大,术后病理检查确诊,治疗采取手术、化疗和/或放疗综合治疗.     

肺叶切除术治疗滋养细胞肿瘤肺转移的价值

目的 评价肺叶切除术在滋养细胞肿瘤肺转移治疗中的作用。方法 对45例行肺叶切除术的滋养细胞肿瘤病例进行回顾性分析,其中侵袭性葡萄胎7例,绒癌38例。结果 45例患者经过一定疗程的化疗后,均进行了肺叶切除术。7例侵袭性葡萄胎患者完全缓解。绒癌Ⅲa期患者ll例,平均化疗13个疗程,10例完全缓解,1例部分缓解;Ⅲb期患者17例,平均化疗14.3个疗程,ll例完全缓解,3例部分缓解,3例肿瘤进展死亡;Ⅳ期患者10例,平均化疗15个疗程,6例完全缓解,4例肿瘤进展死亡。45份手术切除病理标本中,27例为出血坏死组织,其中17例患者完全缓解(63％),4例部分缓解,6例肿瘤进展死亡。16例病灶周围有纤维化,其中14例完全缓解(88％),2例部分缓解。2例病理结果为结核。结论滋养细胞肿瘤的治疗措施虽然以化疗为主,但是肺叶切除术对某些选择性病例仍是必要而且有效的治疗手段。病理结果对预后的判断具有一定的指导意义。     

Non-Hodgkin's lymphoma in childhood--five years survey in VGH-Taipei

From January 1981 to January 1986, 34 children between 2 and 14 years of age were diagnosed as non-Hodgkin's lymphoma by the Rapport's classification at the Department of Pediatrics of Veterans General Hospital, Taipei, R.O.C. These patients were retrospectively analysed. There was male predominance with a male to female ratio of 2.4:1. The most common symptom was the palpable mass (29 cases, 85.3%) involved the neck and abdomen equally. All the cases were diffuse patterns, DUL (diffuse undifferentiated lymphoma) and DPDL (diffuse poorly differentiated lymphoma) both were the common subtypes of histological patterns. Twenty-eight cases (82%) were in the advanced stage (stage III and IV). The incidence of BM and CNS involvement was 56% and 29.4%, respectively. CNS involvement demonstrated a higher mortality of 100%. Surgery, radiation, and chemotherapy were mainly used for stage I-II and chemotherapy for stage III-IV. The 3-year survival rate of the whole series was 26.5%, and stage I, II, III, and IV was 100%, 50%, 33%, 9%, respectively. The causes of death were CNS involvement (10 cases, 40%), extensive involvement (7 cases, 28.0%), and sepsis (3 cases, 12.0%). This study shows that NHL in children are usually diffuse rather than follicular in histological patterns, often present a palpable mass involved the cervical or abdominal area, and commonly are widespread and tend to disseminate early.     

Primary lymphoma of bone

Primary lymphoma of bone is a rare clinical entity that accounts for less than one per cent of all non-Hodgkin's lymphomas. Although they occasionally present as a solitary lesion in bone, lymphoma involving bone is a manifestation of disseminated disease in many instances. All patients initially found to have a solitary lymphoma of bone need to be thoroughly investigated for systemic disease because more than half of the patients presenting with initially solitary bone lesions are found to have systemic disease involving lymph nodes and/or other organs. Choice of therapeutic management is based on the stage of disease. Stage I-E primary lymphoma of bone can be controlled in 70-90% of cases using local radiation therapy alone if adequate radiation doses are used. Patients with advanced disease should be treated with combination chemotherapy in addition to local radiotherapy. Loeffler et al reported long-term survival results of 90% 8-year actuarial overall survival rate for children with primary lymphoma of bone who received combined therapy with radiation and chemotherapy (adriamycin, prednisone and oncovin). The actuarial lymphoma-free survival rate was 100% at eight years. Regardless of stage of the disease, radiation treatment to the primary tumor appears to be critical for adequate local control of disease as well as rapid symptomatic relief.     

原发性胃肠道恶性淋巴瘤15例诊治分析

分析了 1 5例胃肠道恶性淋巴瘤的诊治情况。 1 5例中术前经相关检查确诊者仅 1例 ,余全被误诊为其他疾病。手术切除 1 5例 ,再次手术 1例。手术患者术后全部辅以CHOP方案 (环磷酰胺、阿霉素、长春新碱、强的松 )化疗。病例随访率为 78.5 % ,5年生存率为 37.5 %。