23例睾丸原发性淋巴瘤的临床与病理分析

目的：研究睾丸原发性淋巴瘤的临床和病理特点,探讨最佳的治疗方式。方法：回顾性分析23例睾丸原发性淋巴瘤的临床病理特点、治疗方法及疗效,并进行随访。以Kaplan-Meier法进行生存分析。结果：23例患者主要临床症状为睾丸无痛性肿大。ⅠE期病例18例,占78．3％。病理类型以B细胞来源者为主,多数为中度恶性淋巴瘤。全部患者均行睾丸切除术,术后接受化疗和(或)放疗,中位生存期42个月,中位无病生存期19个月;1,3,5年生存率分别为100．O％、59．8％和36．5％,无病生存率分别为66．7％、42．3％和36．3％。结论：睾丸原发性淋巴瘤应采取综合治疗,术后全身化疗不宜少于6周期,局部放疗有利于减少复发。     

Ⅰ/Ⅱ期乳腺原发非霍奇金淋巴瘤治疗结果及预后分析

背景与目的：乳腺原发非霍奇金淋巴瘤是一种罕见的淋巴瘤，文献报道病例数较少，治疗及预后因素值得探讨。本研究回顾性分析Ⅰ/Ⅱ期乳腺原发恶性淋巴瘤的临床特点、治疗疗效及预后因素。方法：收集1981年至2001年本院收治的25例Ⅰ/Ⅱ期乳腺原发非霍奇金淋巴瘤患者资料，患者均为女性，其中ⅠE期16例，ⅡE期9例。中位年龄42岁（范围：23～74岁）。全部病例经病理证实。23例患者行局部肿块切除术或活检术，2例行乳腺根治切除术。23例患者术后接受辅助化疗，14例患者在术后接受辅助放疗。结果：中位随访时间为5年，全组5年、10年、15年的总生存率分别为69．1％、55．3％．36．9％；无瘤生存率分别为47．5％、34．6％、34．6％。COX单因素分析发现分期、淋巴瘤国际预后指数（IPI）、乳酸脱氢酶（LDH）和辅助放疗对无瘤生存率的影响具有统计学意义。结论：总结本组Ⅰ/Ⅱ期乳腺原发非霍奇金淋巴瘤的特点，发现患者以中年居多，症状以单侧的乳房肿块为主，常伴有LDH升高，病理类型以弥漫性B细胞型为主。IPI是有价值的预后因素。术后联合放、化疗是较合理的治疗方案，但如何进一步降低远处播散是今后要解决的问题。     

睾丸弥漫性大B细胞淋巴瘤临床及病理特点分析(附21例报告)

背景与目的：睾丸弥漫性大B细胞淋巴瘤临床少见,其临床、病理特点及治疗策略有待更进一步认识。本研究通过分析21例睾丸弥漫性大B细胞淋巴瘤患者的相关临床病理资料,探讨其病理特点、预后及治疗策略。方法：回顾性分析中山大学肿瘤防治中心及广州军区总医院2002年9月-2009年4月所有诊断为睾丸弥漫性大B细胞淋巴瘤的21例患者的临床、病理资料,探讨其病理特点、预后及治疗策略。按照AnnArbor临床分期,ⅠE期3例,ⅡE期4例,ⅢE期5例,Ⅳ期9例,行睾丸癌根治性切除术后均接受CHOP方案辅助性化疗,初治性化疗失败以后改用其他挽救性化疗或放疗并定期随访。结果：本组病例随访10～83个月,3例ⅠE期患者均无瘤生存,其余18例可评价疗效。初治性化疗有效率为72．2％（13／18）,其中完全缓解率（compelete response,CR）为33．3％（6／18）,部分缓解率（partial response,PR）为38．9％（7／18）。出现耐药或复发10例,挽救性化疗有效率仅为30．0％（3／10）。随访期内11例（52．3％）死亡,中位生存期为28个月。本组患者术后病理结果显示：CD10阳性患者7例,bcl-6阳性患者5例,bcl-2阳性表达12例,而MUM1阳性表达有15例,bcl-2及MUM1阳性表达提示预后不良。结论：睾丸弥漫性大B细胞淋巴瘤以non—GCB为主,bcl-2及MUM1阳性表达时其预后相对较差,CHOP方案初治性化疗有效的所有患者术后均应接受化疗,早期可治愈,但对复发及耐药患者,挽救性化疗或放疗效果均较差。     

原发于涎腺的非霍奇金淋巴瘤临床分析

目的探讨原发于涎腺非霍奇金淋巴瘤（NHL）的临床、病理特点,治疗方法和预后。方法18例原发于涎腺的非霍奇金淋巴瘤经术后病理证实。术后放射治疗15例,单纯放疗10例,放疗加化疗5例,单纯化疗2例,未治疗1例。放射治疗剂量为40-55Gy（1．8—2．0Gy／次,5次／周）,化疗采用CHOP方案1—4周期。结果5年生存率76．0％,10年生存率60．2％,2例患者死于远处转移。结论涎腺NHL以低度恶性淋巴瘤多见,术后放射治疗为主的局部治疗有较好效果。早、中期患者宜采用放射治疗,晚期患者以放疗加化疗为宜。     

原发性乳腺淋巴瘤临床及预后分析(附37例报告)

目的：回顾性分析原发性乳腺淋巴瘤（PBL）的临床病理特征、治疗经过及预后因素，探讨更好的治疗模式。方法：收集1992年9月，2006年5月间本院收治的37例原发性乳腺淋巴瘤（PBL）的临床发病特点、治疗经过及疗效、预后随访结果。结果：37例PBL患者，均为女性，中位年龄45岁（29～82岁）。根据Ann Arbor分期标准，ⅠE期16例，ⅡE期12例，ⅢE和ⅣE期9例，病理类型均为B细胞性非霍奇金淋巴瘤，以弥漫性大B细胞淋巴瘤为主（26例例／37例）。治疗情况：单纯根治术组2例，手术＋化疗组21例（其中乳房根治或改良根治手术12例，象限切除手术9例），乳腺局部放疗＋化疗组8例，单纯化疗组6例，化疗一般采用CHOP方案，4～6个周期。随访时间1个月～120个月，中位随访时间36个月。全部患者中位生存时间为53个月，3年生存率为80％，5年生存率为38％。手术＋化疗组和放疗＋化疗组，5年生存率无明显差异（38．1％和37．5％，P=0．20）。原发肿瘤大小及临床分期是预后主要相关因素（P=0．04和P=0．01）。结论：PBL多为女性患者，好发生于单侧乳腺，病理以弥漫性大B细胞型最常见。治疗应以局部放疗联合全身化疗为主，须定期随访观察。     

20例原发睾丸淋巴瘤的临床分析

目的：分析原发睾丸淋巴瘤的预后，提出治疗方法。方法：回顾性分析了20例患者，按Ann Arbor分期标准，ⅠE期9例，ⅡE期2例，Ⅲ-Ⅳ期9例。结果：全组5年，10年生存率分别为30．0％和25．0％，ⅠE，ⅡE期5年，10年生存率54．5％，45．5％，Ⅲ，Ⅳ期5年，10年生存率为0。结论：经综合治疗，睾丸淋巴瘤的预后明显改善。建议对早期睾丸淋巴瘤行术后正规，足量化疗。     

27例原发性睾九恶性淋巴瘤的治疗

目的：回顾性分析睾九恶性淋巴瘤的治疗效果并试图探索放射治疗、全身化疗对其预后的影响。材料与方法：上海医科大学肿瘤医院１９７０年－１９９４年收治的２７例睾丸恶性淋巴瘤。全部病例均经睾丸切除后病理证实。全部病例均给予局部放射治疗（多数为腹主动脉旁野＋同侧髂淋巴区），大部分病例同时接受全身化疗（以ＣＨＯＰ．ＣＯＭＰ、ＣＯＰ方案为主）。以寿命表法计算生存结果。结果：１，３，５年生存率分别为９２．０％，７５．８％和７５．８％。４例死于本病全身扩散的均未应用化疗。结论：本病对放、化疗均较敏感，但局部区域性放疗不能解决本病的全身扩散，必须结合全身化疗。     

原发鼻腔非霍奇金淋巴瘤的治疗选择和疗效

目的 分析原发鼻腔非霍奇金淋巴瘤（NHL）放疗和化疗的近期疗效以及治疗方法对预后的影响。方法 129例经病理证实的原发鼻腔NHL患者中,经形态学诊断为鼻腔NK／T细胞淋巴瘤者116例。做免疫组化57例,其中52例为NK／T细胞来源,占91．2％;5例为B细胞来源,占8．8％。根据Ann Arbor分期,ⅠE期102例,ⅡE期22例,ⅣE期5例,ⅠE和ⅡE期患者中,单纯放疗22例,单纯化疗7例,综合治疗95例,ⅣE期以化疗为主。结果 5年总生存率（OS）和无病生存率（DFS）分别为68．0％和55．8％,ⅠE期和ⅡE期患者的5年OS分别为71．7％和70．6％（P=0．77）,DFS分别为60．9％和47．0％（P=0．09）。首程治疗后达CR患者的5年OS为83．1％,而未达CR患者的5年OS为18．0％（P=0．000）,相应5年DFS分别为68．0％和15．5％（P=0．000）。124例ⅠE和ⅡE期患者中,67例患者接受单纯放疗或放疗后化疗,放疗后完全缓解率（CR）为74．7％,其余57例为化疗后放疗或单纯化疗,化疗后CR率仅19．3％（P=0．000）,46例化疗后未达CR的患者中,42例仍局限于局部区域,31例经放疗达到CR,ⅠE和ⅡE期患者中,先放疗组（放疗＋化疗或单纯放疗）、化疗后放疗组的5年OS分别为76．0％和74．4％,DFS分别为65．0％和56．2％（P〉0．05）,ⅠE和ⅡE期单纯化疗7例,3例存活,4例死亡,中位生存时间15个月,1年生存率为26．7％。结论 中国人原发鼻腔NHL主要为NK／T细胞来源,放疗的近期疗效显著优于化疗,化疗加入放疗并未改善生存率,ⅠE和ⅡE期患者应以放射治疗为主要治疗手段。     

ⅠE～ⅡE期鼻腔NK/T细胞淋巴瘤的放疗效果分析

目的 分析ⅠE～ⅡE期鼻腔NK／T细胞淋巴瘤以放疗为主的治疗结果。方法 1983年1月至2003年12月共收治105例经免疫组化证实的Ⅰ～Ⅱ期原发鼻腔T／NK细胞淋巴瘤。根据Ann Arbor分期，Ⅰ期83例，ⅡE期22例。根据原发肿瘤局限于鼻腔或直接侵犯邻近器官，将Ann ArborⅠE期分为局限ⅠE期（37例）和超腔ⅠE期（46例）。全组31例接受单纯放疗，34例放疗后化疗，37例化疗后放疗，3例单纯化疗。结果 全组5年总生存率（OS）和无进展生存率（PFS）分别为71％和59％。ⅠE、ⅡE期5年OS分别为78％、46％（P〈0．01），5年PFS分别为63％、40％（P〈0．01）。91例（87％）治疗后达完全缓解（CR）。接受先放疗的65例中，54例达CR（83％）；而先接受化疗的40例中，仅有8例达CR（20％）。接受单纯放疗或综合治疗的102例中，单纯放疗的5年OS、PFS分别为66％、61％，综合治疗的分别为76％、61％（P〉0．05）。结论 早期鼻腔NK／T细胞淋巴瘤对常规化疗的反应率明显低于放疔。放疗为主的治疗能取得较好治疗效果，化疗加入放疗未显著改善患者的生存率。     

原发于睾丸非霍奇金淋巴瘤19例治疗效果分析

目的 分析１９全原发于睾丸非霍奇金淋巴瘤的生存情况及失败原因，结合文献复习对其治疗原则做一探讨。方法 １９例睾丸非霍奇金淋巴瘤患者均先行经腹股沟睾丸切除术。术后加放射治疗者５例，加化疗者６例，加化疗、放射治疗者７例，单纯手术者１例。结果 生存率用寿命表法计算，１，３，５年生存率分别为８８．２％，６４．４％，３６．７％。全组总失败率为６３．２％（１２／１９）。失败原因为全身多部位受侵，主要见于淋巴结     

Lymphoma of the testis as primary location: tumour review

Non-Hodgkin’s lymphoma as a primary testicular neoplasm accounts approximately 9% of all testicular malignant tumours and about 1–2% of all non-Hodgkin’s lymphoma. This neoplasm is the most common malignant tumour of the testis in the elderly. The most common histotype in primary forms is the diffuse large B-cell lymphoma, whereas more aggressive histologies such as Burkitt’s lymphoma are principal founded in cases of secondary involvement of the testis. Regarding clinical presentation, the most common sign is a unilateral painless scrotal swelling, sometimes with sharp scrotal pain or hydrocele. In patients with advanced stage, the systematic B symptoms are present in 25–41% of all cases. In 35% of patients, bilateral testicular involvement is detected. In more advanced stages with para-aortic lymph-node involvement, ascites and abdominal pain is evident. Despite the fact that responses to doxorubicin-containing chemotherapy, especially in early stages, show good results, relapses are often seen, and the prognosis of this tumour is very poor. Testicular lymphoma often disseminates to other extranodal organs, such as contralateral testis, central nervous system (CNS), lung, pleura, Waldeyer’s ring and soft tissue. For patients with limited disease, the recommended first-line treatment is orchiectomy followed by rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) combination chemotherapy, with central nervous system (CNS) prophylaxis and prophylactic irradiation of the contralateral testis. In more advanced or relapsed disease, management should follow the worldwide recommendations for nodal diffuse large B-cell lymphoma (DLBCL). Here we present a review of this tumour.     

原发性睾丸非霍奇金淋巴瘤

原发性睾丸非霍奇金淋巴瘤(NHL)极少见,仅占所有NHL的1%～2%,弥漫大B细胞淋巴瘤是最常见的病理类型.多发于60岁以上老年人.对侧睾丸受侵率高,易侵及中枢神经系统、皮肤等结外器官.ⅠE/ⅡE期病人睾丸切除术后综合治疗可降低复发率,提高生存率.晚期病人以化疗为主.对侧睾丸预防照射可降低其复发率,但中枢神经系统的预防性鞘内注药是否降低复发率还有争议.该病复发率高,预后差,国际预后指数与其预后相关.     

原发睾丸非霍奇金淋巴瘤26例临床分析

目的：探讨原发睾丸非霍奇金淋巴瘤(non-Hodgidn’s lymphoma,NHL)的临床特点、治疗方法。方法：收集我院1980年10月至2002年2月收治的睾丸NHL26例,Ann Arbor分期ⅠE期17例,ⅡE期6例,ⅣE期3例。全部手术治疗。首程术后化疗24例,以CHOP方案为主,3～6周期,化疗加放疗9例,其中对盆腔／腹主动脉旁／阴囊等区域进行预防性放疗7例,针对病灶区放疗2例。阴囊区用9～12M eV电子线,其余用6～8MV-X线照射。照射剂量范围在36～50Gy,预防照射的平均剂量为40Gy。单纯手术和手术加放疗各1例。结果：全组一、三、五年总体生存率和无进展生存率分别为96．0％、78．1％、52．0％和70．2％、55．3％、49．2％。总失败率为53．8％,其中对侧睾丸、中枢神经系统受侵率分别为15．4％、11．5％,腹膜后淋巴转移率19．2％。结论：睾丸NHL一般为中-高度恶性,结外器官和淋巴结受侵率高,睾丸和腹膜后区分别占结外器官和淋巴结受侵的首位。所有期别的睾丸NHL都应化疗。ⅠE、ⅡE期病例应常规行腹主动脉旁、同侧髂血管旁和阴囊区预防性照射。ⅢE、ⅣE期以化疗为主,残留病灶辅以局部放疗。     

Testicular lymphoma: improved outcome with early brief chemotherapy

We investigated the impact of early brief chemotherapy on the natural history of primary testicular lymphoma. We compared the outcome for patients seen before 1980--a group primarily managed with orchiectomy and regional radiation--with those seen from 1980 to 1986--a prospectively and consecutively gathered group who were offered brief chemotherapy in addition to standard orchiectomy and irradiation. The historical and study groups were similar in clinical characteristics. However, the chemotherapy group had a better relapse-free survival, 93% v 50% (P less than .02), and overall survival, 93% v 50% (P less than .02). With a median follow-up of 44 months in the chemotherapy group, it is clear that the use of early, brief chemotherapy strongly alters the natural history of testicular lymphoma by preventing relapses, the large majority of which occur early after regional therapy. We conclude that a program incorporating orchiectomy, early brief chemotherapy, and involved-field radiation therapy confers the following benefits on patients with primary testicular lymphoma: (1) laparotomy is not needed for staging; (2) relapses, including those in the opposite testicle and CNS, are largely prevented; and (3) toxicity can be kept to a modest level acceptable in elderly patients.     

Patterns of outcome and prognostic factors in primary large-cell lymphoma of the testis in a survey by the International Extranodal Lymphoma Study Group.

PURPOSE: To determine clinical features and patterns of outcome of primary testicular diffuse large B-cell lymphomas (DLCL). PATIENTS AND METHODS: A retrospective international survey of 373 patients with primary testicular DLCL. RESULTS: Most patients presented with localized disease (stage I to II), and the median age at diagnosis was 66 years (range, 19 to 91 years). Anthracycline-based chemotherapy was administered to 255 patients (68%), and prophylactic intrathecal chemotherapy was given to 68 patients (18%); 133 patients (36%) received prophylactic scrotal radiotherapy. Median overall survival was 4.8 years, and median progression-free survival was 4 years. The survival curves showed no clear evidence of a substantial proportion of cured patients. A favorable international prognostic index score (IPI), no B-symptoms, the use of anthracyclines, and prophylactic scrotal radiotherapy were significantly associated with longer survival at multivariate analysis. However, even for patients with stage I disease and good-risk IPI, the outcome seems worse than what was reported for DLCL at other sites. At a median follow-up of 7.6 years, 195 patients (52%) had relapsed. Extranodal recurrence was reported in 140 cases. Relapses in CNS were detected in 56 patients (15%) up to 10 years after presentation. A continuous risk of recurrence in the contralateral testis was seen in patients not receiving scrotal radiotherapy. CONCLUSION: Testicular DLCL is characterized by a particularly high risk of extranodal relapse even in cases with localized disease at diagnosis. Anthracycline-based chemotherapy, CNS prophylaxis, and contralateral testicular irradiation seem to improve the outcome. Their efficacy is under evaluation in a prospective clinical trial.     

Testicular lymphoma: organ-specific treatment did not improve outcome

OBJECTIVES: To assess whether the use of an organ-specific treatment could improve event-free survival (EFS) and overall survival as endpoints in testicular lymphoma in the early stage: IE and IIE. METHODS: Thirty-four patients were selected to be treated with orchiectomy following six cycles of anthracycline-based combined chemotherapy and radiotherapy (scrotum and contralateral testis in stage IE, contralateral testis and lymph nodes in stage IIE). Prophylaxis to the central nervous system was administered with four monthly cycles of a high dose of methotrexate: 6 g/m2. RESULTS: Complete response was achieved in 33 cases (97%). However, relapses continue to be the rule; at a median follow-up of 74 months (range 61-120), 21 patients relapsed. Thus, actuarial curves at 5 years were 32% for EFS and 30% for overall survival, because all patients with failure and relapse died of tumor progression. Relapses were observed in uncommon sites: lung, bone marrow and as disseminate disease; no relapses were observed in irradiated sites of the central nervous system. CONCLUSIONS: Testicular lymphomas remain a problem as regards defining the optimal treatment. The use of a specific treatment based on organ-involved sites did not show any improvement in outcome. It is evident that more specific therapies need to be explored.     

原发性睾丸淋巴瘤诊断及治疗现状

原发性睾丸淋巴瘤（PTL）是60岁以上男性常见的睾丸恶性肿瘤,常见的病理类型是弥漫大B细胞淋巴瘤。PTL有明显的结外侵犯趋势,常侵犯中枢神经系统、对侧睾丸、皮肤、韦氏环、肺、胸膜及软组织。PTL患者初始治疗应选择手术治疗。对于ⅠE的P1匝采用术后全身化疗、预防性鞘内注射及对侧睾丸的预防性照射,对于ⅡE的患者加用区域淋巴结照射。Ⅲ～Ⅳ期的PTL术后以全身化疗为主,对于全身治疗达到完全缓解的再行对侧睾丸的预防性照射及预防性鞘注。PTL在复发方式及预后等方面与其他非霍奇金淋巴瘤有很大区别,应将其看作一种独特的临床疾病。     

Effect of chemotherapy on carcinoma in situ of the testis

Background: Approximately 5% of patients with testicular cancerharbour carcinoma in situ (CIS) in the contralateral testis. CIS willprogress into invasive tumour in about 50% of cases within fiveyears. The present study evaluated the effect of platinum containingchemotherapy on CIS.Patients and methods: Thirty-three patients with disseminated germ-cellcancer and biopsy proven CIS of the testis were evaluated.Results: CIS had disappeared in the first follow-up biopsy in 30patients. Six patients had a relapse of CIS with or without invasive cancerafter 30, 31, 47, 51, 76 and 95 months from start of chemotherapy. Tworelapses were among six patients who initially received cisplatin,vinblastine and bleomycine and four among 27 patients who initially receivedcisplatin, etoposide and bleomycine.The estimated cumulative risk of CIS five and 10 years after chemotherapywas 21% and 42%, respectively. The estimated cumulativeincidence of spermatogenesis was 64% and 81% at five and 10years of follow-up, respectively.Conclusion: Platinum containing chemotherapy may eradicate CIS. However,patients with CIS may develop invasive cancer in spite of chemotherapy. In thelight of the present data, we recommend radiotherapy to the affected testiclein patients with CIS in the contralateral testis and in patients withbilateral testicular CIS. In patients with extragonadal disease and CIS in onetesticle, orchiectomy of the affected testicle is recommended. In patients forwhom future fertility is an important issue, follow-up including repeatedbiopsies can be offered for a period of at least 10 years.     

Localised non-Hodgkin lymphoma of the testis: the Sheffield Lymphoma Group experience

We evaluated clinical features, management and survival of patients with localised (stage 1E or 2E) testicular non-Hodgkin lymphoma (NHL) presenting to the Sheffield Lymphoma Group between 1972 and 2002. Thirty consecutive eligible patients were identified from the lymphoma database and clinical records of all were reviewed. Survival data were statistically analysed. The median age of patients was 74 years (range 38-87). Sixty-three percent were >70 years of age. The median duration of follow-up was 15 months (range 2.1-211). All patients had orchidectomy. Eleven (37%) had orchidectomy alone. Twelve (40%) had orchidectomy and chemotherapy, 4 (13%) had orchidectomy and radiotherapy. Three (10%) had orchidectomy, chemotherapy and radio-therapy. Five (17%) had immediate disease progression following orchidectomy or whilst on treatment. A complete response was seen in the remaining 25 (84%) irrespective of treatment modality. Seven (23%) of patients remain alive, with a median follow-up of 73 months (range 9.9-211). Six (20%) died of causes not related to their lymphoma. Twelve (40%) relapsed following a complete response and median time to relapse was 9 months. Only 1 of these relapses was in the central nervous system; 1 in bone, 1 in skin, 2 in the contralateral testis. The majority of relapses (58%) occurred in the lymph nodes. Primary testicular lymphoma is an uncommon and poor prognosis disease usually affecting older men. The data and experience available to guide the treatment strategies for testicular lymphoma are limited. However, the evidence points to a combined modality approach being the most likely effective treatment, comprising surgery, anthracycline-containing combination chemotherapy with or without prophylactic contralateral testis and regional lymph node irradiation.