Damron T A, Le M H, Rooney M T, Vermont A, Poiesz B J
Section of Orthopedic Oncology, Department of Orthopedic Surgery, State University of New York, Syracuse, USA.
Clin Orthop Relat Res. 1999 Mar(360):221-30. doi: 10.1097/00003086-199903000-00026.
Lymphoma presenting as a soft tissue mass is rare and thus may be confused with the more common soft tissue sarcoma. No previous analysis of the clinical and radiologic features of lymphomas presenting as soft tissue masses is available because most of the cases reviewed are from the pathology literature. Four patients with diagnoses of extranodal lymphomas of the soft tissues were reviewed retrospectively with respect to their clinical features, primary tumor characteristics, stage, radiographic characteristics, treatment, and followup. Mean age was 72.5 years (range, 52-85 years). The soft tissue mass occurred in the thigh (three cases) and shoulder (one case). The median size of the soft tissue mass was 6.7 cm (range, 2-15 cm) in the largest dimension, as measured on magnetic resonance imaging. These patients each had evidence of lymphadenopathy at the time of diagnosis. Lactate dehydrogenase was increased significantly in two cases and increased slightly in two other cases. One case was Stage II(E) at presentation, one was Stage III(E), and two were Stage IV. All were B cell immunophenotype. All patients died between 2 and 24 months after diagnosis, despite the use of Cytoxan, vincristine, adriamycin, and prednisone chemotherapy in each case. Clinical and radiographic features that favor extranodal soft tissue lymphoma over sarcoma include pain and tenderness, lymphadenopathy (particularly when confluent radiologically), ipsilateral extremity swelling, and elevated lactate dehydrogenase.
表现为软组织肿块的淋巴瘤较为罕见，因此可能会与更常见的软组织肉瘤相混淆。由于大多数回顾的病例来自病理学文献，目前尚无对表现为软组织肿块的淋巴瘤的临床和放射学特征进行分析的报道。对4例软组织结外淋巴瘤患者的临床特征、原发肿瘤特征、分期、影像学特征、治疗及随访情况进行了回顾性分析。平均年龄为72.5岁（范围52 - 85岁）。软组织肿块发生在大腿（3例）和肩部（1例）。根据磁共振成像测量，软组织肿块最大径的中位数为6.7 cm（范围2 - 15 cm）。这些患者在诊断时均有淋巴结病的证据。2例乳酸脱氢酶显著升高，另2例轻度升高。1例初诊时为Ⅱ（E）期，1例为Ⅲ（E）期，2例为Ⅳ期。所有患者均为B细胞免疫表型。尽管每例患者均使用了环磷酰胺、长春新碱、阿霉素和泼尼松进行化疗，但所有患者均在诊断后2至24个月内死亡。相较于肉瘤，支持结外软组织淋巴瘤的临床和影像学特征包括疼痛和压痛、淋巴结病（特别是影像学上融合时）、同侧肢体肿胀以及乳酸脱氢酶升高。
