淋巴瘤合并结核21例临床分析

 【摘要】　目的　探讨淋巴瘤合并结核的临床特点、可能的发病机制以及有效的治疗手段。方法　回顾分析21例已确诊的淋巴瘤合并结核患者的临床特点、病理特征、确诊手段、治疗及转归情况。结果　21例患者中,淋巴瘤诊断先于结核诊断者6例,其中5例结核感染时淋巴瘤正在化疗;淋巴瘤诊断在结核感染之后诊断者13例,其中10例陈旧性肺结核者有6例在淋巴瘤治疗过程中复燃;二者同时诊断者2例。淋巴瘤患者中霍奇金淋巴瘤6例,非霍奇金淋巴瘤15例。结论　在结核病的高发地区,结核病和淋巴瘤可同时存在于同一患者;合并结核的淋巴瘤患者中霍奇金淋巴瘤构成比高于普通人群淋巴瘤患者的霍奇金淋巴瘤构成比;对于患有陈旧性肺结核的淋巴瘤患者,化疗过程中要密切注意陈旧性肺结核复燃的可能。     

骨原发性恶性淋巴瘤7例报告及文献复习

为探讨骨原发性恶性淋巴瘤的临床表现、诊治和预后,加深对该病的认识,本文回顾分析7例患者的临床、影像特征、病理学类型及疗效并文献复习。7例患者主要表现为局部疼痛,软组织肿胀。临床分期Ⅰ期2例,Ⅱ期4例,Ⅲ期1例。病理类型有弥漫性大B细胞淋巴瘤3例,伯基特淋巴瘤1例,外周T细胞淋巴瘤1例,间变大细胞性淋巴瘤1例,霍奇金淋巴瘤1例。主要治疗方法包括联合化疗、局部放疗、靶向治疗等。该病临床表现无特殊性,早期诊断困难,确诊依赖病理,采用放化疗为主的综合治疗及靶向治疗明显改善部分患者预后。     

原发性胃肠道淋巴瘤的诊断与治疗

目的探讨原发性胃肠道淋巴瘤的临床特点及诊治方法。方法1983年至2004年在北京大学第一医院外科接受治疗的原发性胃肠道淋巴瘤患者35例,对其临床病理资料及预后进行回顾性分析。结果本组原发性胃肠道淋巴瘤术前诊断率仅为20.0%;18例胃淋巴瘤中16例接受手术治疗,其中12例行根治性切除;17例肠道淋巴瘤均手术治疗,其中14例行根治性切除;Ann Ar-bor临床分期为:ⅠE期14例,ⅡE期10例,ⅢE期1例,ⅣE期10例。MALT淋巴瘤与非MALT淋巴瘤在年龄、性别及发病部位及早晚分期上差异无显著性。MALT淋巴瘤组手术根治率(92.9%)高于非MALT淋巴瘤(68.4%),MALT淋巴瘤组淋巴结转移率(42.9%)明显低于非MALT淋巴瘤组(84.2%)。结论胃肠道淋巴瘤临床表现缺乏特异性,术前诊断率低;胃淋巴瘤与肠淋巴瘤在性别、年龄、手术根治性及临床分期方面无明显区别;MALT淋巴瘤组确诊时分期较早,手术根治率高,淋巴结转移率低,预后优于非MALT淋巴瘤组。外科手术是诊断和治疗原发性胃肠道淋巴瘤的主要方法。     

CTOP方案治疗恶性淋巴瘤疗效观察

目的:观察CTOP方案治疗恶性淋巴瘤的疗效。方法:应用CTOP方案治疗我院收治的32例恶性淋巴瘤患者,2个疗程后评价疗效。结果:32例恶性淋巴瘤患者,其中弥漫大B细胞淋巴瘤20例,套细胞淋巴瘤6例,T细胞性淋巴瘤4例,伯基特淋巴瘤2例,均为初治病人。予CTOP方案治疗2疗程,结果 CR 50%(16例),PR 25%(8例),总有效率为75%(24例)。毒副反应中骨髓抑制为中度,胃肠道反应轻微。心脏毒性表现为心律失常、ST-T改变等,停药后均可恢复。肝肾毒性轻微。结论:CTOP方案是治疗恶性淋巴瘤的有效方案,可作为一线方案在临床应用。     

羟基喜树碱联合方案治疗难治性恶性淋巴瘤

目的 观察以羟基喜树碱(HCPT)注射液为主的联合方案治疗难治性恶性淋巴瘤的疗效。方法 HCPT10mg／次,静脉滴注,2h,联合Ara-C或VP16或PYM治疗难治性恶性淋巴瘤18例,其中非霍奇金淋巴瘤15例,霍奇金淋巴瘤3例。结果 CR1例,PR9例,总有效率55．5％,无进展生存1．5～10个月。该方案毒副作用轻,患者耐受性良好。结论 羟基喜树碱联合方案治疗难治性恶性淋巴瘤有一定疗效,值得进一步观察和总结。     

自体外周血干细胞移植治疗恶性血液病

 目的 观察自体外周血干细胞移植（APBSCT）治疗急性白血病及恶性淋巴瘤的疗效。方法 用APBSCT治疗急性白血病3例,恶性淋巴瘤5例,恶性淋巴瘤采用环磷酰胺联合粒细胞集落刺激因子（G-CSF）动员;3例白血病患者化疗缓解后,予5～9个疗程的化疗巩固治疗,再给予化疗加G-CSF动员。5例恶性淋巴瘤预处理方案为CBV,急性白血病预处理方案为MAC。结果 全部患者均获得完全缓解,随访时间4～12个月,全部病例无病生存,无移植相关死亡。结论 APBSCT是治疗急性白血病及恶性淋巴瘤、改善其预后的主要手段之一,APBSCT后对急性白血病患者应定期进行序贯化疗和免疫治疗,对难治的恶性淋巴瘤患者应进行补救治疗及免疫治疗。     

6例胃肠道恶性淋巴瘤分析

目的:探讨胃肠道恶性淋巴瘤常见的临床表现和诊断治疗方法。方法:分析我科近年来收治的6 例胃肠道恶性淋巴瘤的诊断、治疗和近期疗效。结果:本组6例患者,有3例通过胃镜检查确诊,有3例通过手术切除后病理检验确诊。3例患者手术后进行积极化疗,其中2例NHL(非霍奇金淋巴瘤)患者病情已稳定3个月,1 例HD(霍奇金淋巴瘤)患者手术后及6周期化疗后5个月复发。结论:由于胃肠道恶性淋巴瘤属结外淋巴瘤,它的临床表现、诊断方法、发病频率、细胞来源、组织学类型以及临床预后等均不同于结内恶性淋巴瘤,临床医师应该提高对本病的认识,争取做到及时诊断、积极治疗。     

原发性胃肠道恶性淋巴瘤的临床诊疗分析

为了探讨原发性胃肠道恶性淋巴瘤的临床特点、诊断和治疗方法,回顾性分析我院38例原发性胃肠道恶性淋巴瘤患者的临床资料.38例患者中胃恶性淋巴瘤17例,小肠恶性淋巴瘤12例,结肠淋巴瘤9例,临床表现主要为腹痛、腹部肿块、消瘦和贫血等,霍奇金病4例,非霍奇金淋巴瘤34例;按照1994年Arbor分期标准,Ⅰ E期10例,ⅡE期16例,ⅢE期8例,ⅣE期4例;手术加化疗治疗23例,单纯化疗10例,手术加放疗5例;总5年生存率为57.9%(22/38).初步研究结果提示,原发性胃肠道恶性淋巴瘤的临床表现缺乏特异性,早期诊断困难,误诊率高,内镜病理活检联合CT是诊断胃肠恶性淋巴瘤的主要手段,运用手术及术后放、化疗等综合治疗措施可提高患者的生存率.     

6例胃肠道恶性淋巴瘤分析

目的:探讨胃肠道恶性淋巴瘤常见的临床表现和诊断治疗方法.方法:分析我科近年来收治的6例胃肠道恶性淋巴瘤的诊断、治疗和近期疗效.结果:本组6例患者,有3例通过胃镜检查确诊,有3例通过手术切除后病理检验确诊.3例患者手术后进行积极化疗,其中2例NHL(非霍奇金淋巴瘤)患者病情已稳定3个月,1例HD(霍奇金淋巴瘤)患者手术后及6周期化疗后5个月复发.结论:由于胃肠道恶性淋巴瘤属结外淋巴瘤,它的临床表现、诊断方法、发病频率、细胞来源、组织学类型以及临床预后等均不同于结内恶性淋巴瘤,临床医师应该提高对本病的认识,争取做到及时诊断、积极治疗.     

伴纵隔大包块淋巴瘤17例临床分析

目的 分析伴纵隔大包块淋巴瘤的临床特点、病理诊断和治疗方法.方法 回顾性分析2010年1月至2017年1月北京友谊医院诊治的17例伴纵隔大包块淋巴瘤患者临床资料.结果 17例患者均经病理诊断确诊,其中原发纵隔大B细胞淋巴瘤6例,T淋巴母细胞淋巴瘤5例,霍奇金淋巴瘤3例,其他类型非霍奇金淋巴瘤3例.4例采用化疗联合放疗,7例采用单纯化疗,5例采用化疗联合自体造血干细胞移植,1例化疗后进行异基因造血干细胞移植.终止治疗后评估疗效:完全缓解12例,部分缓解1例,疾病稳定1例,死亡3例.结论 伴纵隔大包块淋巴瘤患者的预后与病理类型及治疗反应有关,采用积极的化疗联合放疗及化疗联合自体或异基因造血干细胞移植可能有助于提高疗效.     

The continuing increase in the incidence of primary central nervous system non-Hodgkin lymphoma: a surveillance,epidemiology, and end results analysis

BACKGROUND: Primary central nervous system lymphoma (PCNSL) is an extranodal form of non-Hodgkin lymphoma arising in the craniospinal axis. The incidence of PCNSL appears to be increasing. METHODS: PCNSL incidence data from 1973-1997 were obtained from the nine Surveillance, Epidemiology and End Results (SEER) registries. To limit the influence of the human immunodeficiency virus on incidence rates, data of never-married males and females and persons of unknown marital status were excluded. As a surrogate for new technology, SEER data were reviewed by dates of diagnosis (surrogate for imaging) and compared with glioma incidence (surrogate for stereotactic neurosurgery and improved diagnostic neuropathology). Age-adjusted incidence rates were estimated and compared for the period prior to computed tomography (CT) (1973-1984) and the magnetic resonance imaging (MRI) period (1985-1997). The estimated annual percent change was calculated based on linear regression analyses using SEER*STAT. RESULTS: The incidence of PCNSL appears to be increasing in all SEER registries examined. All age groups demonstrated an increase over time. This increase was observed both in the CT era as well as in the MRI era. PCNSL age-adjusted incidence (0.15 to 0.48, a 3-fold increase) outpaced that of systemic lymphoma (14.1 to 18.5, a 33% increase) for the same registries over the same time periods. The rate of increase has begun to slow since 1985; the estimated annual percent change for PCNSL was three-fold higher during the period 1973-1985 compared with 1986-1997. CONCLUSION: The incidence rate of PCNSL continues to rise. The increase is evident in all age groups and in both genders. Data from the current study suggest that improved diagnostic tools, such as CT or MRI, cannot explain this increase.     

原发性中枢神经系统淋巴瘤临床病理及免疫组化研究

[目的]探讨原发性中枢神经系统恶性淋巴瘤(PCNSI。)的病理学特点。[方法]收集10例PCNSL病人的临床资料，并进行病理形态及免疫组化分析。[结果]PCNSL病理形态及免疫组化结果提示均为B细胞性淋巴瘤，其中8例为弥漫性大B细胞淋巴瘤，2例为小淋巴细胞性淋巴瘤。[结论]PCNSL是少见的颅内肿瘤，绝大部分为B细胞性，其亲血管性常形成血管袖套状结构。免疫组化在诊断与鉴别诊断中起着重要作用。     

34例原发性中枢神经系统恶性淋巴瘤临床分析

目的：分析免疫功能正常的中国人原发性中枢神经系统淋巴瘤（PCNSL）的临床资料,探讨PCNSL的临床特征,评价大剂量甲氨蝶呤（HD-MTX）加全脑放疗（WBRT）治疗PCNSL的疗效.方法：回顾性分析34例经病理证实的PCNSL患者的临床资料以及治疗效果,Kaplan-Meier法分析患者生存期.结果：34例PCNSL患者中B细胞淋巴瘤31例（91.2%）,T细胞淋巴瘤3例（8.8%）;所有患者治疗后评价完全缓解率（CR）41.2%,2年生存率60.2%;病理类型和是否接受HD-MTX加放疗是影响PCNSL生存期的主要原因（P＜0.05）.结论：PCNSL以颅内高压为主要表现,B细胞亚型占绝对优势,具有独特的预后因素,HD-MTX联合放疗是PCNSL有效的治疗方法.     

Primary central nervous system lymphoma as a secondary malignancy

Primary central nervous system lymphoma (PCNSL) is a rare neoplasm, but it is occurring with increased frequency even among apparently immunocompetent patients. Although secondary malignancies frequently involve the lymphoreticular system, PCNSL has been reported as a second neoplasm only once previously. Seven patients are discussed who developed PCNSL after successful treatment for a prior neoplasm. The original cancer was colon (one), breast (one), thyroid (one), Hodgkin's disease (two), and non-Hodgkin's lymphoma (two). Patients with systemic non-Hodgkin's lymphoma were thought to have a separate cerebral lymphoma on the basis of a prolonged disease-free interval from their systemic lymphoma, and the absence of systemic disease, when PCNSL was diagnosed and through subsequent follow-up. The PCNSL developed a median of 10 years after the diagnosis of the first tumor and 6 years after the last evidence of systemic disease. The diagnosis of PCNSL was often delayed because of confusion with brain metastases, and initial shrinkage or disappearance of the lesion after corticosteroids. Formation of PCNSL may be a consequence of treatment for the first malignancy, reflect an unidentified inherent predisposition to neoplastic transformation, or result from the changing epidemiology of PCNSL in the general population. These mechanisms are not mutually exclusive, and a single hypothesis cannot account for all these cases.     

Magnetic resonance features of primary central nervous system lymphoma in the immunocompetent patient: a pictorial essay

Primary central nervous system lymphoma (PCNSL) is an uncommon but important variant of non-Hodgkin lymphoma and represents up to 6% of all primary central nervous system (CNS) malignancies. Recognition of this entity by radiologist on MRI may avoid unnecessary neurosurgical resection and redirect to biopsy. The pretreatment MRI of patients with biopsy proven PCNSL from the last 5 years at our institution was reviewed. Selected examples were used to construct a pictorial essay to illustrate some of the typical and atypical MR features of PCNSL. MRI of other CNS conditions with imaging similarities to PCNSL was included to demonstrate possible mimics. The typical features of PCNSL lymphoma are intra-axial homogenous single or multiple contrast enhancing lesions, with marked surrounding oedema and restricted diffusion, usually contacting a cerebrospinal fluid (CSF) surface. Necrosis, peripheral enhancement, haemorrhage or calcification are unusual and other diagnoses should be considered if any of these features are present. Potential mimics include high grade glioma, infarcts, metastatic disease, demyelination, abscess and secondary lymphoma. Careful assessment of the MR features and correlation with the clinical findings should enable the radiologists to raise the possibility of PCNSL and minimise the risk of unnecessary resection.     

High-dose methotrexate is beneficial in parenchymal brain masses of uncertain origin suspicious for primary CNS lymphoma

In patients with parenchymal brain masses of uncertain origin responsive to corticosteroids, primary CNS lymphoma (PCNSL) should be considered. PCNSL is a rare but aggressive brain tumor that is highly sensitive to high-dose methotrexate (HDMTX)-based chemotherapy. We report a series of six patients with brain masses without histologic confirmation suspicious for PCNSL based on clinical and radiomorphologic criteria after exclusion of some infectious conditions. All patients were treated with HDMTX. We observed two complete responses, two partial responses, and one stable disease. One patient had progressive disease and received rescue whole-brain irradiation. All patients were alive without disease progression 12-48 months after HDMTX start. No symptoms of late neurotoxicity have occurred so far. The response and survival data in this small series of patients are encouraging and suggest a benefit for patients with suspected PCNSL after initial treatment with HDMTX.     

原发性中枢神经系统淋巴瘤的诊断研究进展

 原发性中枢神经系统淋巴瘤（PCNSL）是一种临床上较为罕见的结外淋巴瘤,病理学分类多为弥漫性大B细胞淋巴瘤。WHO（2008）造血与淋巴组织肿瘤分类将"PCNSL"作为独立疾病实体列出。文章就近年PCNSL的临床诊断研究进展作一介绍。     

The value of bone marrow biopsy for staging of patients with primary CNS lymphoma

BackgroundIn patients with presumed primary CNS lymphoma (PCNSL), a systemic manifestation is found only in a small minority. Although bone marrow biopsy (BMB) is recommended for staging, its diagnostic value is unclear.MethodsA retrospective analysis of 392 patients with presumed PCNSL from 3 university hospitals and 33 patients with secondary CNS lymphoma (SCNSL) and initial CNS involvement from a multicenter Germany-wide prospective registry was performed.ResultsA BMB was performed and documented in 320/392 patients with presumed PCNSL; 23 had pathologic results. One harbored the same lymphoma in the brain and bone marrow (BM), 22 showed findings in BM discordant to the histology of brain lymphoma; n = 12 harbored a low-grade lymphoma in the BM, the other showed B-cell proliferation but no proof of lymphoma (n = 5), monoclonal B cells (n = 3), or abnormalities not B-cell-associated (n = 2). In the group of SCNSL with initial CNS manifestation, 32/33 patients underwent BMB; 7 were documented with bone marrow involvement (BMI); 1 had concordant results in the brain and BM with no other systemic manifestation. Six had additional systemic lymphoma manifestations apart from the brain and BM.ConclusionsIn only 2 out of 352 (0.6%) patients with CNS lymphoma (320 presumed PCNSL and 32 SCNSL), BMB had an impact on diagnosis and treatment. While collected in a selected cohort, these findings challenge the value of BMB as part of routine staging in presumed PCNSL.     

脑原发性淋巴瘤临床病理及免疫组化研究

[目的]收集17例中枢神经系统原发性淋巴瘤 ,对其临床病理特点及免疫组化染色特征进行探讨。[方法]标本采用常规石蜡切片、HE染色及SP法免疫组化染色 ,光镜观察。[结果]17例患者中男性12例 ,女性5例 ;中位年龄50岁。17例中肿瘤位于顶叶5例 ,额叶4例 ,颞叶和基底节区各3例 ,小脑2例。16例肿瘤细胞呈弥漫围绕血管分布 ,仅1例在肿瘤内可见部分滤泡形成。17例肿瘤细胞均为LCA阳性表达 ,其中16例L26阳性 ,1例UCLH1阳性。[结论]PCNSL好发于50岁左右男性患者 ,以顶、额叶多见。镜下见肿瘤细胞多呈弥漫围绕血管分布。免疫组化染色证明肿瘤多为B细胞性淋巴瘤 ,T细胞性淋巴瘤较罕见     

First report on a prospective trial with yttrium-90–labeled ibritumomab tiuxetan (Zevalin) in primary CNS lymphoma

Most patients with primary CNS lymphoma (PCNSL) relapse after primary therapy. Standard salvage treatment has not yet been established in PCNSL. Anti-CD20 immunotherapy has expanded treatment options in systemic B-cell lymphoma; however, its use is limited by reconstitution of the blood–brain barrier after tumor shrinkage. The aim of this phase II trial was to evaluate the therapeutic efficacy, toxicity, and biodistribution of yttrium-90 (⁹⁰Y) ibritumomab tiuxetan in PCNSL. Ten patients with relapsed PCNSL were included in a phase II trial and treated with the ⁹⁰Y-labeled anti-CD20 antibody ibritumomab tiuxetan. Nine patients actually received the planned radioimmunotherapy. In six patients, biodistribution of the antibody was measured by indium-111 (¹¹¹In) ibritumomab tiuxetan whole-body scans and single-photon-emission CT (SPECT) of the brain. All patients were evaluated for toxicity and response at least 4 weeks after therapy. Four patients responded: one patient had a complete response lasting 30+ months, and three patients had short-lived responses of ≤4 weeks. Five patients progressed, and one patient did not receive treatment due to an infection prior to ⁹⁰Y-antibody administration. Target accumulation of the antibody was demonstrated in four of the six patients examined by SPECT imaging with ¹¹¹In ibritumomab tiuxetan. All patients experienced grade 3/4 hematotoxicity but no acute neurotoxicity. Penetration of a therapeutic antibody into PCNSL and significant clinical activity was shown. Because of limited response duration and considerable hematotoxicity, future investigations should focus on a multimodal approach with additional chemotherapy and preferably autologous stem cell support.