以肺部多发磨玻璃样结节影为主要表现的肺原发弥漫大B细胞淋巴瘤1例报告及文献复习

目的：分析以肺部多发磨玻璃样结节影为主要表现的肺原发弥漫大B细胞淋巴瘤（DLBCL）患者的临床特点、影像学表现、诊断方法、病理形态表现和预后，提高临床医生对肺原发DLBCL的认识。方法：收集1例肺原发DLBCL患者的临床资料，患者CT检查主要表现为肺部多发团块状磨玻璃样结节影，初始诊断为肺炎，经过病理和免疫组织化学检查最终确诊，并进行相关文献复习。结果：患者，女性，60岁，以咳嗽和咳痰为首发症状入院。查体无明显阳性体征。胸部CT检查显示双肺多发磨玻璃样结节影。行肿瘤标记物、淋巴结彩超、PET-CT、骨髓穿刺活检、病理活检和其他相关检查，并给予相关治疗。PET-CT检查提示双肺多发磨玻璃结节伴部分代谢增高，病理形态表现和免疫组织化学结果提示非霍奇金DLBCL，起源于生发中心外活化B细胞。最终诊断为肺原发DLBCL。患者给予R-CHOP方案规律化疗，3个月后复查胸部CT显示双肺团块状结节影消失。结论：肺原发DLBCL患者临床特点和影像学表现无明显特异性，其诊断最终依赖病理形态表现和免疫组织化学检查结果，肺原发DLBCL恶性程度较高，预后较差，当肺部出现多发磨玻璃样结节影时应考虑该病。

Primary pulmonary diffused large B-cell lymphoma with multiple ground glass nodule shadows in lungs as main manifestation: A case report and literature review

Objective: To analyze the clinical features, imaging findings, diagnostic methods, pathomorphology and prognosis of the patients with primary pulmonary diffused large B-cell lymphoma (DLBCL) with the multiple ground glassy nodule shadows in the lungs as the main manifestation, and to improve the clinicians'understanding of the primary pulmonary DLBCL. Methods: The clinical data of a patient with primary pulmonary DLBCL were collected. The main manifestation in CT examination of the patient was multiple massive ground glass nodule shadows in the lungs. The initial diagnosis was pneumonia. The final diagnosis of primary pulmonary DLBCL was confirmed by pathology and immunohistochemistry examination. The related literatures were reviewed. Results: The female patient was admitted to hospital due to cough and expectoration as the first manifestations. There were no obvious positive signs in the physical examination. The CT examination results showed multiple ground glassy nodular shadows in both lungs.The tumor markers, lymph node color Doppler ultrasound, PET-CT, bone marrow biopsy, pathological biopsy and the other related examinations were performed, and the related treatment were given. The PET-CT results showed the multiple ground glass nodule in both lungs complicated with increasing of partial metabolism, and the pathological and immunohistochemical results suggested that the patient was non-Hodgkin DLBCL originated from the activated B cells outside the germinal center,and the final diagnosis was primary pulmonary DLBCL. The patient was given R-CHOP regimen regularly.The patient received chest CT examination 3 months later,and the results showed that the massive nodule shadows in both lungs were disappeared. Conclusion: The clinical features and imaging findings of the patient with primary pulmonary DLBCL are not specific, its diagnosis ultimately relies on the pathomophological and immunohistochemical examination results; the degree of malignancy of primary pulmonary DLBCL is high,and the prognosis is poor; when there are multiple ground glass nodule shadows in the lungs, the disease should be taken into account.