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。

Analysis of clinical and pathological feature of testicular diffuse large B cell lymphoma(a report of 21 cases)

Background and purpose: The clinical and pathological characteristics and treatment strategy for the patients with testicular diffuse large B cell lymphoma still need to be further studied. This study was done to evaluate the diagnosis and strategy for the disease by retrospective analysis of 21 patients with testicular diffuse large B cell lymphoma. Methods: 21 patients with pathologically proved as diffuse large B cell lymphoma after surgery in the Sun Yat-sen University Cancer Center and The Guangzhou General Hospital of PLA from September 2002 to April 2009 were accrued. There were 3 in stage Ⅰ_E , 4 in stage Ⅱ_E , 5 in stage Ⅲ_E and 9 in stage Ⅳ according to Ann Arbor stage standard. All patients received adjuvant chemotherapy with CHOP regimen initially after operation. Radiotherapy or other salvage chemotherapy regimen was given after failure of the initial treatment. The follow-up information was collected for to all of the patients. Results: Follow-up time ranged from 10 to 83 months. After completion of first-line chemotherapy(CHOP), overall response rate was 72.2%(13/18)with complete remission (CR) rate of 33.3%(6/18)and partial response rate(PR) of 38.9%(7/18). 3 patients in stage Ⅰ_E survived free from disease until now. Tumor relapsed and refractory eases were observed in 10 patients, and they all showed little response to chemotherapy with a response rate of 30.0%(3/10). Among the 21 patients, 11(52.3%) cases died of the disease with a median survival time of 28 months. Of these 21 patients, 7 patients were CD10(+), 5 patients overexpressed bel-6, 12 patients were bcl-2(+), and 15 patients overexpressed MUM1.Overexpressed bcl-2 and MUM1 indicated bad prognosis. Conclusion: Most of the testieular diffuse large B cell lymphoma patients were non-GCB. And they were sensitive to CHOP chemotherapy. The results suggested that all patients should receive chemotherapy after surgery. It was curable in the early stage. However,the options of treatment method for the patients with relapsed and refractory cases are limited and need to be further explored.