恶性淋巴瘤误诊结核病15例分析

目的探讨误诊为结核病的淋巴瘤的临床特征和误诊原因。方法回顾分析1995～2007年15例误诊为结核的恶性淋巴瘤患者的临床特征，影响学特点，病理结果及诊断。结果其临床特征无特异性，约4例（20，6％）无症状，发热10例（66．7％），咳嗽5例（33．3％），淋巴结肿大12例。其中单一部位5例，多部位8例，其影像学特点是肿块样病变4例，弥漫性病变7例，肺门增大9例，胸腔积液6例，误诊淋巴结核4例，原发性肺结核1例，误诊肺结核并淋巴结结核4例，误诊肺结核淋巴结结核并浆膜腔积液1例。确诊方式：淋巴结病理活检12例，经纤支镜肺活检2例，经皮肺活检4例。病理结合免疫组化诊断：霍奇金瘤4例，非霍奇金瘤1例。结论因两者临床特征相似易误诊．及时早期获得组织病理标本是早期诊断的关键。

The clinical and pathologic analysis of 15 cases malignant lymphoma misdiagnosed as tuberculosis

Objective To study the clinical and pathologic characteristics of malignant lymphoma misdiagnosed as tuberculosis and its misdiagnosed reasons. Methods The clinical and pathologic manifestations, X -ray feature, diagnosis of 15 diagnosed malignant lymphoma cases misdiagno sed as tuberculosis from 1995 to 2007 were retrospectively analyzed. Results There were no specific clinical characteristics, the most common symptoms were fever （10/15）, lough（5/15）, 4 cases without of symptoms（4/15 ）, the enlargement of the lymh nodes were in found in 12 eases. The X -ray showed as bumpnade lesions 4 cases, diffuse lesions 7 eases, hilar lymphadenopathy（ 9eases）, pleural effuison （6cases） , Confirmed diagnosis was made by parhologic and immunohistochemical examinations through lymph node excision （12 cases）, bronchoseopy （2cases）, or percutaneous needle lung biopsy （4eases）, and 4 cases were confirmed as Hodkin＇s lynphomas and 11 cases without Hodkin＇s lymphomas. Conclusion There were similarities on clinical and pathologic manifestations, X - ray features betwen malignant lymphoma and tuberculosis, Misdiagnosis was common, Apppropriate invasine biopsy procedures were necessary for early diagnosis.