Li Li, Han Qi, Gu Yan, Ge Zheng
School of Clinical Medicine, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China.Department of Hematology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China.Department of Respiration, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China.
Department of Hematology, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu Province, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2023 Feb;31(1):109-114. doi: 10.19746/j.cnki.issn.1009-2137.2023.01.017.
To study the clinical, imaging, and pathological features of pulmonary lymphoma.
Patients with pulmonary lymphoma diagnosed by lung biopsy in Zhongda Hospital Affiliated to Southeast University from November 2013 to December 2020 were collected and divided into secondary pulmonary lymphoma (SPL) group and primary pulmonary lymphoma (PPL) group according to the primary site of lymphoma. The clinical characteristics, stages, imaging features, diagnostic methods and pathological types of the two groups were analyzed.
A total of 22 patients were included, 10 cases were PPL and 12 cases were SPL. The main symptoms of the two groups were cough, dyspnea and chest pain. The proportion of stage III/IV patients and international prognostic index (IPI) in SPL group were significantly higher than those in PPL group (<0.05). Chest high-resolution computed tomography (HRCT) mainly showed masses, nodules and consolidation in both groups. The proportions of single mass and air bronchial sign in PPL group were significantly higher than those in SPL group, while the proportions of multiple nodules, mediastinal/hilar lymphadenopathy and pleural effusion were significantly lower (<0.05). The max standardized uptake value (SUV), peak standardized uptake value (SUV), total lesion glycolysis (TLG) and metabolic tumor volume (MTV) of F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) in PPL group were lower than those in SPL group, but the differences were not statistically significant (>0.05). In PPL group, 8 cases were diagnosed by transbronchial lung biopsy (TBLB) and 2 cases by percutaneous lung puncture. In SPL group, 4 cases were diagnosed by TBLB, 7 cases by percutaneous lung puncture, and 1 case by surgery. 95.5% patients were diagnosed by non-surgical methods. The main pathological type of PPL was mucosa-associated lymphoid tissue (MALT) lymphoma, while that of SPL was diffuse large B-cell lymphoma (<0.05).
The clinical symptoms of pulmonary lymphoma are nonspecific, but the chest HRCT has characteristic manifestations, which can also help to distinguish between SPL and PPL. F-FDG PET/CT is also a potential method to distinguish between SPL and PPL. TBLB and percutaneous lung puncture biopsy are reliable methods for the diagnosis of lung lymphoma. The main pathological type of PPL is MALT lymphoma, while that of SPL is diffuse large B-cell lymphoma.
研究肺淋巴瘤的临床、影像学及病理特征。
收集2013年11月至2020年12月在东南大学附属中大医院经肺活检确诊的肺淋巴瘤患者，根据淋巴瘤的原发部位分为继发性肺淋巴瘤（SPL）组和原发性肺淋巴瘤（PPL）组。分析两组的临床特征、分期、影像学特征、诊断方法及病理类型。
共纳入22例患者，其中PPL组10例，SPL组12例。两组的主要症状为咳嗽、呼吸困难和胸痛。SPL组Ⅲ/Ⅳ期患者比例及国际预后指数（IPI）显著高于PPL组（<0.05）。胸部高分辨率计算机断层扫描（HRCT）主要表现为两组均有肿块、结节及实变。PPL组单发病灶及空气支气管征比例显著高于SPL组，而多发结节、纵隔/肺门淋巴结肿大及胸腔积液比例显著低于SPL组（<0.05）。PPL组氟代脱氧葡萄糖（F-FDG）正电子发射断层显像/计算机断层扫描（PET/CT）的最大标准化摄取值（SUV）、峰值标准化摄取值（SUV）、总病变糖酵解（TLG）及代谢肿瘤体积（MTV）低于SPL组，但差异无统计学意义（>0.05）。PPL组8例经支气管镜肺活检（TBLB）确诊，2例经皮肺穿刺确诊。SPL组4例经TBLB确诊，7例经皮肺穿刺确诊，1例经手术确诊。95.5%的患者通过非手术方法确诊。PPL的主要病理类型为黏膜相关淋巴组织（MALT）淋巴瘤，而SPL为弥漫大B细胞淋巴瘤（<0.05）。
肺淋巴瘤的临床症状无特异性，但胸部HRCT有特征性表现，也有助于区分SPL和PPL。F-FDG PET/CT也是区分SPL和PPL的一种潜在方法。TBLB及经皮肺穿刺活检是诊断肺淋巴瘤的可靠方法。PPL的主要病理类型为MALT淋巴瘤，而SPL为弥漫大B细胞淋巴瘤。
