42例淋巴瘤尸检病例心脏播散的病理特征

目的：探讨淋巴瘤心脏播散的病理特点，以了解淋巴瘤心脏播散对其功能的影响。方法：对42例死亡的淋巴瘤患者进行尸体解剖，通过大体及镜下观察其心脏病理变化。结果：42例中发生心脏播散8例，占19．5％，包括心包、心壁播散，播散表现为结节型、弥漫型和混合型，并可形成瘤性心肌炎。结论：淋巴瘤心脏播散的特征具有多样性，不同形式的播散对心脏功能可产生不同影响。     

16例睾丸原发性恶性淋巴瘤的免疫组化,病理及预后分析

Sixteen cases of primary malignant lymphoma of the testis were studied retrospectively by immunohistochemistry and pathology. According to non-Hodgkin's lymphoma classification revised in 1985, these 16 cases were divided into three types: small noncleaved cell type (2 cases), lymphoblastic cell type (2 cases) and polymorphous T cell type (12 cases). All died of widespread dissemination 3-9 months after orchidectomy with an average survival of 7 months. The authors consider that this short survival after orchidectomy is closely related to pathological type, dissemination of micro-foci before or during the operation, physiologico-anatomic characteristics of the testis, initiation of subclinical recessive foci resulting from decline of immune function after operation.     

早期原发性肾淋巴瘤四例临床病理回顾性分析

目的:探讨早期原发性肾淋巴瘤的临床及组织病理学特点。方法:回顾性分析4例早期原发性肾淋巴瘤的临床及组织病理学资料。结果:原发性肾淋巴瘤早期即可出现腰痛,发热等临床症状,B超及CT影像学检查表现为乏血供影像学特征,组织病理学表现为肿瘤细胞呈生发中心状的弥漫性大B细胞非霍奇金淋巴瘤。结论:早期原发性肾淋巴瘤是具有良性疾病临床症状及影像学特征的高恶性度肿瘤。要充分认识肿瘤细胞生发中心存在的可能。建议对诊断困难的肾脏微小病灶可积极行腹腔镜手术探查。     

Primary gastrointestinal non-Hodgkin’s lymphoma: clinicopathological and prognostic analysis

The objective is to investigate the association between pathological type and clinical features, response to treatment and prognosis of primary gastrointestinal Non-Hodgkin’s lymphoma (PGINHL). The clinicopathologic features, response to treatment and survival of 124 patients with PGINHL, were investigated retrospectively. Ninety-one patients were treated with surgery, most of which included combined therapy, while 32 patients received chemotherapy alone. Survival analysis was performed by Kaplan–Meier and Cox regression method. The most common immunophenotype was B-cell subtype. In 115 (92.7%) patients of B-cell lymphoma, mucosa-associated lymphoid tissue lymphoma (MALToma) and diffuse large B-cell lymphoma (DLBCL) were 55 and 50 patients, respectively. The patients of two pathological types had different clinical features including stage, B symptoms, sites of tumor, distant involvement, International Prognosis Index Score, size of tumor, and response to treatment. Both overall survival curve and multiple Cox regression analysis indicated that pathological type was statistically significant. The pathological subtype of PGINHL was an important prognostic factor. The patients with MALToma appear to have more favorable prognosis than those with DLBCL.     

原发性中枢神经系统淋巴瘤临床病理及免疫组化研究

[目的]探讨原发性中枢神经系统恶性淋巴瘤(PCNSI。)的病理学特点。[方法]收集10例PCNSL病人的临床资料，并进行病理形态及免疫组化分析。[结果]PCNSL病理形态及免疫组化结果提示均为B细胞性淋巴瘤，其中8例为弥漫性大B细胞淋巴瘤，2例为小淋巴细胞性淋巴瘤。[结论]PCNSL是少见的颅内肿瘤，绝大部分为B细胞性，其亲血管性常形成血管袖套状结构。免疫组化在诊断与鉴别诊断中起着重要作用。     

27例眼附属器淋巴瘤的临床病理特征分析

目的 探讨国人眼附属器淋巴瘤的临床病理特征。方法 回顾性分析解放军八一医院全军肿瘤中心1990年1月至2013年12月收治的27例经病理组织学检查确诊为眼附属器淋巴瘤患者的临床及病理学特征。结果 27例患者均为非霍奇金淋巴瘤,原发于眼部者25例,其他部位淋巴瘤累及眼部者2例。病理分型：NK/T细胞淋巴瘤2例;B细胞淋巴瘤25例,其中包括黏膜相关淋巴组织（MALT）淋巴瘤13例,淋巴浆细胞性淋巴瘤（LPL）4例,套细胞淋巴瘤（MCL）3例,小淋巴细胞性淋巴瘤（SLL）2例,髓外浆细胞瘤（EMP）3例。13例既往诊断为小B细胞淋巴瘤,经免疫组织化学染色,确诊为MALT淋巴瘤8例、MCL 3例和SLL 2例。结论 眼附属器淋巴瘤的病理诊断分类多样,明确诊断可以为患者治疗方案的选择和判断预后提供更合理的建议。     

Lymphoma type adult T-cell leukemia--a clinicopathologic study of HTLV related T-cell type malignant lymphoma

The clinical and pathological features of T-cell type malignant lymphoma related to human T-cell leukemia virus (HTLV) were investigated in eight patients presenting lymphadenopathy. Biopsy of lymph nodes showed an histology of diffuse non-Hodgkin's lymphoma. All patients were positive for anti-ATLA antibody and HTLV proviral DNA in the lymph node cells. Most patients showed pronounced hypercalcemia and high serum levels of lactic dehydrogenase. All patients died between 3 and 17 months (mean 8 months) after the onset of disease. HTLV-related malignant lymphoma should be added to the spectrum of ATL, being classified as a lymphoma type ATL.     

原发纵隔淋巴瘤研究进展：第19届欧洲血液学会年会报道

原发纵隔大B细胞淋巴瘤（PMBCL）是一种特殊类型的B细胞淋巴瘤,推测来源于胸腺髓质B细胞,占所有弥漫大B细胞淋巴瘤（DLBCL）的6％～10％,具有特殊的病理特征、免疫表型和基因异常,需要与经典型霍奇金淋巴瘤和其他结性DLBCL亚型鉴别.文章就PMBCL的病理学特征、分子生物学改变、治疗、预后及正电子发射型计算机断层扫描显像（PET）在评估初始治疗反应中的作用进行介绍.     

头颈部淋巴瘤计算机体层摄影、磁共振成像影像特点及临床病理分析

 【摘要】 目的 探讨头颈部结内型及结外型淋巴瘤的计算机体层摄影（CT）与磁共振成像（MRI）影像特点及临床病理特点。方法 分析46例经手术病理或穿刺活检证实的头颈部淋巴瘤患者临床病理及CT、MRI资料,结合文献复习,评价头颈部淋巴瘤的影像特点及临床、病理特点。结果 46例中38例为非霍奇金淋巴瘤（NHL）,8例为霍奇金淋巴瘤（HL）。结外型21例（45.65 %）,包括原发鼻腔10例、咽环（Waldeyer环）7例、喉部2例、甲状腺及腮腺各1例,其中13例伴发颈部淋巴结转移;结内型25例（54.35 %）,主要累及颈部Ⅱ～Ⅳ区淋巴结。Ann Arbor分期：Ⅰ期14例,Ⅱ期19例,Ⅲ期0例,Ⅳ期13例。根据病变形态分为4型：多发结节型25例,肿块型11例,弥漫肿胀型8例,溃疡坏死型2例。结论 头颈部淋巴瘤的CT、MRI影像表现有一定特点,影像检查对淋巴瘤的诊断、鉴别诊断及观察侵犯范围有一定临床价值。     

Primary cardiac lymphoma: utility of multimodality imaging in diagnosis and management

Primary cardiac lymphoma (PCL) is an extremely rare disease defined as a lymphoma strictly confined to the heart or pericardium without dissemination. We present the case of an 82 yr old male with newly diagnosed PCL and two years of subsequent follow up. This report highlights the utility of a multimodality imaging approach in the diagnosis and management of PCL.     

原发性颅内恶性淋巴瘤17例临床分析

总结原发性颅内恶性淋巴瘤的临床、影像学及病理学特征。回顾性分析17例原发性颅内恶性淋巴瘤的临床资料,并对其临床、影像学及病理学检查进行分析。原发性颅内恶性淋巴瘤是颅内少见的肿瘤,临床表现复杂,颅内高压是其主要表现之一(13/17),颅脑CT和MRI检查显示肿瘤位于额颞叶多见(12/17),主要发病起源于B细胞,综合治疗效果好,总体预后差。初步研究结果提示,原发性颅内恶性淋巴瘤的临床与影像学特征缺乏特异性表现,早期诊断困难,临床误诊率高,颅内活组织病理学检查是确诊本病的主要手段,综合治疗(手术放疗和化疗)可取得较好的疗效。     

The patterns of failure in patients with pathological stage I and II diffuse histiocytic lymphoma treated with radiation therapy alone

Radiation therapy was used to treat 36 patients with pathological Stage I and II diffuse histiocytic lymphoma at The University of Chicago Hospitals from 1970 to 1986. Twenty-two patients had pathological Stage I and 14 had pathological Stage II diffuse histiocytic lymphoma. The patients were treated with a median tumor dose of 50 Gy (range of 40-60 Gy). Therapy consisted of extended field radiation therapy in 27 patients (extended mantle or total nodal irradiation) and involved field irradiation in nine patients. The 10-year actuarial relapse-free survival for pathological Stage I and pathological Stage II patients was 91% and 35%, respectively (median follow-up of 7 years). None of the 22 pathological Stage I patients had bulky mediastinal or abdominal disease. Of the 22 pathological Stage I patients, one failed in an unirradiated contiguous lymph node and one relapsed with disseminated disease. Of the 14 pathological Stage II patients, two patients with bulky disease failed in field, one patient failed in a contiguous node, three patients failed within the abdomen, and three patients failed with disseminated disease. To better evaluate the efficacy of staging laparotomy, we analyzed the patterns of failure of 17 clinical Stage I and II diffuse histiocytic lymphoma patients. Four of these patients failed in field (three in sites of bulky disease), and five patients relapsed in the abdomen (three with disseminated disease). Salvage treatment with multiagent chemotherapy resulted in second complete responses in seven of ten patients; however, all but one have recurred and are dead of disease. Radiation therapy may be used as the sole treatment in patients with pathological Stage I diffuse histiocytic lymphoma without bulky disease. Patients with pathological Stage II diffuse histiocytic lymphoma and clinically staged patients have a higher incidence of dissemination and relapse within the abdomen. A benefit resulting from the administration of extended field irradiation was not revealed by this study.     

弥漫大B细胞淋巴瘤的DNA甲基化改变及治疗进展

弥漫大B细胞淋巴瘤(DLBCL)异质性较高,具有不同的临床和病理特征,是成人淋巴瘤的一种常见类型。尽管一部分DLBCL已经可以治愈,但难治和复发患者的治疗仍然具有挑战性。近年来,DNA甲基化等表观遗传修饰成为DLBCL的研究热点。调控甲基化修饰的基因突变及抑癌基因甲基化修饰在DLBCL发病及预后中起到关键作用。本文对DLBCL的DNA甲基化研究进展进行综述。     

鼻腔NK/T细胞淋巴瘤临床病理特征及诊断分析

目的 探讨鼻腔NK/T细胞淋巴瘤的临床、病理特征,诊断和误诊原因.方法 复习62例鼻腔NK/T细胞淋巴瘤的临床资料,应用组织病理学、免疫组化和原位杂交技术分析其临床特点、诊断、病理特征和免疫表型.结果 鼻腔NK/T细胞淋巴瘤以鼻塞、涕血和头痛为主要症状,表现为面部中线破坏性病变.病理改变为肿瘤性淋巴样细胞弥漫或散在分布于凝固性坏死和多种炎细胞混合浸润的背景上.所有病例表达T细胞标记,不表达B细胞标记;NK细胞标记阳性5例;EB病毒mRNA阳性56例(90%).结论 鼻腔NK/T细胞淋巴瘤临床表现不典型,易误诊误治.免疫组化检查是确诊的重要方法.患者以T细胞为主,大多有EBV感染.     

原发肠道非霍奇金淋巴瘤32例临床分析

目的研究原发肠道非霍奇金淋巴瘤（NHL）的临床、病理特点,治疗手段和预后因素。方法回顾性分析32例原发肠道NHL患者的临床表现、病理特征和治疗结果。全部数据应用SSPS 10．0软件进行统计处理。结果32例原发肠道NHL患者的发病部位：大肠16例（50．0％）,小肠8例（25．0％）,回盲部6例（18．8％）,多发部位2例（6．2％）。临床表现：腹痛、腹胀26例（81．2％）,腹部肿块14例（43．8％）,腹泻12例（37．5％）,便血10例（31．3％）,消瘦10例（31．3％）,发热8例（25．0％）。本组B细胞型NHL21例（65．6％）,其中弥漫大B细胞型（DLBCL）15例（46．9％）;T细胞型NHL10例（31．2％）;组织细胞型1例（3．1％）。32例中,29例患者行手术和（或）化疗,19例（59．4％）获得完全缓解。Cox多因素分析显示,Ⅲ、Ⅳ期、B症状及T细胞型,是影响预后的独立不良因素（P〈0．05）。结论原发肠道NHLI临床表现不特异,弥漫大B细胞型淋巴瘤多发;根治性手术联合化疗为最佳治疗手段;预后与分期、B症状和T细胞型有关。     

综合影像学、组织学和免疫组织化学特点诊断肺MALT淋巴瘤

背景与目的:肺的黏膜相关淋巴组织淋巴瘤(MALT淋巴瘤)是原发性肺恶性肿瘤中的少见类型,但在全身各部位所有的MALT淋巴瘤中,肺MALT淋巴瘤并不罕见。由于肺MALT淋巴瘤的临床表现和影像学特点不典型,常与炎症或肺上皮性恶性肿瘤不易鉴别。本研究综合肺MALT淋巴瘤的影像学、大体形态、组织学和免疫组织化学特点,帮助对肺MALT淋巴瘤的认识和诊断。方法:收集15例肺MALT淋巴瘤,根据大体形态和HE图像其组织学特点;并回顾各病例的胸片或(和)CT资料,收集特异性表现;免疫组织化学EnVision法评价BCL10蛋白的表达。结果:在组织学图像上,肺MALT淋巴瘤具有与胃MALT淋巴瘤类似的细胞学特点,但也有肺组织特异性的诊断图像;BCL10免疫组化显示61.5%(8/13)的病例具有核染色;影像学分析显示肺MALT的图像可分为两型:炎症型和肿块型。炎症型表现为单发或多发或弥漫性斑片状模糊影、毛玻璃样影和实变影,内可有支气管充气征;肿块型表现为单发或多发结节或肿块,周围型多见,呈类圆形,边界清楚或模糊,可有分叶及毛刺。结论:肺MALT淋巴瘤有相对特异性的病理形态学特点,BCL10免疫组化能辅助MALT淋巴瘤的诊断,影像特点可能对手术、治疗反应和复发等有作用,但临床病理的关键是与肺"炎性假瘤"及其他非特异性炎症的鉴别诊断。     

伴PET/CT骨髓弥漫性糖代谢增高的淋巴瘤患者骨髓浸润情况及相关因素分析

背景与目的：正电子发射计算机断层显像技术(positron emission tomography-computed tomography,PET/CT)在淋巴瘤的诊断、治疗和随访中发挥着越来越重要的作用。该研究旨在探索PET/CT显示骨髓弥漫性糖代谢异常增高的淋巴瘤患者骨髓有无浸润、淋巴瘤病理类型以及其他临床特点。方法：回顾性分析复旦大学附属中山医院62例经病理确诊为淋巴瘤且PET/CT显示骨髓弥漫性糖代谢增高患者的临床资料、病理以及PET/CT详细数据,并行统计学分析。结果：PET/CT显示有骨髓弥漫性糖代谢异常增高的患者,其淋巴瘤病理类型分布与国内所报道各亚型淋巴瘤发病比例基本一致;侵袭性与惰性淋巴瘤之间［标准摄取值(standard uptake value,SUV)分别为8.43与5.38,P=0.048］、有或无B症状之间(SUV分别为8.30与5.72,P=0.033)、有或无骨髓浸润之间(SUV分别为8.78与6.96,P=0.020),SUV的差异均有统计学意义。32例(51.6%)患者经骨髓活检病理证实骨髓受累。骨髓受累者其淋巴瘤病理类型的分布上与未受累者差异有统计学意义(P=0.001);骨髓受累者套细胞淋巴瘤、结内边缘区B细胞淋巴瘤、伯基特淋巴瘤和间变大细胞淋巴瘤者比例较高,而骨髓未受累者弥漫大B细胞淋巴瘤、外周T细胞淋巴瘤、肠病相关性T细胞淋巴瘤和NK/T细胞淋巴瘤(鼻型)者比例较高。PET/CT骨摄取假阳性可能与发热、贫血等有关。结论：PET/CT骨髓弥漫性糖代谢异常增高虽然对临床诊疗有一定的提示,但应结合PET/CT骨糖代谢异常增高的特点、患者的临床因素及病理亚型综合分析,以减少误诊与漏诊,更精确地指导分期及治疗。     

原发性皮肤淋巴瘤的临床病理学观察

目的 研究原发性皮肤淋巴瘤的临床表现、组织学特点及免疫表型.方法 对17例原发性皮肤淋巴瘤病例进行回顾性分析,按照世界卫生组织.欧洲癌症研究与治疗组织(WHO-EORTC)分类标准,结合形态和免疫组化结果对其进行分类.对不同类型的临床病理学特点分别进行观察、总结.结果 17例患者中,男性10例,女性7例.平均年龄为51(16～78)岁.患者均以发现皮肤病就诊.其中T细胞淋巴瘤14例,包括5例原发性皮肤间变性大细胞淋巴瘤,2例蕈样霉菌病,4例皮下脂膜炎样T细胞淋巴瘤及3例原发性皮肤外周T细胞淋巴瘤(其中1例为原发性皮肤侵袭性亲表皮性CD8+细胞毒性T细胞淋巴瘤).B细胞淋巴瘤3例,包括2例原发性皮肤弥漫大B细胞淋巴瘤(腿型)和1例原发性皮肤滤泡中心淋巴瘤(Ⅲ级).结论 原发性皮肤淋巴瘤临床表现及病理学特点复杂多样,两者必须紧密结合才能做出正确的诊断.     

皮下脂膜炎样T细胞淋巴瘤1例报道并文献复习

目的：探讨皮下脂膜炎样T细胞淋巴瘤（SPTCL）的临床特点、病理特征和治疗方法。方法：报告1例发生在全身的多发性皮下节结伴发热的SPTCL病例,并结合文献复习,对其临床特点、组织学特点、治疗等进行分析。结果：SPTCL主要表现为皮下节结,全身表现多种多样,可伴致死性噬血细胞综合征（PHS）,临床病程反复。组织病变呈脂膜炎样改变,肿瘤细胞弥漫浸润皮下脂肪组织,肿瘤T细胞免疫表型。结论：SPTCL是一种以累及皮下脂肪组织为主的特殊类型的淋巴瘤,预后较好。     

原发性胃淋巴瘤与原发性大肠淋巴瘤临床特点的差异分析

目的　了解原发性胃淋巴瘤和大肠淋巴瘤临床特点的差异。方法　回顾性调查１９９９年１月至２００９年６月间在我院住院且确诊为原发性胃肠道淋巴瘤（ＰＧＩＬ）患者,分析胃淋巴瘤与大肠淋巴瘤之间在发病年龄、性别、内镜下表现、病理特征等方面的差异。结果　共７９例患者诊断为ＰＧＩＬ,其中原发胃淋巴瘤４８例,原发大肠淋巴瘤３１例,两组均以腹痛、贫血为主要表现。与原发大肠淋巴瘤相比,原发胃淋巴瘤合并腹胀较多见,而腹部包块少见,但在性别和病程方面两组无明显差异（Ｐ＞０.０５）。原发胃淋巴瘤的平均发病年龄为（５５.７±１４.７）岁,大于原发大肠淋巴瘤的（３５.１±１７.６）岁（Ｐ＜０.０１）。原发性胃淋巴瘤Ⅲ ～Ⅳ期患者较多,以Ｂ系淋巴瘤为主,多数均行根治性手术＋化疗;而原发性大肠淋巴瘤Ⅱ期较多见,虽然Ｂ系占主要部分,但Ｔ系比例多于胃淋巴瘤（１０.１％ ｖｓ．１.３％,Ｐ＜０.０５）,且行姑息手术治疗的比例高（３２.３％ ｖｓ．６.３％,Ｐ＜０.０１）。原发性胃淋巴瘤和大肠淋巴瘤内镜下诊断率分别为２６.３％和１４.３％,内镜活检标本诊断率分别为５７.９％和６０.４％。结论　原发性胃淋巴瘤和大肠淋巴瘤在发病年龄、临床症状、临床分期、治疗方法上均有差异,且内镜下诊断率偏低。