Tucci Alessandra, Motta Maddalena, Ungari Marco, Ruggeri Giulia, Crippa Claudia, Borlenghi Erika, Ubiali Alessandro, Facchetti Fabio, Rossi Giuseppe
U.O. Ematologia, I Divisione Anatomia Patologia, Spedali Civili, Cattedra di Anatomia Patologica, Università di Brescia, Brescia, Italy.
Haematologica. 2005 Mar;90(3):348-52.
Distinct types of lymphoma may develop in the same patient either simultaneously or sequentially. The frequency and clinical significance of this phenomenon are still only partially known.
We conducted a retrospective analysis of all cases of lymphomas of different histology occurring in the same patient, denoting these cases as multiple histology lymphoma (MHL). The clinicopathologic characteristics of these cases were compared with those of cases with a single histology (SHL). The histologic classifications were made according to the REAL classification by the same pathologists throughout the study period.
MHL were identified in 46 of 347 (13%) consecutive cases of lymphoma diagnosed at a single institution. They presented more frequently in stage III-IV (p=0.008), but the age, sex, and IPI score of patients with MHL did not differ from those of patients with SHL. Small lymphocytic/lymphoplasmacytic subtype was more frequent (16.1% vs 3%, p<0.0001) and Hodgkin's lymphoma (4% vs 16%; p=0.004) less frequent in MHL. Response rates to treatment were similar (85% vs 77.5%), whereas 5-year overall survival was significantly lower for MHL than for SHL (31% vs 67%; p=0.015). Among MHL, 14 cases were diagnosed simultaneously and 32 sequentially, after a median of 18 months. The two subgroups with simultaneous and sequential presentation did not differ in their demographic, clinicopathologic or prognostic characteristics.
Lymphomas of different histology develop frequently in the same patient, either simultaneously or sequentially. Patients with MHL form a subgroup with few peculiar presenting clinicopathologic features but a markedly worse prognosis, thus warranting prospective biological and clinical studies.
不同类型的淋巴瘤可在同一患者体内同时或先后发生。这一现象的发生率及临床意义目前仍仅部分为人所知。
我们对同一患者发生的所有不同组织学类型的淋巴瘤病例进行了回顾性分析，将这些病例定义为多组织学类型淋巴瘤（MHL）。将这些病例的临床病理特征与单一组织学类型（SHL）的病例进行比较。在整个研究期间，组织学分类均由同一位病理学家依据REAL分类法进行。
在某单一机构确诊的347例连续淋巴瘤病例中，有46例（13%）为MHL。MHL更多见于Ⅲ-Ⅳ期（p=0.008），但MHL患者的年龄、性别及国际预后指数（IPI）评分与SHL患者并无差异。MHL中，小淋巴细胞/淋巴浆细胞亚型更为常见（16.1%对3%，p<0.0001），而霍奇金淋巴瘤则较少见（4%对16%；p=0.004）。治疗缓解率相似（85%对77.5%），但MHL患者的5年总生存率显著低于SHL患者（31%对67%；p=0.015）。在MHL中，14例为同时诊断，32例为先后诊断，先后诊断者的中位间隔时间为18个月。同时诊断和先后诊断的两个亚组在人口统计学、临床病理或预后特征方面并无差异。
不同组织学类型的淋巴瘤常可在同一患者体内同时或先后发生。MHL患者构成一个亚组，其临床病理特征鲜有独特之处，但预后明显较差，因此有必要开展前瞻性生物学及临床研究。
