Evans综合征后发生非霍奇金淋巴瘤1例并文献复习

报道Evans综合征后发生非霍奇金淋巴瘤（NHL）1例。该患者乙肝病毒携带病史7年，乙肝后肝硬化病史1年余，确诊为Evans综合征后经糖皮质激素、COP方案治疗，最终以脾切除治疗缓解。2年后出现颈部首发的淋巴结肿大，胸部CT示两肺结节状阴影及纵隔淋巴结肿大，病理检查和免疫组化证实为弥漫大B细胞淋巴瘤，采用CHOP方案化疗后淋巴结明显缩小。复习相关文献并结合本例报道发现Evans综合征伴发NHL罕见，发病无明显性别差异，患者年龄较大，部位多以结外为主，病理分型B细胞型较多，两病发病间隔时间较长，发病机制可能与免疫异常和（或）化疗免疫抑制剂应用、免疫监视失控有关。

Non-Hodgkin lymphoma following Evans syndrome: report of 1 case and literature review

A case of non-Hodgkin lymphoma(NHL) following Evans syndrome is reported in this article.The patient had a past history of HBV carrier for 7 years and post-HB liver cirrhosis for 1 year.He was diagnosed to have Evans syndrome and received the treatment with glucocorticoid and COP therapy.The condition finally remitted after splenectomy.Two years later,enlarged lymph nodes were found in the neck,chest CT revealed tuberous shadows in both lung fields and enlarged lymph nodes in the mediastinum.Histopathology and immunohistochemistry confirmed the diagnosis of lymphoma,diffuse large B-cell type.The patient was managed by adopting CHOP regimen of chemotherapy,and the enlarged lymph nodes became evidently reduced in size.Review of literature and the present case suggests that Evans syndrome followed by NHL is a rare condition.It occurs in elder patients of either sex.The pathological changes are mainly outside lymph nodes and are of B-cell type.The onset of NHL usually lags behind Evans syndrome for a long period of time(more than 2 years).Its pathogenesis may be related to immunological incompetence or the use of immunodepressive drugs causing escape from immunosurveillance.