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目的了解累及肺的恶性淋巴瘤临床及病理特征。方法分析16例肺淋巴瘤患者的年龄、性别、肿瘤大小、临床分期、手术方式、病理类型、术后治疗方式及生存情况。结果 16例肺恶性淋巴瘤中12例为黏膜相关淋巴组织(MALT)边缘区B细胞性淋巴瘤,2例为弥漫大B细胞性淋巴瘤(DLBCL),1例为霍奇金淋巴瘤(HL);1例为肺淋巴瘤样肉芽肿(PLG)。肺MALT边缘区B细胞淋巴瘤可见肺组织内小淋巴细胞样细胞弥漫浸润,可见明显的淋巴上皮病变;CD20和CD79a(+)。DLBCL见肿瘤性大B淋巴样细胞的弥漫性浸润破坏肺实质;CD20和CD79a(+)。HL见纤维硬化背景上淋巴细胞、浆细胞、嗜酸性粒细胞和组织细胞等细胞呈结节状增生,结节内可见多少不等的异型大细胞,细胞呈霍奇金样和RS细胞样;CD15和CD30(+),LCA、CD20和CD3(-)。PLG见不典型的B细胞多形性浸润和大量反应性T细胞,具有明显的血管浸润现象和坏死;LCA、CD20和CD79a(+)。所有患者随访8～47个月,除1例MALT淋巴瘤患者失访外,其余全部存活,4例患者复发。结论累及肺的恶性淋巴瘤中常见的类型为MALT边缘区B细胞淋巴瘤。掌握肺淋巴瘤手术切除标本的诊断要点,有利于提高肺小活检的病理诊断水平。
Objective To understand the clinical and pathological features of lung malignant lymphoma. Methods The age, sex, tumor size, clinical stage, operation method, pathological type, postoperative treatment and survival of 16 patients with pulmonary lymphoma were analyzed. Results Twelve of 16 patients with malignant lymphoma were marginal B cell lymphoma of mucosa associated lymphoid tissue (MALT), 2 were DLBCL, and 1 was Hodgkin ’s lymphoma ); 1 case of lymphoma-like granuloma (PLG). MALT marginal zone B-cell lymphoma can be seen in the lung tissue of small lymphocyte-like cells diffuse infiltration, visible lymphoid epithelial lesions; CD20 and CD79a (+). Diffuse infiltration of large, tumorigenic B-lymphoid cells in DLBCLs disrupts lung parenchyma; CD20 and CD79a (+). HL see fibrosis sclerosis background lymphocytes, plasma cells, eosinophils and tissue cells were nodular hyperplasia, the nodules can be seen in the number of different shaped large cells, cells were Hodgkin-like and RS cell-like; CD15 and CD30 (+), LCA, CD20 and CD3 (-). PLG see typical B-cell pleomorphic infiltration and a large number of reactive T cells, with significant vascular infiltration and necrosis; LCA, CD20 and CD79a (+). All patients were followed up for 8 ~ 47 months. All but one MALT lymphoma patients were lost to follow-up. All patients survived and 4 patients relapsed. Conclusions A common type of malignant lymphoma involving the lung is MALT marginal zone B-cell lymphoma. Grasp the diagnosis of surgical specimens of pulmonary lymph nodes, is helpful to improve the pathological diagnosis of lung biopsy.