结外非何杰金氏淋巴瘤：附22例报道

结外非何杰金氏淋巴瘤少见。本文总结我院14年来所见的结外非何杰金民淋巴瘤共22例,占同期非何杰金氏淋巴瘤的6.7％,其中男17例,女5例,年龄6.5-65岁。因其临床表现复杂,无固定特征,所以常误诊为其他疾病。22例中延误诊断最短者为1个月,最长者达9年。活检前误诊率为90.9％,活检后的误诊率仍占9.1％。结果提示:应注意结外非何杰金氏淋巴瘤的诊断。     

原发纵膈非何杰金氏淋巴瘤17例临床分析

原发性纵膈非何杰金氏淋巴瘤65%发病年龄在25岁以下;60%自发病到确诊的时间在2个月以内;100%的病人首发症状为咳嗽、闷气、60%有上腔静脉综合征;71%有颈部淋巴结转移;41%有肝肿大;60%有骨髓侵犯;35%为淋巴母细胞型。     

The Pattern of Malignant Lymphoma in India: A Study of 1371 Cases

A retrospective clinical and histopathological analysis was performed of 1371 patients with Non-Hodgkin's lymphomas presenting between January 1981 and December 1985. Pathologic material was reviewed and classified according to the modified Rappaport classification. The most common histologic type encountered was diffuse histiocytic lymphoma (29.5%), followed by diffuse poorly differentiated lymphoma (28%). A very low incidence of nodular lymphomas (10.6%) was seen. Twenty three percent of the patients had clinically stage 1 disease; 24.6% stage 11; 25.9% stage 111 and 26.2% stage IV disease. Bone marrow involvement was seen in 22.6% of patients. B symptoms were seen in 23.9% of patients. Primary extranodal lymphoma was seen in 307 (22.4%) patients. The commonest site of extranodal involvement was head and neck (36.1%) followed by gastrointestinal tract (24.4%). Treatment results could be analysed in only 599 patients. The response rate was 89% and complete response was seen in 67.5% patients. The overall survival for treated patients was 37.5% after 36 months, which is comparable to that reported by other investigators. This series is compared with different series reported from Asian as well as Western countries in order to highlight some common features as well as other major differences.     

175例鼻腔非何杰金淋巴瘤临床病理及免疫组化分析

目的：探讨鼻腔非何杰金淋巴瘤（NHL）的临床病理及免疫级化特点。方法：收集本院175例鼻腔NHL的临床病理资料并利用免疫组化（ABC法）进行分析。结果：本组病例男女性别之比为3.5：1，平均年龄46.6岁，其中T细胞性淋巴瘤146例（占83％）；B细胞性淋巴瘤29例（占17％）。100例免疫组化标记，瘤细胞表达T细胞分化抗原的有81例；表达B细胞分化抗原有19例；无一例肿瘤细胞表达Mac-387、LYS、AAT。结论：鼻腔NHL以高度恶性T细胞性为多见，且临床情况特殊，真正的组织细胞性淋巴瘤非常罕见。     

乳腺原发非何杰金淋巴瘤临床病理及免疫组化分析(附8例报告)

收集8例乳腺原发性非何杰金淋巴瘤进行回顾性研究。6例临床诊断乳腺癌并行根治术，其中4例术中冰冻切片，均误诊为髓样痛和低分化癌。7例作了免疫组化检查，LCA全部阳性，其中6例L26阳性，1例UCHL1阳性，余1例为髓外装细胞瘤．提示乳腺恶性淋巴瘤多数为B淋巴细胞性。研究结果显示：本病在临床和病理诊断中易误诊为乳腺癌，免疫组化有助于鉴别诊断。     

29例原发性前列腺恶性淋巴瘤的临床分析

目的:探讨原发性前列腺淋巴瘤的临床特点、病理、治疗和预后。方法:对29例原发性前列腺恶性淋巴瘤进行回顾性临床分析。患者中位年龄66岁。以下尿路梗阻为主要症状。前列腺有不同程度增大。全部病例均经病理诊断为B细胞来源的非何杰金淋巴瘤,以弥漫性大细胞淋巴瘤为主。治疗方法包括手术、化疗和放疗。结果:19例于诊断后发生其他部位受累。10例死于淋巴瘤,且中位生存期23个月(2～30月),7例患者在确诊后生存期超过60个月。结论:原发性前列腺淋巴瘤非常罕见,且预后较差。预后与年龄无明显关联,而与组织学分类、肿瘤临床分期和治疗方法有关。化疗为主要治疗手段。     

女性生殖器官原发非霍奇金淋巴瘤5例

目的：报道5例女性生殖器官非霍奇金淋巴瘤，其中1例原发性子宫体非霍奇金淋巴瘤伴子宫内膜浆液性腺癌为国内首例及文献第7例报道，由此提供了有价值的病理文献资料。方法：按Ann Arbor淋巴瘤临床分期及WHO（1997）组织学分类，分析临床症状，病理检查，免疫表型及预后。结果：5例患者年龄33－60岁，肿瘤分别位于卵巢（1例），子宫体（2例）和宫颈（2例），免疫表型4例为B细胞性，1例为T细胞性，除2例于1年内死亡外，余3例随访4－4年6个月均生存，结论：女性生殖器官病理标本的各没解剖部位均应分别取材，否则容易遗漏病变，术中应详细探查肿瘤范围，方能确定肿瘤的临床分期主原或继发性，患者应采取有效治疗，虽已有局部扩散，仍有机会获得较好预后。     

非何杰全氏淋巴瘤流式细胞术分析及其临床意义探讨

应用流式细胞术(FCM)对86例非何杰金氏淋巴瘤(NHL)石蜡包埋组织细胞DNA含量进行分析.结果表明,86例 NHL中的28例为异倍体(32.6%),其余为二倍体.高度恶性(HG)及中度恶性(IG)组异倍体发生率明显地高于低度恶性(LG)组(P<0.01).但是,HG、与 IG组间差异不显著(P>0.05).异倍体发生率与分期及患者年龄、性别无关.HG、IG和 LG三者间S期比率差异显著或极显著.S期比率>18%病人 2年存活率显著低于 S期比率≤18%者(P<0.01).     

原发骨非霍奇金淋巴瘤临床分析

目的:探讨原发骨非霍奇金淋巴瘤的临床特点、诊断、治疗及预后。方法:选择1970年11月～2003年2月我院收治的21例原发于骨的非霍奇金淋巴瘤,其中Ⅰ期14例(66.7%),Ⅱ期2例(9.5%),Ⅳ期5例(23.8%)。弥漫性大B细胞型12例(57.1%),混合细胞型4例(19.0%),小淋巴细胞型1例(4.8%),T细胞型1例(4.8%),未分型3例(14.3%)。采用单纯放疗6例(28.6%),放疗和化疗综合治疗15例(71.4%)。结果:中位随访86个月,2例(9.5%)局部复发,9例(42.9%)出现远处受侵,3年、5年、10年无进展生存率分别为56.7%、38.9%、29.1%;3年、5年、10年总生存率分别为69.1%、42.2%、42.2%。结论:原发于骨的非霍奇金淋巴瘤首选放疗和化疗的综合治疗;放疗剂量推荐45Gy～46Gy。     

A Rare Case of Asynchronous Bilateral B-cell Lymphoma of the Breast

We report an asynchronous bilateral malignant lymphoma of thebreast, in a 56-year-old woman, presenting unusual clinicalsigns and histological features. The patient, who had a familyhistory of breast cancer, had undergone a standard right radicalmastectomy four years previously for a non-epithelial malignanttumor. At that time, the tumor was thought to be a stromal sarcoma,because some of the neoplastic cells were elongated or vacuolated.The patient recently became aware of a rapidly growing tumorof the left nipple without erosion or pain. This tumor underwentbiopsy, and the histological examination showed a non-Hodgkin'slymphoma of diffuse mixed type. Staging procedures demonstratedno sign of generalized disease. Following a modified left radicalmastectomy for optimal local control and accurate staging, adjuvantchemotherapy consisting of vincristine, cyclophosphamide, prednisoloneand doxorubicin was initiated. Immunohistochemical stainingfor PAN-B and leucocyte common antigen revealed both tumorsto be malignant lymphomas of B-cell type, and the first lymphomaof the right breast was thought to be showing ‘signetring’ cell change. Since the two tumors were morphologicallyquite different from each other, h was suggested that they wereasynchronous bilateral primary malignant lymphomas; however,the possibility remains that the recent left breast tumor isa recurrence of the malignant lymphoma of the right breast.The patient is currently disease-free, 10 months after surgery     

增强剂量CHOP方案治疗非霍奇金淋巴瘤51例

〔目的〕探讨增强剂量CHOP方案治疗非霍奇金淋巴瘤的临床完全缓解率和3年生存率及骨髓抑制等情况。（方法）对51例非霍奇金淋巴瘤患者进行增强剂量CHOP方案治疗及良好的支持治疗并长期、定期治疗及随访。（结果）全组完全缓解率为784％；3年生存率为779％。（结论）增强剂量CHOP方案与传统CHOP方案相比在完全缓解率和3年生存率上有明显提高，而其骨髓抑制等毒副反应未见明显增加。     

Childhood B-Cell Non-Hodgkin's Lymphoma in Israel

The non-Hodgkin's lymphomas of childhood and adolescence are a heterogeneous group of diseases that constitute 7-10 percent of all pediatric malignancies. Major strides have been made in recent years in understanding the pathogenesis of lymphomas at a molecular level but have not yet led to a modification of clinical management. Between 1973 and 1992, 112 children with B-cell non-Hodgkin's lymphoma were diagnosed. The median age was 5.7 years, with male to female ratio of 3 to 1. Fifty percent presented with abdominal masses, mostly confined to the ilco-ccccal region and to the retroperitoneum. In 39 percent there was head and neck involvement, with 15 percent jaw lesions. Until 1978 patients were treated with the Beilinson Medical Center (BMC) protocol, which yielded only 26 percent disease-free survival for stage IV patients. The introduction of the LMB-86 regimen significantly improved the disease-free survival of patients with advanced stage III and IV disease (84 and 68 percent, respectively). Bone marrow (over 70 percent blasts) and central nervous system involvement remain the major prognostic criteria.     

96例外周T细胞非霍奇金淋巴瘤预后分析

目的：分析外周T细胞淋巴瘤的临床特征、近期疗效、远期生存及预后因素。方法：对96例患者的临床特征、治疗效果及预后因素进行分析。外周T细胞淋巴瘤-非特异型（PTCL-U）66例,间变大细胞性淋巴瘤（ALCL）6例,NK/T淋巴廇（NK/TCL）17例,肠道T细胞性淋巴瘤（ITCL）5例,血管免疫母T细胞性淋巴瘤（AITCL）2例。结果：96例患者中89例接受CHOP方案为主的联合化疗,有效率（RR）为88.8%,完全缓解（CR）率为57.3%。中位随访时间30（2～98）个月,死亡52例,中位生存期31.9个月,1、3、5年生存率分别为83.3%、42.7%、35.1%。多因素分析结果显示,IPI评分是PTCL的独立预后指标（P〈0.05）。结论：外周T细胞淋巴瘤常规化疗近期疗效尚可,但远期生存率低,预后不良,需进一步探索新的治疗策略。     

108 例非霍奇金淋巴瘤预后因素分析

目的:分析非霍奇金淋巴瘤（NHL ）的预后相关因素,探讨NHL 患者入院时外周血淋巴细胞绝对计数的预后价值。方法:回顾性分析2000年1 月至2008年1 月间108 例非霍奇金淋巴瘤患者的临床特征,结合随访资料,应用SPSS14.0 软件进行统计分析,采用Kaplan-Meier 法对生存概率进行评估,进一步采用Cox 回归模型对单因素分析中有统计学意义的参数进行多因素分析。结果:108 例非霍奇金淋巴瘤患者中,男女比例约为1. 5:1,中位年龄48岁。治疗前,61.1% 的患者为Ann ArborⅠ～Ⅱ期,ECOG 体力状态（performance status）评分0～1 的患者约占总数的93% ,乳酸脱氢酶升高见于19.2% 的患者,80.6% 的患者属于IPI低危组。入院时外周血淋巴细胞绝对计数减少（ALC ≤1 × 109/L ）见于35.2% 的患者,29.6% 的患者有贫血（Hb≤110g/L）,26.9% 的患者伴有B 症状。ALC>1 × 109/L 患者70例,平均Hb为129.2 ± 17.5g/L,而ALC ≤1 × 109/L 患者38例,平均Hb为98.1 ± 20.6g/L（P<0.05）。 全组患者中位随访时间2 年,中位生存时间2.3 年,2 年和 5 年的总生存率分别为73.2%和39.6%。单因素生存分析显示,ALC ≤1 × 109/L、Hb≤110g/L、B 症状及国际预后指数（IPI）≥2 是NHL 的不良预后因素。多因素分析显示,ALC ≤1 × 109/L 、B 症状及IPI≥2是NHL 的独立不良预后因素。结论:外周血淋巴细胞绝对计数及B 症状是独立于国际预后指数之外的非霍奇金淋巴瘤预后指标。临床上,根据IPI 及简单的临床参数ALC 和B 症状判断NHL 预后,对实施个体化治疗可能具有更大实用价值。      

Trofosfamide in Non-Hodgkin's Lymphoma a Phase II Study

Twenty-three patients (12 females, 11 males) with malignant non-Hodgkin's lymphoma were treated with oral trofosfamide 50 mg t.i.d. Median age was 72 years. Fifteen patients had low-grade and 8 had high-grade lymphomas. Twenty-one patients had stage III and IV disease. Seven patients had WHO performance status of 3-4. The overall response rate was 61% (CR 22%, PR 39%) and the median duration of response 4 months (range 1.5-15+). The main side-effect was bone marrow depression and 7 patients experienced grade II or III hematological toxicity. No gastrointestinal or renal toxicity, no hair loss and no neurotoxicity were observed. The subjective tolerance was good.     

美罗华联合CTOP方案治疗B 细胞非霍奇金淋巴瘤35例临床分析

目的:评价美罗华联合环磷酰胺、吡柔比星、长春新碱、泼尼松（R-CTOP 方案）治疗B 细胞非霍奇金淋巴瘤的疗效及不良反应,分析影响疗效的相关因素。方法:回顾性分析我院35例经病理证实为CD20+ 的B 细胞非霍奇金淋巴瘤患者的临床资料,评估R-CTOP 方案化疗的疗效及不良反应,分析性别、年龄、疾病分期、病理类型、LDH 水平及IPI 评分等影响疗效的相关因素。结果:35例患者中33例可评价疗效,其中完全缓解（CR）17例（51.5%）,部分缓解（PR）11例（33.3%）,有效率（CR+PR）84.8% 。23例初治患者中,CR13例（56.5%）,PR8 例（34.8%）,有效率（CR+ PR）91.3% ;10例复发难治患者中,CR4 例（40%）,PR3 例（30%）,有效率70% 。疗效与性别、疾病分期、病理类型、LDH 水平及IPI 评分等因素无显著相关,年龄对疗效有一定影响（P=0.012 ）。 35例患者中无治疗相关死亡,不良反应主要为骨髓抑制（Ⅲ～Ⅳ度白细胞下降32.1%）,心脏毒性和脱发较轻,主要为Ⅰ～Ⅱ级反应。其它不良反应经对症处理后均可耐受。结论:R-CTOP 方案治疗B 细胞非霍奇金淋巴瘤有效率高且不良反应轻微,可作为治疗B 细胞非霍奇金淋巴瘤特别是老年非霍奇金淋巴瘤患者的优先选择。      

CHOP方案治疗复发性非何杰金氏淋巴瘤38例近期疗效分析

 本文报道CHOP方案治疗38例复发性非何杰金氏淋巴瘤（NHL）的结果，全部病例均经病理组织学证实。按成都会议方案属中、高度恶性者78．9%，Ⅲ、Ⅳ期病人占65．8%。均经CHOP方案化疗4～11疗程，6疗程以上者占71%，8例加用其它一些抗癌药，9例化疗后予以放疗或手术切除。全组总的缓解率71%，完全缓解率31%，中位缓解期10．3个月。主要毒副反应为消化道反应、白细胞减少及脱发，一般病人都可耐受。作者认为，CHOP方案是一个安全有效的化疗方案，可用于复发性NHL的治疗。     

HIV-Associated Lymphoma of the Gastrointestinal Tract: The University of Toronto AIDS-Lymphoma Study Group Experience

We present a retrospective analysis of 31 (30 male) patients with HIV-associated gastrointestinal lymphoma which was undertaken to determine the natural history and response to therapy. Only seven patients had stage I or II lymphoma and 22 had stage IV. Pathology included diffuse large cell (13), immunoblastic (10), and small cell non-cleaved (7). The median age at presentation was 39 years (range 24-59), and the median CD4 count before treatment was 100/μL (range 4-1150). Eighty-seven percent of patients received systemic chemotherapy and significant response was seen in 84% (CR 38%; PR 46%). Hematologic toxicity was high (febrile neutropenia in 44% and dose reductions were required in 81%) and perforation occurred in five patients. Median survival for all patients was 6 months and death was secondary to lymphoma in 61%, treatment toxicity in 10%, other AIDS-related illnesses in 25% and other causes in 4%. Survival was shorter for patients with bone marrow involvement and for those with poor performance status. HIV-associated GI lymphoma has a poor prognosis despite good initial response to chemotherapy and is associated with a higher perforation rate than in HIV negative patients.     

原发性睾丸非霍奇金淋巴瘤11例临床分析

目的：探讨原发性睾丸非霍奇金淋巴瘤的治疗方法及预后。方法：对11例睾丸非霍奇金淋巴瘤的临床病理资料进行回顾性分析。结果：睾丸非霍奇金淋巴瘤占同期恶性淋巴瘤的2.34%,占结外淋巴瘤的8.33%,第1年死亡3例（高度恶性2例,中度恶性1例;T细胞3例;ⅣE1例,ⅢE2例,）,3年存活8例,3年生存率为72.7%（8/11）,5年存活4例（其中3例为术后化、放疗的病例,ⅠE3例,ⅡE1例）,5年生存率为36.4%（4/11）。结论：高度恶性、T细胞者预后较差,分期越早预后越好,术后化疗加局部放射治疗预后较好。     

18例原发性结外型非何杰金淋巴瘤临床分析

恶性淋巴瘤有少部分患者可首发于淋巴结外，本文报告18例原发于结外的非何杰金淋巴瘤，其中发生于胃肠道的9例，头颈部6例，其他部位少见。病理学特点多为弥漫型。手术在结外非何杰金淋巴瘤的诊断和治疗中占首要地位。本组结外非何杰金淋巴瘤首选手术16例，首选化疗2例，总的完全缓解（CR）为13例，占72％。