口腔颌面部淋巴瘤的临床特征及诊断

目的探讨原发于口腔颌面部淋巴瘤的临床特点、误诊情况及其诊断与鉴别诊断。方法回顾性分析中山大学附属第一医院口腔科1991年1月至2008年3月收治的29例口腔颌面部淋巴瘤病例的临床资料：同时通过中国医院知识数据库收集1991年1月至2008年6月国内报道的有关口腔颌面部淋巴瘤的文献．对这些文献进行归纳与总结．探寻本病的一般临床特点及其诊断与鉴别诊断。结果口腔颌面部淋巴瘤可发生于任何年龄，患者年龄最小11个月，最大86岁，平均约50．2岁：男女之比为1．26：1：好发部位依次为颈部（20．1％）、颌颏下区（16．8％）、腮腺（11．4％）、腭部（10．3％）、下颌骨（7．3％）等处。临床表现呈多样性：无痛性肿块型（74％）、溃疡坏死型（13．9％）、炎症浸润型（7．3％）及水肿红斑型（1．5％）等。首诊易误诊为慢性淋巴结炎、淋巴结转移癌及颌面部软组织炎症等。病理分型中非霍奇金淋巴瘤（90．5％）较霍奇金淋巴瘤（9．5％）多见，非霍奇金淋巴瘤中B细胞型淋巴瘤（83％）较T细胞型淋巴瘤（17％）多见。结论原发于口腔颌面部的淋巴瘤临床表现呈多样性．需与其他疾病相鉴别。以减少误诊；确诊需依靠病理学诊断。

The clinical features and diagnosis of lymphomas in oral and maxillofacial region

Objective To investigate the phenotypes, misdiagnosis and the clinical differential diagnosis of lymphomas in oral and maxillofacial region. Methods Retrospective study was made on all 29 cases with oral and maxillofacial lymphomas in our department from Jan.1991 to Mar.2008. From Jan. 1991 to Jun. 2008, the references about oral and maxillofacial lymphomas were collected from CHKD. We analyzed these references to find commonly clinical features of this tumor. Results The patients with lymphomas have a wide range of age. The youngest patient is 11 months, and the oldest one is 86 years old. The average age is 50.2. Males are more than females, the ratio is 1.26：1. Lymphomas is often found in cervial part （20.1%）, submaxillary region （16.8%）, parotid gland （11.4%）, pars palatalis （10.3%） and so on. It is easy to be misdiagnosed as chronic inflammation of lymphonodes, metastatic carcinoma, or lymph tuberculosis due to their muti- phenotypes such as masses （74%）, ulcer and necrosis（13.9%）, inflammatory infihration（7.3%）, erythemoid nodules（1.5%）, etc. NHL（90.5%） is more than HL（9.5%） according to the pathological classification of lymphomas. Among NHL, the type of B cell （83%） is more than T cell （17%）. Conclusions Misdiagnosis in oral and maxillofacial lymphomas is very common in clinic due to it＇s multi-manifestation. The differential diagnosis should be emphasized clinically. And the suspicious cases should be diagnosed definitely through pathological examination.