恶性淋巴瘤相关自身免疫性溶血性贫血七例并文献复习

目的 探讨恶性淋巴瘤(ML)相关自身免疫性溶血性贫血(AIHA)的临床特点及预后.方法 回顾性分析7例ML相关AIHA患者的临床资料,并进行相关文献复习.结果 4例患者出现交叉配血困难,2例急性溶血发作期间死亡,1例虽溶血得到控制,但短期内淋巴瘤疾病进展加重死亡.4例生存者中2例联合激素化疗后目前病情仍稳定,1例Ⅰ期淋巴瘤患者激素联合沙利度胺、环孢素、甲氨蝶呤口服治疗,未进行联合化疗,至截稿前病情仍稳定,1例患者失访.结论 ML合并AIHA并非罕见,更多见于T细胞亚型,可出现溶血危象,需高度警惕.     

霍奇金淋巴瘤合并溶血性贫血一例并文献复习

目的：探讨霍奇金淋巴瘤（HL）合并溶血性贫血（HA）的特点及诊治方法。方法报道1例合并 HA 的 HL 患者临床资料，并复习相关文献。结果该例 HL 合并 HA 患者因诊断及时、治疗方案正确，在第4个疗程化疗结束后溶血症状消失，肿大淋巴结缩小明显，目前在继续随访中。结论 HL 合并 HA 比较少见，伴贫血症状患者的死亡风险要比非贫血患者高，早诊断、早治疗可延长患者生存并提高生命质量。     

双侧肾上腺髓质脂肪瘤病例报道及文献复习

目的:结合文献报道一例双侧肾上腺髓质脂肪瘤病例以提高认识。方法:报道一例双侧肾上腺髓质脂肪瘤病例并对文献进行复习。结果:患者,男,56岁,10年前于常规体检时发现左侧肾上腺占位性病变。外院行手术治疗未能成功切除左侧肾上腺病变。术后随访示左侧肾上腺病变逐年增大。患者遂至我院进一步治疗。入院影像学检查显示双侧肾上腺占位性病变,呈现脂肪及多发软组织密度,直径分别为15.8 cm×13.5 cm和6.3 cm×2.5 cm。诊断为双侧肾上腺髓质脂肪瘤。行开放手术切除左侧肾上腺肿物。术后随访未见异常。结论:双侧肾上腺髓质脂肪瘤多继发于内分泌疾病,诊断时应注意原发疾病,必要时采用手术治疗。     

以自身免疫性溶血性贫血为首发症状的脾淋巴瘤一例并文献复习

目的探讨以自身免疫性溶血性贫血(AIHA)为首发症状的脾淋巴瘤的临床特征及诊治方法。方法回顾性分析2017年6月南京医科大学附属南京医院收治的1例以AIHA为首发症状的脾弥漫大B细胞淋巴瘤(DLBCL)患者的诊疗经过,并复习相关文献。结果该患者以溶血为首发症状,经实验室诊断为AIHA,最初激素治疗有效,后病情进行性加重,予外科脾切除,术后病理示DLBCL。结论恶性淋巴瘤合并AIHA临床较少见,患者缺乏典型的临床表现及实验室改变,临床预后差,需提高认识,做到早诊断、早治疗,以提高生存率。     

异基因造血干细胞移植后自身免疫性溶血性贫血一例并文献复习

目的 总结异基因造血干细胞移植(allo-HSCT)后自身免疫性溶血性贫血(AIHA)的临床特征和诊治经验.方法 分析苏州大学附属第一医院血液科收治的1例allo-HSCT后发生AIHA患者的临床资料,并进行文献复习.结果 1例青年男性重型再生障碍性贫血患者在接受单倍体allo-HSCT近2年后,无诱因下发生AIHA,经糖皮质激素、静脉注射用丙种球蛋白、血浆置换术联合抗CD20单抗治疗后痊愈.文献复习显示,allo-HSCT后AIHA患者对含利妥昔单抗的治疗方案反应率相对较高,成年人及基础疾病为恶性病的allo-HSCT后AIHA患者病死率高,患者对利妥昔单抗反应不佳是预后差的最大危险因素.结论 allo-HSCT后发生的AIHA对激素不敏感,治疗反应率低,是导致allo-HSCT患者病死率升高的危险因素.     

Oxaliplatin induces a delayed immune-mediated hemolytic anemia: a case report and review of the literature

We report a case of a 59-year-old woman with metastatic carcinoma of the ileocecal region who received FOLFOX(oxaliplatin/leucovorin/5-fluorouracil) and bevacizumab therapy and exhibited a partial remission with minimal side effects. She developed a mild self-limited episode of immune-mediated hemolytic anemia during her 16th cycle of chemotherapy, which precluded her from receiving further oxaliplatin. We review the literature on oxaliplatin-induced immune-mediated hemolysis, including its mechanism, presenting symptoms, laboratory features, management, and implications for future therapy.     

T细胞淋巴瘤合并自身免疫性溶血性贫血二例并文献复习

目的 提高对T细胞淋巴瘤合并自身免疫性溶血性贫血(AIHA)的诊治认识.方法 对2例T细胞淋巴瘤合并AIHA患者的临床特点进行分析,并结合相关文献,探讨T细胞淋巴瘤合并AIHA的流行病学、病理生理机制及治疗原则.结果 2例患者均以多发浅表淋巴结肿大为首发症状,病程中突然出现酱油色血尿.患者血红蛋白进行性减少、网织红细胞升高,总胆红素及间接胆红素升高,抗人球蛋白试验(Coombs-IgG)阳性,骨髓红系增生活跃.经糖皮质激素或丙种球蛋白治疗后,1例溶血好转,2例最终均死于多脏器衰竭.结论 T细胞淋巴瘤合并AIHA临床罕见,预后差,化疗联合激素或丙种球蛋白可能提高患者生存率.     

Follicular lymphoma with bilateral testicular and epididymal involvement: case report and review of the literature

Testicular involvement with indolent lymphoma is extremely rare, particularly in the absence of transformation to an aggressive histology. We report a case of a 64-year-old man who presented with cervical lymphadenopathy. Staging CT scans revealed extensive lymphadenopathy as well as bilateral testicular and epididymal masses. Histologic examination of lymph node, bone marrow, and testicular/epididymal biopsies revealed involvement with grade I follicular lymphoma. The patient was started on chemotherapy with cyclophosphamide, vincristine, prednisone, and rituximab in addition to intrathecal methotrexate and testicular radiation. He is now 6 months into therapy and responding well. A review of the literature demonstrated this to be the first confirmed case of testicular and epididymal involvement with grade I follicular lymphoma.     

利妥昔单抗联合ABVD方案治疗霍奇金淋巴瘤合并自身免疫性溶血性贫血一例并文献复习

目的:探讨利妥昔单抗联合ABVD（表柔比星、博来霉素、长春地辛、达卡巴嗪）方案对霍奇金淋巴瘤（HL）合并自身免疫性溶血性贫血（AIHA）的疗效。方法:回顾性分析2019年11月河南省肿瘤医院收治的1例HL合并AIHA患者的临床资料,并进行文献复习。结果:患者行左颈部淋巴结活组织检查以及骨髓活组织检查,并完善淋巴瘤相关基因突变及全谱遗传病基因检测,诊断为HL（结节硬化型Ⅳ期）合并AIHA,给予6个周期利妥昔单抗联合ABVD方案治疗后评估疗效,贫血得到纠正,HL也获得完全缓解。结论:利妥昔单抗联合ABVD方案治疗HL合并AIHA的患者具有较好的效果。     

Primary adrenal lymphoma discovered as an incidentaloma: case report and review of the literature

Primary adrenal lymphoma (PAL) discovered at an early stage is extremely rare. We report a case of PAL incidentally discovered by abdominal computed tomography (CT) scan as a 4.5-cm solid mass in the left adrenal gland. The patient was an 80-year-old man, and, from imaging studies, the left adrenal mass was considered to be a non-functioning adrenal cortical cancer. Left adrenalectomy was performed, and the resected tumor proved to be non-Hodgkin's lymphoma of diffuse large B-cell type. Adjuvant chemotherapy was administered, and the patient has been well with no evidence of the disease for 20 months postoperatively. Received: September 3, 1998 / Accepted: November 30, 1998     

Autoimmune hemolytic anemia and dermoid cyst of the mesentery. A case report

An autoimmune hemolytic anemia has been detected in a patient suffering from a dermoid cyst of the mesentery. Early recognition of the teratoma is important, since only removal of the tumor is consistently curative. Investigations showing immunocompetent cells within the cyst's wall lend further support to the contention that the tumor tissue itself produces, for reasons yet unknown, antitumor autoantibodies that could cross-react with the patient's erythrocytes. The role of computerized tomography (CT) in the diagnosis of abdominal teratoma is emphasized, since CT has permitted visualization of the cystic structure of the tumor before the surgical removal of the mass.     

Desmoid tumor treated with polychemotherapy followed by imatinib: a case report and review of the literature

Desmoid tumors, also known as aggressive fibromatosis, are tumors of intermediate dignity, which grow slowly but are locally aggressive. These tumors do not metastasize but can be potentially life threatening when infiltrating vital structures. The therapy strategy consists of surgery, radiation and systemic therapy with non-steroidal anti-inflammatory drugs, antiestrogen compounds and cytotoxic chemotherapy. We report on a 40-year-old male patient with advanced fibromatosis of the neck who has been treated with 7 cycles of polychemotherapy (adriablastin, ifosfamide and dacarbazine) followed by targeted therapy with imatinib. Tumor response was evaluated clinically and by magnetic resonance imaging. The tumor decreased significantly after the first cycle of chemotherapy and tumor-related symptoms declined. The response continued after switching to targeted therapy with imatinib, which is currently ongoing. The best treatment for this rare tumor remains under discussion. Doxorubicin and dacarbazine are frequently used agents. We included ifosfamide in our therapy, which is standard in the treatment of soft tissue tumors. The tyrosine kinase inhibitor imatinib seems to offer new possibilities and is currently investigated in randomized trials. We conclude that combination chemotherapy including doxorubicin, ifosfamide and dacarbazine in the treatment of aggressive fibromatosis should be considered for patients suffering from unresectable, advanced disease and clinical symptoms which require a rapid response to therapy.     

Mitomycin-C induced hemolytic uremic syndrome: a case report and literature review

Hemolytic uremic syndrome spontaneously arises in a few patients with advanced cancer, but it is more commonly related to the use of certain chemotherapeutic agents. Mitomycin-C is, etiologically, the most common causative agent inducing hemolytic uremic syndrome, in a dose dependent manner. We report this syndrome, attributable to mitomycin-C at a cumulative dose of 40 mg/m2, in a gastric cancer patient. A 42-year-old female with stage III gastric cancer underwent radical gastrectomy and was given mitomycin-C at 10 mg/m2 intravenously every four weeks as adjuvant therapy. Hemolytic uremic syndrome was diagnosed three months after the last dose of mitomycin-C administration. The most prominent symptoms included pallor, hypertension and anasarca, with laboratory evidence of microangiopathic hemolytic anemia, azotemia and hyperkalemia. Her disease was progressive, but fortunately stabilized after staphylococcus column A dialysis. Her disease remained in remission for 24 months from the time of diagnosis, and then relapsed in the form of peritoneal carcinomatosis with partial intestinal obstruction.      

原发性心脏淋巴瘤一例并文献复习(英文)

Primary cardiac lymphoma (PCL) is an extremely rare neoplasm and usually defined as a non-Hodgkin’s lymphoma being exclusively located in the heart and/or the pericardium. It is particularly difficult to diagnose this rare disease due to its nonspecific clinical manifestations. The prognosis of this disease is poor. In this diffuse large B-cell lymphoma, the patient finally died of heart failure after 2 courses of chemotherapy with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone).     

原发性卵巢伯基特淋巴瘤一例并文献复习

目的 探讨原发性伯基特淋巴瘤（BL）的临床病理和免疫表型特征.方法 对1例散发性卵巢BL患者肿瘤组织进行病理形态学、免疫组织化学检测,并结合临床特征进行临床病理分析.结果 患者,36岁.光学显微镜下BL瘤细胞呈弥漫一致的中等大细胞,伴有“星空现象”和多量的核碎片,易见核分裂象.免疫表型示瘤细胞CD20＋和（或）CD79a＋、Ki-67＋＋＋,bcl-2、TdT和MPO均阴性.结论 BL属高度恶性淋巴瘤,主要应与淋巴母细胞性淋巴瘤、髓系白血病及非淋巴造血系统小细胞恶性肿瘤等相鉴别.     

原发性肺非霍奇金淋巴瘤1例并文献复习

原发性肺非霍奇金淋巴瘤(primary pulmonary non-Hodgkin’s lymphoma,PPNHL)是指起源于肺内淋巴组织的恶性淋巴瘤,是结外淋巴瘤的一种罕见类型,本文通过报道1例老年女性患者PPNHL,并结合相关文献复习,探讨了PPNHL的临床特点、诊断、治疗方法,以提高诊断率。     

隐匿性弥漫性癌肿相关微血管病性溶血性贫血4例并文献分析

目的探讨隐匿性弥漫性癌肿相关微血管病性溶血性贫血（MAHA）患者的临床特点,有利于癌肿的早期诊断和治疗。方法报道4例隐匿性弥漫性癌肿相关MAHA病例,并综合国内相关文献进行分析。结果近30年间国内报道19例隐匿性弥漫性癌肿相关MAHA患者,包括现在报道4例共23例患者,中位年龄45岁（16～86岁）,男8例,女15例,突出的临床表现包括MAHA相关症状、发热、多处骨痛、神经精神异常、皮肤黏膜出血以及上腹痛伴呕血或黑便,发生率分别为78%、48%、48%、35%、35%和26%。实验室检查：Hb中位数52（26～89）g/L,血小板中位数35（5～98）×109/L;12例患者凝血功能检查7例有PT延长等异常,其中4例并发DIC;11例患者骨髓涂片和病理活检发现转移癌细胞。经病理诊断的21例患者中腺癌17例,其中胃癌11例。结论隐匿性弥漫性癌肿继发MAHA患者多为腺癌,骨痛、骨髓涂片和活检以及动态凝血纤溶检查,有助于与血栓性微血管病性溶血性贫血（TTP）的早期鉴别诊断,及时发现转移癌的证据,进一步胃镜等检查有利于尽快确定原发癌的部位。