Mentzer S J, Reilly J J, Skarin A T, Sugarbaker D J
Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115.
Surgery. 1993 May;113(5):507-14.
Recent evidence has suggested that the anatomic distribution of malignant lymphomas may reflect important differences in biologic behavior. To determine if the anatomic distribution of malignant lymphomas in the lung correlated with the disease course, we examined the pattern of lung involvement in patients with Hodgkin's and non-Hodgkin's lymphomas.
We reviewed the medical records of 651 patients with a diagnosis of malignant lymphoma and identified 54 patients with histologically documented lung involvement. Based on radiologic and surgical findings, these patients had lung involvement characterized as either (1) bronchovascular-lymphangitic, (2) nodular, or (3) alveolar. The pattern of lung involvement was correlated with clinical manifestations and disease course.
Distinct clinical courses were associated with these three patterns of lung involvement. In contrast, traditional histopathologic classification did not correlated with the pattern of lung involvement was a poor prognostic factor and was associated with a median survival of 12 1/2 months. Pleural effusions eventually developed in 24 patients and were associated with a median survival of only 3 months.
These findings suggest that the anatomic pattern of lung involvement is a measure of biologic behavior and may be a useful variable in the staging of patients with malignant lymphoma.
最近的证据表明，恶性淋巴瘤的解剖分布可能反映出生物学行为的重要差异。为了确定肺部恶性淋巴瘤的解剖分布是否与疾病进程相关，我们研究了霍奇金淋巴瘤和非霍奇金淋巴瘤患者的肺部受累模式。
我们回顾了651例诊断为恶性淋巴瘤患者的病历，确定了54例经组织学证实有肺部受累的患者。根据影像学和手术结果，这些患者的肺部受累表现为以下三种类型之一：（1）支气管血管淋巴管型，（2）结节型，或（3）肺泡型。肺部受累模式与临床表现和疾病进程相关。
这三种肺部受累模式与不同的临床进程相关。相比之下，传统的组织病理学分类与肺部受累模式无关，是一个不良的预后因素，中位生存期为12.5个月。24例患者最终出现胸腔积液，中位生存期仅为3个月。
这些发现表明，肺部受累的解剖模式是生物学行为的一个指标，可能是恶性淋巴瘤患者分期的一个有用变量。
