Bostwick D G, Iczkowski K A, Amin M B, Discigil G, Osborne B
Department of Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Cancer. 1998 Aug 15;83(4):732-8. doi: 10.1002/(sici)1097-0142(19980815)83:4<732::aid-cncr15>3.0.co;2-t.
Malignant lymphoma involving the prostate is rare, and to the authors' knowledge the factors determining patient outcome have not been studied in a large series.
The authors evaluated the clinical and pathologic findings in 60 cases of non-Hodgkin's lymphoma and 2 cases of Hodgkin's lymphoma involving the prostate. A variety of clinical and histologic findings were considered as factors predictive of patient outcome.
Lymphoma tended to occur in elderly men, with a mean age at diagnosis of 62 years (range, 5-89 years), although 6 patients were age < 40 years (ages 5, 19, 30, 32, 38, and 38 years, respectively). Clinical signs and symptoms were due to lower urinary tract obstruction. Twenty-two patients (35%) presented with primary extranodal lymphoma of the prostate with a variety of histologic subtypes, including small lymphocytic (4 patients); follicular center cell, diffuse, small cell (2 patients); follicular center cell, Grade 1 (according to the revised European-American classification (small cleaved) (1 patient); Grade 2 (mixed) (1 patient); diffuse large B-cell (12 patients); and high grade B-cell lymphoma, Burkitt-like (2 patients). At the time of presentation, none of these patients had hepatosplenomegaly, inguinal lymphadenopathy, or an abnormal complete blood count. Thirty other patients (48%) with previously documented lymphoma at other sites developed prostatic involvement; these secondary prostatic lymphomas displayed a variety of subtypes, including small lymphocytic (8 patients, all with concomitant leukemia); follicular center cell lymphoma, diffuse, small cell (2 patients); follicular center, Grade 1 (small cell) (1 patient); follicular center, Grade 2 (1 patient); diffuse large B-cell (11 patients); peripheral T-cell lymphoma (2 patients); high grade B-cell lymphoma, Burkitt-like (1 patient); Burkitt's lymphoma (1 patient); Hodgkin's lymphoma (nodular sclerosing [1 patient] and mixed cellularity [1 patient]); and unknown (1 patient). Ten cases were not classifiable as primary or secondary lymphomas. Twenty-five patients died of malignant lymphoma, 14 died of unknown or other causes, 18 patients were alive 12-20 months after diagnosis (8 primary and 10 secondary tumors; 3 had persistent lymphoma; all treated since 1981), and 5 were lost to follow-up. Lymphoma specific survival was 64% at 1 year (95% confidence interval [CI], 51-80%), 50% at 2 years (95% CI, 36-68%), 33% at 5 years, 33% at 10 years, and 16% at 15 years. There was no difference in median survival after diagnosis of prostatic involvement between primary and secondary lymphoma (23 months vs. 28 months, respectively) or among histologic types.
Although malignant lymphoma involving the prostate is rare, it should be considered in the differential diagnosis of lower urinary tract obstruction, particularly in patients with a previous history of lymphoma.
前列腺恶性淋巴瘤较为罕见，据作者所知，尚未有大量研究确定影响患者预后的因素。
作者评估了60例非霍奇金淋巴瘤和2例霍奇金淋巴瘤累及前列腺患者的临床和病理表现。多种临床和组织学表现被视为预测患者预后的因素。
淋巴瘤倾向于发生在老年男性中，诊断时的平均年龄为62岁（范围5 - 89岁），不过有6例患者年龄小于40岁（分别为5岁、19岁、30岁、32岁、38岁和38岁）。临床体征和症状由下尿路梗阻引起。22例患者（35%）表现为原发性前列腺结外淋巴瘤，有多种组织学亚型，包括小淋巴细胞型（4例）；滤泡中心细胞型，弥漫性，小细胞型（2例）；滤泡中心细胞型，1级（根据修订的欧美分类法[小裂细胞型]）（1例）；2级（混合型）（1例）；弥漫性大B细胞型（12例）；高级别B细胞淋巴瘤，伯基特样型（2例）。就诊时，这些患者均无肝脾肿大、腹股沟淋巴结肿大或血常规异常。另外30例患者（48%）先前在其他部位有淋巴瘤病史，出现了前列腺受累；这些继发性前列腺淋巴瘤表现为多种亚型，包括小淋巴细胞型（8例，均合并白血病）；滤泡中心细胞淋巴瘤，弥漫性，小细胞型（2例）；滤泡中心，1级（小细胞型）（1例）；滤泡中心，2级（1例）；弥漫性大B细胞型（11例）；外周T细胞淋巴瘤（2例）；高级别B细胞淋巴瘤，伯基特样型（1例）；伯基特淋巴瘤（1例）；霍奇金淋巴瘤（结节硬化型[1例]和混合细胞型[1例]）；以及不明类型（1例）。10例病例无法分类为原发性或继发性淋巴瘤。25例患者死于恶性淋巴瘤，14例死于不明或其他原因，18例患者在诊断后12 - 20个月存活（8例原发性肿瘤和10例继发性肿瘤；3例有持续性淋巴瘤；均自1981年起接受治疗），5例失访。淋巴瘤特异性生存率在1年时为64%（95%置信区间[CI]，51 - 80%），2年时为50%（95% CI，36 - 68%），5年时为33%，10年时为33%，15年时为16%。原发性和继发性淋巴瘤在前列腺受累诊断后的中位生存期无差异（分别为23个月和28个月），组织学类型之间也无差异。
尽管前列腺恶性淋巴瘤罕见，但在鉴别下尿路梗阻时应考虑到，尤其是有淋巴瘤病史的患者。
