血管内皮生长因子测定对鉴别结核性和恶性胸腔积液的意义

目的　探讨血管内皮生长因子 (VEGF)测定对鉴别结核性和恶性胸腔积液的意义。方法　采用酶联免疫吸附试验(ELISA)法检测 2 6例恶性胸腔积液患者和 18例结核性胸腔积液患者血清和胸腔积液中VEGF含量。结果　恶性胸腔积液患者血清和胸腔积液中VEGF含量分别为 ( 787.3± 82 .9) pg/ml ,( 3390 .9± 468.5 ) pg/ml ,明显高于结核性胸腔积液患者 [分别为( 32 4.1± 84.2 ) pg/ml ,( 10 5 8.1± 137.8)pg/ml] ,P <0 .0 1。 2组患者的血清和胸腔积液的VEGF比值自相比较也存在显著性差异 (P <0 .0 5 )。联合检测血清和胸腔积液中的VEGF对恶性胸腔积液诊断的特异性为 94.4% ,敏感性为 65 .4%。结论　血清和胸腔积液中VEGF的测定有利于结核性和恶性胸腔积液的鉴别诊断     

Development of a Novel Prognostic Risk Classification System for Malignant Pleural Mesothelioma

IntroductionThis study aimed to assess prognostic factors to better understand malignant pleural mesothelioma (MPM) and to develop a new classification protocol beyond the standard tumor node metastasis (TNM) staging system.Materials and MethodsWe retrospectively reviewed the data of 188 patients with MPM who had not undergone surgical resection. For each patient, we calculated the maximum standardized uptake value (SUVmax), metabolic tumor volume, and total lesion glycolysis (TLG) on pretreatment ¹⁸F-fluoro-2-deoxyglucose-positron emission tomography/computed tomography. Using the Cox proportional hazards model, we evaluated the relationships among potential MPM predictors, including age, gender, performance status, histologic type, stage, possible serum markers, and volume-based positron emission tomography parameters, as well as overall survival.ResultsThe median survival was 461 days, and the 1- and 2-year overall survival rates were 60.70% and 31.10%, respectively. Univariate and multivariate analyses revealed that the significant independent predictors of poor survival outcomes were the non-epithelioid histologic type, elevated serum lactate dehydrogenase levels, a neutrophil-to-lymphocyte ratio of ≥ 5.0, and a TLG of ≥ 525 g. We then used these results to develop a prognostic risk classification system. From the resulting survival curve, we found a significant difference among the 3 risk groups of independent variables. Moreover, there were significant differences between all pairs of 2 separated risk groups.ConclusionsPathologic subtypes, serum lactate dehydrogenase, neutrophil-to-lymphocyte ratio, and TLG in ¹⁸F-fluoro-2-deoxyglucose-positron emission tomography/computed tomography were independent and significant prognostic factors of MPM. Using this model, we created a new risk classification system that supplants the standard TNM staging protocol.     

化疗辅加吡柔比星治疗老年人恶性淋巴瘤临床疗效观察

目的:更好了解吡柔比星(THP)在老年人恶性淋巴瘤治疗中的效果、毒副作用及耐受性。方法：总结分析有吡柔比星组成的化疗方案治疗老年人恶性淋巴瘤与有阿霉素组成的化疗方案治疗恶性淋巴瘤的疗效和毒副作用。结果：THP组对老年人淋巴瘤有较好的疗效,胃肠道反应、脱发、心脏毒副作用明显低于ADM组,两者对比有显著性差异。THP组也只表现较度的骨髓抑制作用。结论：THP在治疗老年人恶性淋巴瘤有较好的反应性、安全性和耐受性。     

Plasmacytic Pleural Effusion as a Major Presentation of Angioimmunoblastic T-Cell Lymphoma: A Case Report

Angioimmunoblastic T-cell lymphoma is one of the peripheral T-cell lymphomas. Reactive plasma cells can occasionally be observed in AITL patients’ peripheral blood and bone marrow. Plasmacytic pleural effusion as the presentation of AITL has not been reported before. The mechanisms of plasmacytic pleural effusion are not fully understood. Here we present an 82-year-old male with exuberant plasma cells in his pleural effusion in addition to his peripheral blood and bone marrow aspiration. By presenting this case, we would like to expand the spectrum of disease presentations in AITL and discuss the significance of flow cytometry in the differential diagnosis of pleural effusion. To our knowledge, this is the first case report in the literature, which will be crucial to assist the hematopathologist in accurate diagnosis and treatment.     

原发性胃肠道恶性淋巴瘤71例临床分析

我院自1962～1984年间共收治原发性GIT-ML71例,占同期胃肠道恶性肿瘤2％。胃32例,肠39例。多灶淋巴瘤10例,双重恶性肿瘤2例。主要临床表现为腹痛、食欲减退、体重下降、腹块、贫血、腹泻等。诊断仍以钡剂造影及内窥镜检查为主要手段。治疗应用手术 放疗 化疗等综合疗法。预后与疾病分期,肿瘤侵犯深度,组织学类型及治疗方式有关。     

睾丸恶性淋巴瘤12例临床分析

目的 探讨睾丸恶性淋巴瘤的诊治经验，以提高患者生存率。方法 对12例睾丸恶性淋巴瘤患者的临床资料进行分析。结果 该病的主要临床特点为无痛性睾丸肿大，确诊后行根治性睾丸切除术及放化疗，化疗方案以CHOP、CHOP—B、CHOP-E和HEPP为主。结论 该病恶性程度高，预后差，应积极进行综合治疗，以提高患者生存率。     

Microsatellite Instability and k-ras, p53 Mutations in Thyroid Lymphoma

Patho-epidemiological studies showed that thyroid lymphoma (TL) arises in inflammatory lesions of chronic lymphocytic thyroiditis (CLTH). Replication error (RER) is found in inflammatory lesions and associated cancer, suggesting that chronic inflammation could be a risk factor for neoplastic development through causing RER. To clarify whether RER is involved in the pathogenesis of TL, we examined the microsatellite instability (MSI) in 9 cases with CLTH and 19 with TL, including 10 diffuse large B-cell lymphoma (DLBL), 4 follicle center cell lymphoma, 3 marginal zone B-cell lymphoma of extranodal (MALT) type, and 2 lymphoplasmacytic type. Sixteen distinct microsatellite repeats were analyzed. Mutations of p53 and k- ras genes were also examined. When alterations at 2 or more microsatellite loci were judged as positive, only 5 DLBL cases exhibited MSI. The frequency of MSI in DLBL was significantly higher than that in other types of TL and CLTH ( P < 0.05). Four of 19 cases (21.1%) showed point mutation of the k- ras gene. The k- ras mutations occurred in the cases with DLBL with RER, and four of five cases with RER had a k- ras mutation, indicating a close association between RER and k- ras mutation. p53 mutations were not found in the CLTH. Two of 19 TL cases showed mutations of p53 gene. There was no significant association between RER and p53 mutation. These findings indicate that genomic instability contributes to the progression of TL from low grade to high grade, but not to the development of low grade lymphoma in CLTH lesions.     

原发性乳腺淋巴瘤(15例报告及文献复习)

目的：总结原发性乳腺淋巴瘤（PBL）的临床特征并探讨其预后因素。方法：回顾性分析15例PBL的临床资料并复习同期国内文献共134例报告,运用SPSS软件包分析其预后因素。结果：15例PBL均为术后明确诊断。中位年龄42岁,全部为NHL,其中DLCL型占53．33％,10例右乳首发,文献统计分析显示右乳多发（59％）,且乳房肿块大小和治疗模式是重要的预后因素,而与年龄、左或右乳首发分组其生存期无显著差别。结论：PBL以NHL占绝大多数,右乳首发多见,术前诊断困难,治疗宜选择手术联合放疗或（和）化疗的综合治疗模式。     

结肠恶性淋巴瘤（附27例报告）

结肠原发性非何杰金氏恶性淋巴痛并不少见,其临床表现与结肠癌有些相似,故需病理确诊。本组27例全部属B细胞性,以淋巴浆细胞性、裂细胞性,裂一无裂细胞性常见。单纯手术治疗者15例,1、3年存活率分别为80%和33％;手术加化疗和放疗者,1、3年存活率分别为90％和60％。随访表明,肿瘤浸润肠壁深度,有无局部淋巴结转移。肿瘤大小、组织学类型与是否综合性治疗为影响本病预后的重要因素。     

原发乳腺非霍奇金淋巴瘤6例临床分析

目的 分析原发乳腺非霍奇金淋巴瘤的临床特点,探讨诊断、分期和治疗方法及其预后的影响因素。方法 回顾性分析6例原发乳腺非霍奇金淋巴瘤的临床资料。6例病例均获随访,均于手术局部切除后辅助化疗和（或）放疗。结果 6例的中位生存期为53．5个月,均无瘤生存。结论 与原发乳腺非霍奇金淋巴瘤预后密切相关的因素依次是临床分期、病理类型和原发肿瘤大小、对原发乳腺非霍奇金淋巴瘤行综合治疗,可取得满意疗效。     

Lymphoma-Associated Pancreatitis as a Presenting Manifestation of Immunoblastic Lymphoma

A 55 year old man presented with clinical signs and symptoms of subacute pancreatitis of unknown aetiology. Two weeks later, inguinal lymphadenopathy developed and a lymph node biopsy revealed a B cell immunoblastic lymphoma. Computerized tomography showed enlargement of the pancreas and immaging features consistent with pancreatitis. Administration of VACOP-B combination chemotherapy achieved complete resolution of the pancreatic mass and the enlarged lymph nodes. We consider this patient to have had lymphoma associated pancreatitis. This case represents a rare clinical presentation of lymphoma suggesting an alternative aetiology of subacute pancreatitis in some cases.     

恶性淋巴瘤简易分类初探

采用Logistic多因素分析法探求恶性淋巴瘤临床病理学简易分类的可能性。以寿命法和时序检验,绘制简易分类中4种类型的不同生存率曲线。结果:何杰金氏病(HD)、淋巴母细胞淋巴瘤(LBL)、外周T细胞淋巴瘤(PTL)和B细胞淋巴瘤(BL)是可以独立存在的4大类型。它们具有可以明确区别的临床病理学特征和不同变化趋势和生存率曲线。这种简易分类易为病理科医师掌握,也易被临床医师理解。本文比较了纯形态和综合诊断指标的分类价值。     

Primary Non-Hodgkin Malignant Lymphoma of the Male Breast

A case of primary non-Hodgkin lymphoma of the male breast isreported. The patient was a 76-year-old Japanese with a historyof bilateral gynecomastia. After the patient had received sexhormone treatment for the gynecomastia, rapid growth of a tumorin the right breast was noted, with regression of a contralateralbreast lesion. Clinically, inflammatory breast cancer was suspected,and right mastectomy with ipsilateral axillary lymph node dissectionwas performed after intraarterial infusion chemotherapy usinga cis-platinum derivative. The histology of the surgical specimenwas non-Hodgkin malignant lymphoma of the diffuse large celltype, with focal tumor necrosis. Immunohistochemically, thetumor cells showed a B-cell nature. The patient is currentlywell without disease 39 months after surgery.     

Value of Serum Beta 2 Microglobulin as an Indicator of Early Relapse in Diffuse Large Cell Lymphoma

In patients with diffuse large cell lymphoma treated with chemotherapy the presence of high levels of serum beta 2 microglobulin has been considered as a bad prognostic factor. Until now, attempts to detect early relapse in patients with diffuse large cell lymphoma have been sparse. To address this issue we began a prospective clinical trial to evaluate the role of different clinical, laboratory and radiographic tests in the detection of early relapse in non-Hodgkin's lymphoma (NHL).

Only serum beta 2 microglobulin levels had clinical significance and 26 of 53 patients (49%) had abnormal levels, 3 to 23.1 months (mean 8.5 months) before evident relapse. Elevated serum lactic dehydrogenase (LDH) levels and beta 2 microglobulin were observed in six patients and all relapsed, suggesting that the combination of these two tests should be considered in future prospective clinical trials in order to define the utility of both tests to detect early relapse. This information may allow us to begin chemotherapy when the tumor mass is still low thereby making the probability of achieving a long second remission more likely.     

Effects of the in vivo Administration of Recombinant Human Granulocyte Colony-stimulating Factor Following Cytotoxic Chemotherapy on Granulocytic Precursors in Patients with Malignant Lymphoma1

We examined the effects of the in vivo administration of recombinant granulocytc colony-stimulating factor (rhG-CSF) on granulocytic precursors in the bone marrow of 4 patients with malignant lymphoma who received chemotherapy. Patients were treated with rhG-CSF at doses of 100–800 μg/ m²/day intravenously for 14 days only in the first course of chemotherapy (G-CSF course) followed by the second course of chemotherapy without rhG-CSF which was used as a control course. In the G-CSF course, white blood cell counts (WBCs) demonstrated a biphasic response consisting of a first peak observed within a few days after the initiation of rhG-CSF administration, and a second peak observed on the last day of rhG-CSF injection or the day after. In the second peak, the incidence of granulocyte-macrophage colony-forming units (CFU-GM) in mononucleated bone marrow cells did not change significantly after treatment with rhG-CSF as compared with a control. However, since the number of nucleated cells in the bone marrow increased, the absolute number of CFU-GM in the bone marrow increased. The number of mature and immature granulocytes in the bone marrow increased. These findings suggest that G-CSF stimulates the proliferation and differentiation of granulocytic precursors in the bone marrow in granulocytopenic patients who received cytotoxic drugs and causes mature granulocytes to be released from the bone marrow.     

原发性结直肠恶性淋巴瘤的诊治体会

目的：探讨结直肠恶性淋巴瘤的诊治方法。方法：对18例结直肠恶性淋巴瘤的临床资料进行回顾性分析,结果：肿瘤发发部位在右半结肠,临床表现为以腹部肿块,腹痛、体重下降以及血便、腹胀为主要特点,病理类型绝大多数为非霍奇金淋巴瘤（NHL）,组织学以弥漫型B细胞为主,本病少见,临床易误诊为癌,治疗宜采用以根治性手术切除为主的综合治疗。结论：诊断时应综合临床表现,影像学及内窥镜检查结果,以提高诊断符合率,治疗应采取根治性手术切除为主的综合治疗,预后较好。     

原发性胃肠道恶性淋巴瘤诊治探讨

目的：探讨原发胃肠道恶性淋巴瘤的临床特征、术前提高诊断率的有效措施、最佳手术方式及术中注意事项与术后综合治疗方案。方法：对34例PGIML进行回顾性分析并结合有关文献对PGIML诊话进行探讨。结果：PGIML术前漏误诊率迭85.8％92.3％,全组均行手术治疗,大部分术后行化(放)疗,单纯手术组3年、5年生存率分别为30.0％和10.0％,明显差于手术加化(放)疗组的72.7％和63.7％。结论：PGIML术前应采用内镜、X线、CT、分子生物学等各种手段明确诊断。治疗不应单纯手术,术后应辅以化疗和(或)放疗以提高长期存活率。     

以胸部病变为表现的恶性淋巴瘤33例临床分析

目的分析以胸部病变为表现的恶性淋巴瘤的临床特点。方法分析33例患者的临床表现、影像学改变、病理类型及诊治情况。结果临床主要表现为呼吸困难,咳嗽,胸痛等,胸部CT以纵隔淋巴结肿大及胸腔积液最多见,多数病例经穿刺活检确诊,以非霍奇金淋巴瘤为主。结论恶性淋巴瘤常侵犯胸部,临床及影像学表现缺乏特征性,应及早活检获取病理以利早期诊治。     

An Assessment of Race as a Risk Factor for Doxorubicin-Related Cardiotoxicity in Diffuse Large B-Cell Lymphoma

BackgroundDoxorubicin carries a risk of congestive heart failure (CHF). Black race has been suggested as a risk factor for doxorubicin-related cardiotoxicity, but data are limited. We assessed whether HF occurs at higher rates in Black patients compared to White patients who receive doxorubicin for DLBCL, and evaluated race as an independent risk factor for the development of HF after adjusting for known risk factors.Patients and MethodsWe used SEER-Medicare to identify patients 66 years and older with DLBCL. We excluded patients with CHF documented prior to diagnosis with DLBCL. We assessed for hypertension, type 2 diabetes, coronary artery disease, and arrhythmias prior to diagnosis with DLBCL. The primary outcome was documented CHF at any point following DLBCL diagnosis. Secondary outcomes included CHF in the first year following diagnosis and death. We performed analyses additionally stratified by cumulative dose of doxorubicin.ResultsOur study population consisted of 8,604 patients (White 96.8%, Black 3.2%). In both Kaplan-Meier and competing risk analyses, we observed no significant difference in the incidence of CHF between Black and White patients, both before and after adjusting for covariates. Finally, we observed no significant differences in the incidence of CHF by race after stratification by cumulative doxorubicin dose.ConclusionsCHF is common following doxorubicin chemotherapy for DLBCL in older patients. No association was observed between Black race and the onset of heart failure in this setting. Rigorous screening for known clinical risk factors is likely more relevant than race in treatment selection and optimization.