颈淋巴结非霍奇金淋巴瘤是否需照射韦氏环

目的：探讨颈淋巴结非霍奇金淋巴瘤（NHL）是否需预防照射韦氏环？方法：对颈淋巴结淋巴瘤，分期检查中特别注意剔除韦氏环，纵隔和腋窝受累者，106例临床局限于颈淋巴结的NHL中，单纯放射治疗17例，放射＋化疗89例，化疗方案为CHOP或COMP。预防照射韦氏环者常规用面颈联合野，不照射韦氏环者主要用颈切线野，侵犯一侧颈者（Ⅰ）期90例，侵犯两侧颈者（Ⅱ期）16例，侵犯上中颈且病理为中高度恶性的80例列入分析组。结果；分析组做化疗并预防照射韦氏环者5年生存率和5年无瘤生存率（DFS）分别为58．4％、58．8％；做化疗未预防照射者5年生存率和DFS分别为67．4％及63．8％（P值均＞0．05）。全组预防和未预防照射韦氏环者韦氏环复发率分别为0％（0／43）和1．6％（1／63），分别组中预防和未预防照射韦氏环者韦氏环复发率分别为0％（0／34）和2．2％（1／46）。结论：颈淋巴结NHL似可不预防照射韦氏环，特别在做化疗＋放射综合治疗时更可如此。治疗前须常规做韦氏环特别是鼻咽部活检及CT检查，以排除原发性韦氏环NHL。     

粘膜相关淋巴组织淋巴瘤的临床研究

目的　提高对黏膜相关淋巴组织 (MALT)淋巴瘤临床特征的认识。方法　经我院确诊的MALT淋巴瘤 12例 ,进行回顾性临床分析研究。结果　按原发部位可分为胃肠 (GI)和非胃肠 (NON GI)两组。GI组 6例 ( 5 0 % ) ,NON GI组 6例 ( 5 0 % ) ,后者包括膀胱 2例 ,睾丸 1例 ,甲状腺 1例 ,乳腺 1例 ,眼眶 1例。手术治疗 11例 ,其中单用手术治疗 4例 ,手术加化疗 7例。单用化疗 1例。随访 12例 ,1例死亡 ,11例存活 1年 ,6例存活 3年 ,2例存活 5年。结论　MALT淋巴瘤是非霍奇金淋巴瘤的一种独特亚型 ,具有起病隐匿、病程长、进展慢及患病率低 ,好发于中老年男性 ,B组症状少见 ,治疗效果和预后良好等特征。     

原发扁桃体非霍奇金淋巴瘤的预后因素

目的：评价原发扁桃体非霍奇金淋巴瘤（NHL）的肿瘤侵犯范围（T分期）和国际预后指数（IPI）的预后价值,并对早期患者提出治疗建议。方法：回顾分析306例原发扁桃体NHL,根据Ann Arbor分期,I期35例,II期178例,Ⅲ期49例,Ⅳ期44例,根据1997年AJCC TNM分期标准,TI 29例,T2 142例,T3 117例,T4 18例,I期单纯放射治疗12例,综合治疗23例,Ⅱ期单纯放射治疗57例,单纯化疗2例,综合治疗119例,Ⅲ,Ⅳ期以化疗为主,结果：T1,T2,T3和T4的5年癌症相关生存率（CSS）分别为73．8％,59．0％,56．5％和26．5％（P＜0．05）,IP1评分0分,1分和2或3分的5年CSS分别为69．9％,49．0％和25．0％（P＜0．01）,II期单纯放疗和综合治疗的5年无瘤生存率（DFS）分别为46．2％和60．4％（P＜0．05）,多因素分析证明,影响预后的因素有一般状态,B症状,Ann Arbor分期,T分期和IPI,结论：原发肿瘤T分期和IPI是扁桃体NHL重要的预后因素,综合治疗改善了II期扁桃体NHL的DFS。     

原发性扁桃体NHL临床特点和预后分析

目的:扁桃体是淋巴结外恶性淋巴瘤的好发部位,本研究对扁桃体恶性淋巴瘤的临床特点和预后因素进行分析,探讨临床指标与预后的关系。方法:对我院1990年1月至2000年12月收治的26例原发于扁桃体的恶性淋巴瘤患者的临床特点,预后因素、治疗进行总结,并结合文献进行分析。结果:本组扁桃体恶性淋巴瘤患者以中老年居多,病理均为非霍奇金淋巴瘤(non-hodgkin'slymphoma,NHL)。中高度恶性居多。全组5年总生存率、癌症相关生存率、无瘤生存率分别为68%、70.8%、61%。死亡15例,12例死于肿瘤本身,3例死于并发症。Cox多因素分析显示,年龄、国际预后指数(internationalprognosticIndex,IPI)、血清乳酸脱氢酶(serumlactatedehydrogenase,LDH)、一般状况和分期是影响预后的独立因素。结论:原发于扁桃体的非霍奇金淋巴瘤,年龄、IPI、LDH、一般状况和分期是预后的重要指标。早期发现,早期治疗是提高生存率的重要途径。     

原发于咽淋巴环的两种细胞型非霍奇氏淋巴瘤的预后分析

用免疫组化技术可将非霍奇金氏淋巴瘤(NHL)分为T细胞型与B细胞型[1].目前,不论T细胞型还是B细胞型的咽淋巴环NHL,临床上治疗均采用放射治疗与化疗结合的综合治疗.但两种细胞型的NHL的放射剂量及化疗方案是否需一致,尚无定论.本文试就上述问题作一探索.     

90例粘膜相关淋巴瘤患者的临床预后分析

背景与目的：粘膜相关淋巴瘤是一种边缘带非霍奇金淋巴瘤,由于其惰性的临床过程,对其临床特点及预后因素的报道比较少见。本研究对该肿瘤的临床特点及预后因素进行探讨。方法：收集1997年12月至2007年2月经病理确诊的粘膜相关淋巴瘤病例共90例,分为胃组和胃外组进行回顾性分析。结果：全组90例患者中,中位年龄52岁（13～77岁）,原发于胃的23例（25．6％）,胃外67例（74．4％）临床分期为Ⅰ～Ⅱ期的75例（83．3％）,Ⅲ～Ⅳ期15例（16．7％）多器官累及的患者占34．4％,淋巴结累及的患者占44．4％,原发胃外的患者更易出现淋巴结转移（P=0．040）。经治疗后完全缓解率为72．1％。中位随访时间31．4个月,淋巴结阳性和阴性患者的5年生存率分别为58．7％和88．4％（P=0．012）。IPI评分0～2分和首次治疗后完全缓解的患者中位无进展时间分别为61．9个月和未达到,而IPI评分〉2分和首次治疗未达完全缓解的患者中位无进展时间分别为5．2个月和15．0个月,结果差异具有统计学意义（P=0．005和P=0．030）。在67例胃外组患者中,IPI评分是总生存的独立预后指标（P=0．023）。结论：粘膜相关淋巴瘤应被认为是一种广泛播散的惰性淋巴瘤,原发胃外的患者更易出现淋巴结侵犯。具有不良预后因素包括淋巴结侵犯,IPI评分〉2和首次治疗疗效未达到完全缓解的患者应给予更加积极的治疗．     

恶性淋巴瘤分类研究进展

按在各种肿瘤中，恶性淋巴瘤(ML)病因复杂，病理形态和临床表现多种多样，其分类历来争议较多，特别是NHL分类更为繁杂，目前已成为人们共同关注的热点问题。正如Willis所说：“病理学上没有其它肿瘤象淋巴样肿瘤命名那样存在着概念上的混乱情况”。这种情况至今还没有多大改善，给ML的诊断带来了很大的困难。为此，本刊特邀请许良中教授对ML的分类研究进展撰写专稿，文中着重介绍了世界卫生组织(WHO)对ML新分类的国际统一标准，使临床治疗有了更明确的针对性，借此能寻找更为合理的、统一的、简明的、能被广泛接受的分类方法。这不仅是病理学工作者亟待解决的问题，也是广大临床肿瘤工作者确定患者治疗方法和评估预后的重要问题。许良中教授是我国多年来从事病理学基础研究与临床实践的资深专家。本文条理清晰，文笔简练。现刊登于此，以飨读者。     

化,放疗治疗Ⅰ,Ⅱ期咽淋巴环NHL

咽淋巴环非霍奇金淋巴瘤常规首选放疗，我们自１９８０－１９９０年对收治的２５例原发于咽淋巴Ⅰ，Ⅱ期ＮＨＬ的病人，采用化疗－放疗－化疗即“三明治”法，亦取得可喜的近期及远期疗儿，所有２５例均经病理证实，按照Ａｎｎ Ａｒｂｏｒ临床分期，Ⅰ期８例，Ⅱ期１７例。     

原发扁桃体非霍奇金淋巴瘤89例临床分析

背景与目的：扁桃体是原发头颈部非霍奇金淋巴瘤（non-Hodgkin’s lymphoma,NHL）的最常见部位。本研究主要分析和总结原发扁桃体NHL的临床特点及治疗预后,探讨进一步改善预后和治疗后生存质量的可能途径。方法：回顾性分析1990年5月至2003年1月,89例初治原发扁桃体NHL患者的临床资料。按照改良的欧洲．美国淋巴瘤和WHO淋巴瘤分类原则进行病理分类。根据AnnArbor标准进行分期。Ⅰ期和Ⅱ期患者主要接受放化疗联合治疗,Ⅲ期和Ⅳ期患者以化疗为主。结果：89例患者中弥漫大B细胞型60例（67％）,外周T细胞型11例（12％）,惰性淋巴瘤5例（6％）,间变大T细胞型和T淋巴母细胞型各1例,未明确分类11例（12％）。Ⅰ期和Ⅱ期患者8l例（91％）,其中58例（72％）为放化疗联合治疗,19例（23％）为单纯放疗,3例（4％）为单纯化疗,1例（1％）为放化疗联合美罗华治疗。全组患者5年总生存率和无病生存率均为80％,Ⅰ期和Ⅱ期患者的5年生存率为84％。早期患者的生存率与原发耐药、复发和国际预后指数（internationalprognostic index,IPI）评分有显著性相关;而性别、年龄、病理类型、B症状、是否有巨块等对生存率均无显著性影响。结论：原发于扁桃体的NHL绝大部分为Ⅰ期和Ⅱ期的早期患者．因此预后较好。病理类型以弥漫大B细胞型最为多见。Cox回归分析显示在早期患者中原发耐药、复发和IPI〉1是影响预后的主要因素。     

影响甲状腺乳头状腺癌双颈淋巴结转移预后多因素分析

总结了上海肿瘤医院头颈外科１９５６－１９９０年手术治疗１３９例甲状腺乳头状腺癌双颈淋巴结转移患者，男性７３例，女性６６例，年龄１１－７０岁，中位随访期为１１４上。采用了单因素和多因素分析，５，１０，１５年生存率分别为９４．７％，８５．９％和８２．３％。     

粘膜相关淋巴瘤和结外弥漫大B细胞淋巴瘤临床病理特征和预后分析

目的:比较粘膜相关淋巴瘤和结外弥漫大B细胞淋巴瘤的临床病理特征和预后,探讨两类淋巴瘤的预后影响因素.方法:94例结外B细胞淋巴瘤(粘膜相关淋巴瘤62例,结外弥漫大B细胞淋巴瘤32例),经诊断复查后,收集其临床病理和随访资料,进行统计学分析.结果:两类淋巴瘤相比较,MALT淋巴瘤发病的中位年龄、临床病理分期、复发率、淋巴结累及率和细胞增殖活性均偏低,5年生存率较高.94例结外B细胞淋巴瘤的生存影响因素分析:肿瘤细胞增殖指数＞20%的患者生存状况较＜20%的患者低,I E期以上患者生存状况较I E期患者差,伴有淋巴结累及的患者生存状况较无累及患者低.结论:粘膜相关淋巴瘤与结外弥漫大B细胞淋巴瘤在发病年龄、细胞增殖水平、临床分期、复发等临床病理特征上有明显差异.肿瘤细胞增殖活性、临床病理分期及淋巴结累及对两种淋巴瘤的生存状况和预后有明显影响.     

PET/CT in Disease Detection and Follow-up of Subcutaneous Involvement in Marginal Zone Lymphoma

BackgroundThe value of positron emission tomography/computed tomography (PET/CT) in the staging and assessment of treatment response in marginal zone lymphoma (MZL) lymphomas remains controversial. We investigated radiologic characteristics of subcutaneous MZL as imaged on PET/CT scans.Patients and MethodsFrom the records of a single medical center, for the years 2008 and 2017, we identified subcutaneous lesions in PET/CT scans of patients with histopathologically confirmed MZL in sites other than subcutaneous tissue.ResultsOf 571 scans of 178 patients, subcutaneous lesions were found in 20 (11%). Lesions were located in soft tissue structures, mainly along the lateral aspects of the buttocks, thighs and lower and upper back areas, the flank, and the shoulders. Median lengths of the long and short axes of the lesions were 2.0 (range, 1.1-6.0) cm and 0.8 (range, 0.3-2.0) cm, respectively. Median standardized maximum uptake value was 2.3 (range, 0.9-7.6). In 12 patients (60%), MZL was diagnosed at an early stage; 15 (75%) had lymph node involvement and 10 (50%) extranodal involvement. One had spleen and 2 had cutaneous involvement; none had gastric findings.ConclusionThe findings of this study support the usefulness of PET/CT in the detection of subcutaneous MZL as well as in staging and treatment decisions.     

Molecular Genetics of Extranodal Marginal Zone (MALT-Type) B-Cell Lymphoma

Mucosa-associated lymphoid tissue lymphoma is now classified as extranodal marginal zone B-cell lymphoma. We reviewed the current literature on the biological and genetic mechanisms that lead to the development and progression of this unusual lymphoma. Particular attention was given to the clinical and biological significance of the immunoglobulin genes rearrangement, that has been proposed and widely used both diagnostically and as a tool to monitor the response to antibiotic treatment.     

Gastric Diffuse Large B-Cell Lymphoma after the Diagnosis of Primary MALT Lymphoma of the Breast-One Case Report

Primary breast and gastric lymphomas as manifestations of primary extranodal lymphomas are rare malignancies,and their diagnosis,prognosis,and treatment modalities remain unclear.We report for the firs...     

Results of Upfront Therapy for Marginal Zone Lymphoma

BackgroundMarginal zone lymphomas (MZLs) are indolent disorders composed of 3 subtypes: extranodal marginal zone lymphoma (MALT), splenic marginal zone lymphoma (SMZL), and nodal marginal zone lymphoma (NMZL). Early-stage MALT is treated with radiotherapy or antibiotics, and advanced MALT and NMZL are managed with either watch and wait or chemotherapy. SMZLs are treated with splenectomy or rituximab. However, because these approaches have failed to cure patients with SMZL and NMZL, we have systematically used upfront chemotherapy for them, as well as for advanced MALT. We report the outcomes of this approach.Patients and MethodsA total of 44 patients with MZL were identified from our database and divided into 2 groups. Group 1 (22 with early-stage MALT) patients received either radiotherapy (n = 17) or antibiotics with or without surgery (n = 5). Group 2 included 9 patients with advanced MALT, 9 with SMZL, and 4 with NMZL. Group 2 was treated with FND-R (fludarabine 25 mg/m² on days 1 to 3, mitoxantrone 10 mg/m² on day 1, dexamethasone 20 mg on days 1 to 5, and rituximab 375 mg/m² on day 1; n = 14) or CHOP-R (cyclophosphamide 750 mg/m² on day 1, doxorubicin 50 mg/m² on day 1, vincristine 2 mg intravenous push on day 1, prednisone 100 mg/m² orally on days 1 to 5, rituximab 375 mg/m² on day 1; n = 8), followed by maintenance rituximab for 70%.ResultsAll patients achieved complete remission, and only 2 patients in group 1 had developed a relapse at 70 and 75 months. Both relapses were stage I MALT that had initially been treated with radiotherapy. Both were salvaged with FND-R and remained free of disease at 27 and 39 months after the relapse. At 10 years, the failure-free survival for the 44 patients was 80% and the overall survival was 100%. None of the patients in group 2 developed a relapse. The long-term toxicities have been acceptable.ConclusionsThe excellent responses using upfront chemotherapy for MZL suggests that this disorder is curable. Our results should be confirmed in a prospective trial.     

非霍奇金淋巴瘤1012例临床病理分析

目的:了解我院近10年来非霍奇金淋巴瘤(NHL)的发病特点,分析影响NHL预后的相关因素.方法:回顾性分析了近10年来我院收治的1012例NHL患者的临床病理特点,对影响新疆地区NHL生存率及预后的临床病理因素进行分析.结果:1012例NHL中以40～60岁汉族男性发病多见,最主要病理类型依次为弥漫性大B细胞淋巴瘤(DLBCL)346例(34.1%),外周T细胞淋巴瘤(PTCL)185例(18.3%),滤泡淋巴瘤(FL)97例(9.6%),黏膜相关淋巴组织淋巴瘤(MALT)94例(9.3%),NK/T细胞淋巴瘤62例(6.1%),T-淋巴母细胞淋巴瘤(T-LBL)47例(4.6%).结性起病的淋巴瘤619例(61.2%),结外起病的淋巴瘤393例(38.8%).本组维吾尔族女性FL淋巴瘤患者人数比例较汉族女性患者高(P=0.002),汉族男性PTCL患者人数比例高于维吾尔族男性患者(P=0.015).5年总生存率为45.8%.单因素分析显示临床分期,行为状态评分(PS),B症状,年龄,肿块大小,血清乳酸脱氢酶(LDH),结外器官受侵数目及IPI是NHL的预后因素(P＜0.05).多因素分析提示T细胞来源,Ⅲ～Ⅳ临床分期,IPI评分3～5分及LDH增高是NHL独立的预后不良因素(P＜0.05).结论:新疆地区NHL发病以中年多见,结性起病者多于结外起病,B细胞淋巴瘤多于T细胞淋巴瘤.免疫分型、临床分期、IPI、血清LDH水平与NHL预后相关.     

Extranodal Marginal Zone Lymphoma of the Central Nervous System

Extranodal marginal zone lymphoma of the central nervous system (CNS EMZBL) is a rare disease. We present a review of the literature and describe its presentation, differential diagnosis, treatment options, and outcomes. Systematic search of PubMed, Medline, and Embase databases via the Ovid engine for primary articles and case reports yielded 37 unduplicated peer-reviewed articles of CNS EMZBL. We identified 69 cases in these articles and 1 unreported case at our institution, which were included for this review's analysis. Median age at diagnosis was 55 years (range, 18-78 years), with a female preponderance of 77% (n = 54). Most common presenting symptoms were headache in 43% (n = 30), seizures in 31% (n = 22), and visual defects in 27% (n = 19). The most common treatment modalities were localized therapies, which were provided to 67% (n = 47) of cases. These included radiotherapy in 27% (n = 19), radiotherapy with surgery in 24% (n = 17), and surgery alone in 16% (n = 11). Ninety percent (n = 63) of patients had a median follow-up of 23 months. Complete remission was experienced by 77% (n = 49) patients, and 22% (n = 14) were alive with disease. Three patients had evidence of relapse, and one patient died. CNS EMZBL is an indolent, low-grade, radiosensitive lymphoma with good treatment outcomes and prognosis. It is an important differential to consider in extra-axial dural-based masses. Individualized management plans, with preference given to localized treatment options, should be considered after factoring in the site and extent of disease, its resectability, and the expected adverse effects of systemic therapy.