肺黏膜相关淋巴组织淋巴瘤临床特征分析

目的：提高肺黏膜相关淋巴组织淋巴瘤诊治水平。方法回顾性分析江西省人民医院及南昌大学第二附属医院自2005年1月至2015年1月确诊的8例肺黏膜相关淋巴组织淋巴瘤的临床表现、影像学特点、诊断手段、误诊情况、治疗及预后。结果8例肺黏膜相关淋巴组织淋巴瘤中男6例,女2例,年龄38~75岁,中位年龄65岁。主要症状：咳嗽(5例)、咳痰(4例)、发热(2例)、胸闷(4例)、乏力(3例)、消瘦(3例),无症状2例。胸部 CT 表现：双肺分布5例,单肺分布3例,实变影5例,肿块及结节影4例,斑片状浸润影3例,支气管充气征5例,钙化1例,空洞2例。确诊方法：经气管镜活检1例,CT 引导下经皮肺穿刺5例,外科手术2例。误诊分析：5例误诊为细菌性肺炎,1例误诊为肺真菌病,1例误诊为肺癌,1例误诊为肺转移癌。治疗及预后：2例外科手术患者术后未行放化疗,4例转入血液内科行化疗(CHOP 方案),2例放弃治疗。8例患者随访时间2~105个月,2例死亡,6例存活。结论肺黏膜相关淋巴组织淋巴瘤临床表现不典型,容易误诊,诊断需要组织病理活检。

Clinical features of pulmonary mucosa-associated lymphoid tissue lymphoma

Objective To improve the level of diagnosis and treatment of pulmonary mucosa-associated lymphoid tissue(MALT) lymphoma.Methods The clinical data of eight cases of pulmonary MALT lymphoma in Jiangxi Provincial People′s Hosptial and the Second Hospital affiliated to Nanchang University from January 2005 to January 201 5 were retrospectively analyzed.Results Among these patients,there were six males and two females,age was 38-75 years old (median 65 years old).Clinical manifestations included cough (five cases),sputum (four cases),fever (two cases),apnea (four cases), fatigue (three cases),weight loss(three cases),two cases had no symptom.Features of chest CT included bilateral (five cases),unilateral (three cases),consolidation (five cases),nodule and mass (four cases), infiltration(three cases),air bronchogram (five cases),calcification (one case),cavity (two cases). Diagnostic method included bronchoscopic biopsy (one case),percutaneous lung biospy (five cases), surgical operation(two cases).Misdiagnosis analysis:bacterial pneumonia(five cases),pneumonomycosis (one case),lung cancer (one case),lung metastases (one case).Treatment and prognosis:surgery (two cases),chemotherapy(four cases),release treatmet (two cases).Follow-up time was 2-105 months,two patients died,six patients were still alive.Conclusions The clinical manifestations of pulmonary MALT lymphoma are nonspecific and misdiagnosis is common.Formal diagnosis of pulmonary MALT lymphoma requires histologic biospy and pathological examination.