脾原发性恶性淋巴瘤

脾肿瘤临床不多见 ,脾原发性恶性肿瘤更为少见。Ｋｒｕｍｂｈａａｒ统计脾原发性恶性肿瘤仅占人体恶性肿瘤的0 6 4% 〔1〕。临床无大宗病例报道。其中以脾原发性恶性淋巴瘤 (ｐｒｉｍａｒｙｍａ ｌｉｇｎａｎｔｌｙｍｐｈｏｍａｏｆｔｈｅｓｐｌｅｅｎ)发病率相对较高 ,约占脾原发恶性肿瘤的 70 %～75 %。我院 40年来仅近期收治 1例 ,现报告如下。一、临床资料病人女性 ,70岁 ,因典型的胆绞痛、以急性胆囊炎、胆囊结石收入院。经保守治疗症状缓解 ,但肋缘下始终可触及胀大的胆囊 ,而左上腹无自觉不适 ,未触及脾脏 ,无浅表淋巴结肿大。血常…     

脾原发性恶性淋巴瘤并自发性脾破裂一例报告

患者 :男 ,36岁。因左上腹隐胀痛伴乏力、发热 1月入院。入院前 1月感左上腹隐胀痛 ,深吸气时明显 ,疼痛向左肩部放射。伴乏力、不规律发热 ,体温 38℃左右。病程中有左季肋部剧烈疼痛史 ,体重下降 6公斤 ,二便正常。既往无疟疾、肝病病史 ,无外伤史。查体 :无黄疸 ,全身浅表淋巴结无肿大。左上腹略饱满 ,腹软 ,脾肿大于左锁骨中线肋缘下 5ｃｍ ,质硬、固定、轻触痛 ,作者单位 :6610 0 0　云南省个旧市人民医院普外科脾迹消失 ,脾区叩痛阳性 ,无腹水征。血常规 :ＷＢＣ 12 .1× 10 9/Ｌ ,Ｎ 0 .70 ,Ｌ0 .176 ,Ｂ型超声 :脾肿大 16 .7ｃｍ× …     

人脾原发性恶性淋巴瘤裸小鼠皮下及原位移植模型的建立

目的 建立人脾原发性恶性淋巴瘤裸小鼠皮下和原位移植模型，为探讨其发病机制和实验治疗提供工具。方法 将人脾原发性恶性淋巴瘤新鲜组织块分别种植于裸鼠肩胛间皮下和脾实质内，观察皮下和原位移植的成瘤率，移植瘤的侵袭和转移及其形态学特征（光镜，电镜，免疫组织化学）。结果 11例人脾原发性恶性淋巴瘤标本7例移植成功，从中筛选出一株同一人体瘤源人脾原发性（非霍奇金B细胞性裂核细胞型）恶性淋巴瘤裸鼠皮下移植模型BFNHL－HMN－1和原位移植模型BFNHL－LMN－2，瘤株生长稳定，已分别传至50代和51代。共移植鼠308只，其肿瘤移植生长率和液氮冻存复苏成活率均达到100％。BFNHL－LMN－1移植瘤呈瘤呈结节状生长，均可向周围组织侵润，BFNHL－LMN－2移植瘤在脾内自主呈结节状生长，伴有脾门淋巴结累及和肝转移。移植瘤病理学，超微结构观察，流式细胞仪DNA含量测定及染色体核型的分析，表明与人脾原发性恶性淋巴瘤细胞相似。结论 经我们检索BFNHL－LMN－1和BFNHL－LMN－2是首次建立成功的人脾原发性恶性淋巴瘤裸鼠皮下和原位移植模型。为研究人脾原发性淋巴瘤的生物学和实验治疗提供了理想的动物模型。     

腹腔镜脾切除治疗脾原发性套细胞淋巴瘤一例

脾脏是人体最大的淋巴器官,临床上常见淋巴瘤累及脾脏,而脾脏原发性恶性淋巴瘤罕见[1]。脾脏套细胞淋巴瘤(splenic mantle cell lymphoma,SMCL)报道极少,套细胞淋巴瘤(mantle cell lymphoma,MCL)是一种独立的B淋巴细胞非霍奇金淋巴瘤[2]。我院收治1例现报告如下。     

人脾原发性恶性淋巴瘤裸小鼠皮下及原位移植模型的建立

目的 建立人脾原发性恶性淋巴瘤裸小鼠皮下和原位移植模型,为探讨其发病机制和实验治疗提供工具。方法 将人脾原发性恶性淋巴瘤新鲜组织块分别种植于裸鼠肩胛间皮下和脾实质内,观察皮下和原位移植的成瘤率、移植瘤的侵袭和转移及其形态学特征（光镜、电镜、免疫组织化学）。结果11例人脾原发性恶性淋巴瘤标本7例移植成功,从中筛选出一株同一人体瘤源人脾原发性（非霍奇金B细胞性裂核细胞型）恶性淋巴瘤裸鼠皮下移植模型BFNHL-HMN-1和原位移植模型BFNHL-HMN-2,瘤株生长稳定,已分别传至50代和51代。共移植裸鼠308只,其肿瘤移植生长率和液氮冻存复苏成活率均达到100％。BFNHL-HMN-1移植瘤呈结节状生长,均可向周围组织侵润,BHNHL-HMN-2移植瘤在脾内自主呈结节状生长,伴有脾门淋巴结累及和肝转移。移植瘤病理学、超微结构观察、流式细胞仪DNA含量测定及染色体核型的分析,表明与人脾原发性恶性淋巴瘤细胞相似。结论 经我们检索BFNHL-HMN-1和BFNHL-HMN-2是首次建立成功的人脾原发性恶性淋巴瘤裸鼠皮下和原位移植模型。为研究人脾原发性淋巴瘤的生物学和实验治疗提供了理想的动物模型。     

原发性甲状腺恶性淋巴瘤1例

患者女,85岁.因颈前肿块逐渐增大8个月,声嘶、气促1周入院.既往曾行"胆囊切除"及"右乳癌根治术".体查:体温36.8℃,脉博68次/min,呼吸24次/min,血压150/80mmHg,颈软、气管左移,右侧甲状腺扪及一5cm×4cm大小包块,表面多个结节感,质硬较固定.左侧扪及一3cm×2cm大小包块,质韧,表面不平,可随吞咽上下活动.左颌下扪及一肿大淋巴结,质硬,无压痛,活动度可,余全身未扪及肿大淋巴结.     

原发性甲状腺恶性淋巴瘤5例分析

原发性甲状腺恶性淋巴瘤５例分析南京市鼓楼医院外科（２１０００８）潘一明蒋智铭原发性甲状腺恶性淋巴瘤（ＭＬＴ）临床较少见，我院自１９８０～１９９２年共收治５例。现结合文献及本组资料，就其临床病理及诊断和鉴别诊断分析如下。１临床资料本组５例中男３例，女２...     

A case of adenomatosis coli complicated with malignant lymphoma of the spleen

A case of adenomatosis coli complicated with malignant lymphoma of the spleen is described herein. An increase in the serum lactic dehydrogenase level of a 50 year old female was noted 9 years after she underwent a total colorectal resection for adenomatosis coli complicated by cancer. A tumor was observed in the spleen on CT and ultrasonography, and a diagnosis of malignant lymphoma was subsequently made by biopsy. At the time of splenectomy, no extension of the tumor was observed in any other organs and it was found histologically to be large cell type follicular lymphoma. A review of the 903 patients with adenomatosis coli documented in Japan revealed the occurrence of mesodermal malignant tumors to be considerably high. Hence, adenomatosis coli appears likely to be a causative factor in malignant lymphoma of mesodermal origin.     

Unsuspected primary pulmonary malignant lymphoma

A 70-year-old man referred for treatment of a left lower lung tumor was shown in chest computed tomography to have a homogeneous round tumor 45 mm in diameter with an enhanced thin wall in the lower lobe of the left lung. No specific finding was seen in material obtained by transbronchial and computed tomography (CT)-guided lung tissue biopsy, so the presumptive diagnosis was a lung abscess. Despite antibiotics administered for 2 weeks, radiography showed the tumor had grown, necessitating left lower lobectomy. The permanent section was diagnosed as diffuse large B-cell lymphoma. Because CT findings for the tumor suggested a lung abscess and the central part of the tumor consisted of fibrotic and necrotic tissue, we had difficulty establishing a final diagnosis. The literature showed primary pulmonary lymphomas yielded a variety of findings radiographically, making surgery paramount for ascertaining a final diagnosis.     

Primary malignant lymphoma of the spleen

We treated two patients with primary splenic malignant lymphoma. One was a 63-year-old man with diffuse histiocytic non-Hodgkin's lymphoma accompanied by multiple liver metastases which were composed of necrotic tissue probably due to preoperative transarterial chemoembolization (TAE). He eventually died of liver failure two years and six months after splenectomy. The autopsy revealed that a large part of the cirrhotic liver had been occupied by a diffuse-type hepatocellular carcinoma, but no recurrence of the malignant lymphoma was found in the liver or other organs. The second patient was a 40-year-old woman with a massive invasion of the stomach, colon, pancreas, and diaphragm by a splenic tumor. The splenic tumor and the adjacent involved organs were resected. Pathologically, well-differentiated diffuse lymphocytic non-Hodgkin's malignant lymphoma was evident. No recurrence has been found for six years and two months. Based on an evaluation of the 71 patients with primary splenic malignant lymphoma reported to data in Japan, the patients treated by a curative resection in an early clinical stage have a more favorable prognosis.     

原发性胃黏膜相关淋巴组织淋巴瘤临床病理与预后分析

目的探讨原发性胃黏膜相关淋巴组织淋巴瘤的临床病理特征、治疗方法、预后影响因素等。方法分析我院与天津医科大学总医院1994年至2006年收治的41例患者的病理及临床特点、治疗方法和预后。结果患者平均发病年龄63．6岁;男女比例为1．3：1;症状以上腹不适、上腹隐痛、呕血和／或黑便为主者约占90．2％;内镜下主要表现为溃疡型肿物者约占61．0％,病变部位以胃窦小弯侧多见占78．0％;幽门螺旋杆菌阳性率为82．9％;82．9％的患者行手术切除治疗。患者平均5年生存率为51．5％,是否进行抗幽门螺旋杆菌治疗以及手术治疗方式的选择等对生存率有显著影响。结论原发性胃黏膜相关淋巴组织淋巴瘤发病以中老年人为主,男性稍多,临床症状不典型,大部分患者无明显体征,可疑患者应做胃镜及多处活检,对于中晚期患者如病情及患者身体条件允许,全胃切除术能提高生存率。     

原发性胰腺淋巴瘤诊治分析:附八例

目的 总结原发性胰腺淋巴瘤的诊治经验.方法 回顾性分析2002年10月至2006年8月间复旦大学附属华山医院收治的8例原发性胰腺淋巴瘤病人资料.结果 病灶位于胰头部7例,胰体尾部1例.临床表现包括上腹痛、上腹压痛、纳差、呕吐、黄疸、腰背痛、上腹肿块、发热、体重减轻等.5例合并胰胆管扩张,其中4例血清CA19-9轻度升高,其余肿瘤指标均处于正常范围.3例行血β2-微球蛋白及乳酸脱氢酶检查,均显示升高.1例行Whipple术,并行CHOP方案与美罗华化疗;2例直接行CHOP方案与美罗华化疗;4例行姑息性肿瘤切除,其中2例术后行CHOP方案与美罗华化疗,1例仅行美罗华化疗,另1例未行化疗;1例仅行剖腹探查病灶活检术.结论 原发性胰腺淋巴瘤临床表现无特异性,辅助检查对诊断有提示作用,化疗为其主要的治疗手段,预后明显优于胰腺癌.     

原发性胃肠道恶性淋巴瘤的诊治体会

目的探讨原发性胃肠道恶性淋巴瘤的临床特征、诊断和治疗。方法对广东省普宁市人民医院1999年1月～2009年12月普外科所收治22例原发性胃肠道恶性淋巴瘤患者临床资料进行回顾性分析。结果本组22例中,男性13例,女性9例,所有患者均经手术或内窥镜病理活检证实为恶性淋巴瘤,病理均为非霍奇金淋巴瘤（NHL）。病灶位于胃14例,肠道8例。给予手术、放疗、化疗等综合治疗。本组随访19例,3年生存率52.6%（10/19）,5年生存率26.3%（5/19）。结论原发性胃肠道恶性淋巴瘤发病率低,临床表现复杂,易漏诊、误诊,应早期诊断,合理治疗。治疗以手术、化疗、放疗综合治疗效果良好。     

原发性胃恶性淋巴瘤57例诊治探讨

本文报告１９７１～１９９３年收治的５７例原发性胃恶性淋巴瘤，其中ＩＥ期３３例、ⅡＥ期７例、ⅢＥ期３例、Ⅳ期１４例。本组术前确诊仅１２例。误诊主要原因是本病临床表现缺乏特异性，更重要的是其Ｘ线征象与胃癌或溃疡病酷似。本组手术切除率９２．２％（４７／５１）。全组５年生存率６２．７％，１０年生存率４７．６％。在ＩＥ期３３例中，８例单一手术切除，术后５年生存率５９．２％；２５例术后加用化疗和／或放疗，则术后５年生存率达９０．３％。显然切除原发灶，联合术后化疗和／或放疗是合理的。     

Successful surgical resection and reconstruction for a huge primary cardiac lymphoma filling the right heart

Primary cardiac lymphoma (PCL) is rare, with a frequency of 1.0%–1.6% among cardiac malignant tumors. Chemotherapy is often selected as a first‐line treatment for PCL. However, when the tumor causes heart failure or life‐threatening hemodynamic collapse, antecedent urgent surgery is required. We herein report a successful case of complete tumor resection and reconstruction of the right atrium and right ventricle using a bovine pericardial patch combined with tricuspid valve replacement in a patient with a huge PCL filling the right heart that manifested as tricuspid valve stenosis and subsequent heart failure.     

原发性大肠恶性淋巴瘤的临床分析(附16例报告)

目的 探讨原发性大肠恶性淋巴瘤的诊断方法和疗效。方法 对16例原发性大肠恶性淋巴瘤进行回顾性分析。结果 临床表现缺乏特异性,16例患者在术前确诊仅有2例。手术治疗16例,5年生存率50％。结论 临床表现、钡餐检查、纤维内镜、活检和剖腹探查等综合分析,可提高对本病的诊断率。对本病应采用比大肠癌更为积极的治疗措施。