头颈部黏膜相关淋巴组织淋巴瘤的临床特征
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摘要
目的:总结头颈部黏膜相关淋巴组织(MALT)淋巴瘤的临床特征、诊断及治疗方法。方法:回顾性分析收治的22例头颈部MALT淋巴瘤患者的临床资料。结果:22例患者中发病部位分别为唾液腺13例,喉及气管4例,鼻咽部3例,甲状腺2例。临床上均表现为局部占位病变或压迫症状。化疗或放化疗12例,手术加化疗5例,手术加放疗3例,单纯手术切除及单纯放疗各1例。15例在初始治疗后病变完全缓解,6例部分缓解,1例疾病稳定。平均随访时间92个月(8～211个月)。随访期间共18例患者生存,4例死亡,3年无进展生存率及总生存率均为95.2%,5年无进展生存率及总生存率分别为79.4%及89.6%。结论:头颈部MALT淋巴瘤预后较好,无特异性临床表现,治疗上以化疗为主,病变局限者可选择局部治疗。
Objective: To summarize the clinical features, diagnosis and treatment of mucosa-associated lymphoid tissue(MALT) lymphoma in head and neck. Method: The clinical data of 22 hospitalizedpatients with MALT lymphoma in head and neck during the recent 18 years were analyzed retrospectively. Result: Among the 22 cases, 13 patients showed salivary gland lesions, 4 showed larynx and trachea lesions, 3 showed nasopharynx lesions and 2 showed thyroid gland lesions. The clinical manifestation was occupying or compression. Among them, 12 patients received chemotherapy or chemoradiotherapy, 5 received surgery plus chemotherapy, 3 received surgery plus radiotherapy, 1 received surgery alone and 1 received radiotherapy alone; complete response(CR) occurred in 15 patients, partial response(PR) occurred in 6 patients, and 1 was stable disease(SD). The mean follow-up time was 92(8-211) months. During the follow-up period, 18 patients survived, 4 died, the three-year progression free survival(PFS) and overall survival(OS) were both 95.2%, and the five-year PFS and OS were 79.4% and 89.6% respectively. Conclusion: The prognosis of MALT lymphoma in head and neck was good. MALT lymphoma has no specific clinical manifestations. Chemotherapy was the main treatment. Local treatment can be conducted for patients with localized lesions.
Objective: To summarize the clinical features, diagnosis and treatment of mucosa-associated lymphoid tissue(MALT) lymphoma in head and neck. Method: The clinical data of 22 hospitalizedpatients with MALT lymphoma in head and neck during the recent 18 years were analyzed retrospectively. Result: Among the 22 cases, 13 patients showed salivary gland lesions, 4 showed larynx and trachea lesions, 3 showed nasopharynx lesions and 2 showed thyroid gland lesions. The clinical manifestation was occupying or compression. Among them, 12 patients received chemotherapy or chemoradiotherapy, 5 received surgery plus chemotherapy, 3 received surgery plus radiotherapy, 1 received surgery alone and 1 received radiotherapy alone; complete response(CR) occurred in 15 patients, partial response(PR) occurred in 6 patients, and 1 was stable disease(SD). The mean follow-up time was 92(8-211) months. During the follow-up period, 18 patients survived, 4 died, the three-year progression free survival(PFS) and overall survival(OS) were both 95.2%, and the five-year PFS and OS were 79.4% and 89.6% respectively. Conclusion: The prognosis of MALT lymphoma in head and neck was good. MALT lymphoma has no specific clinical manifestations. Chemotherapy was the main treatment. Local treatment can be conducted for patients with localized lesions.
引文
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[19] WOZNIAK R,BECKWITH L,RATECH H,et al.Maltoma of thethyroid in a man with Hashimoto's thyroiditis[J].J Clin Endocrinol Metab,1999,84:1206-1209.
[20] HOFFMANN M,W?HRER S,BECHERER A,et al.18F-Fluoro-deoxy-glucose positron emission tomography in lymphoma of mucosa-associated lymphoid tissue:histology makes the difference[J].Ann Oncol,2006,17:1761-1765.
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[22] WOTHERSPOON A C,FINN T M,ISAACSON P G.Trisomy 3 in low-grade B-cell lymphomas of mucosa-associated lymphoid tissue[J].Blood,1995,85:2000-2004.
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[24] AUER I A,GASCOYNE R D,CONNORS J M,et al.t(11;18)(q21;q21) is the most common translocation in MALT lymphomas[J].Ann Oncol,1997,8:979-985.
[25] RINALDI A,MIAN M,CHIGRINOVA E,et al.Genome-wide DNA profiling of marginal zone lymphomas identifies subtype-specific lesions with an impact on the clinical outcome[J].Blood,2011,117:1595-1604.
[26] THIEBLEMONT C.Clinical presentation and management of marginal zone lymphomas[J].Hematol Am Soc Hematol Educ Program,2005,23:307-313.
[27] TANIMOTO K,KANEKO A,SUZUKI S,et al.Long-term follow-up results of no initial therapy for ocular adnexal MALT lymphoma[J].Ann Oncol,2006,17:135-140.
[28] SUH C,HUH J,ROH J L.Extranodal marginal zone B-cell lymphomaof mucosa-associated lymphoid tissue arisingin the extracranial head and neck region:A high rateof dissemination and disease recurrence[J].Oral Oncol,2008,44:949-955.
[29] 徐鹏程,周心一,周晨,等.腮腺黏膜相关淋巴组织淋巴瘤的临床特点分析[J].临床耳鼻咽喉头颈外科杂志,2017,30(1):61-64.
[30] KIESEWETTER B,LUKAS J,KUCHAR A,et al.Clinical features,treatment and outcome of mucosa-associated lymphoid tissue(MALT)lymphoma of the ocular adnexa:single center experience of 60 patients[J].PLoS One,2014,9:e104004.
[2] HARRIS N L,JAFFE E S,DIEBOLD J,et al.World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues:report of the Clinical Advisory Committee meeting-Airlie House,Virginia,November 1997[J].J Clin Oncol,1999,17:3835-3849.
[3] PERRY A M,DIEBOLD J,NATHWANI B N,et al.Non-Hodgkin lymphoma in the developing world:review of 4539 cases from the international non-hodgkin lymphoma classification project[J].Haematologica,2016,101:1244-1250.
[4] RADERER M,KIESEWETTER B,FERRERI A J.Clinicopathologic characteristics and treatment of marginal zone lymphoma of mucosa-associated lymphoid tissue(MALT lymphoma)[J].CA Cancer J Clin,2016,66:153-171.
[5] ZUCCA E,CONCONI A,PEDRINIS E,et al.Nongastric marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue[J].Blood,2003,101:2489-2495.
[6] ZINZANI P L,MAGAGNOLI M,GALIENI P,et al.Nongastrointestinal low-grade mucosa-associated lymphoid tissue lymphoma:analysis of 75 patients[J].J Clin Oncol,1999,17:1254-1258.
[7] CHESON D B,FISHER R I,BARRINGTON S F,et al.Recommendations for initial evaluation,staging,and response assessment of Hodgkin and non-Hodgkin lymphoma:The Lugano classification[J].J Clin Oncol,2014,32:3059-3067.
[8] VEGA F,LIN P,MEDEIROS L J.Extranodal lymphomas of the head and neck[J].Ann Diagn Pathol,2005,9:340-350.
[9] PICARD A,CARDINNE C,DENOUX Y,et al.Extranodal lymphoma of the head and neck:a 67-case series[J].Eur Ann Otorhinolaryngol Head Neck Dis,2015,132:71-75.
[10] THIEBLEMONT C,BASTION Y,BERGER F,et al.Mucosa-associated lymphoid tissue gastrointestinal and nongastrointestinal lymphoma behavior:analysis of 108 patients[J].J Clin Oncol,1997,15:1624-1630.
[11] RADASZKIEWICZ T,DRAGOSICS B,BAUER P.Gastrointestinal malignant lymphomas of the mucosa-associated lymphoid tissue:factors relevant to prognosis[J].Gastroenterology,1992,102:1628-1638.
[12] ZUCCA E,BERTONI F,ROGGERO E,et al.The gastric marginal zone B-cell lymphoma of MALT type[J].Blood,2000,96:410-419.
[13] COGLIATTI S B,SCHMID U,SCHUMACHER U,et al.Primary B-cell gastric lymphoma:a clinicopathological study of 145 patients[J].Gastroenterology,1991,101:1159-1170.
[14] BAYERDORFFER E,NEUBAUER A,RUDOLPH B,et al.Regression of primary gastric lymphoma of mucosa-associated lymphoid tissue type after cure of Helicobacterpylori infection.MALT Lymphoma Study Group[J].Lancet,1995,345:1591-1594.
[15] ROGGERO E,ZUCCA E,PINOTTI G,et al.Eradication of Helicobacter pylori infection in primarylow-grade gastric lymphoma of mucosa-associated lymphoidtissue[J].Ann Int Med,1995,122:767-769.
[16] ISAACSON P G.Mucosa-associated lymphoid tissue lymphoma[J].Semin Hematol,1999,36:139-147.
[17] PARIENTE D,ANAYA J M,COMBE B,et al.Non-Hodgkin's lymphoma associated withprimary Sj?gren's syndrome[J].Eur J Med,1992,1:337-342.
[18] HYJEK E,SMITH W J,ISAACSON P G.Primary B-cell lymphoma ofsalivary glands and its relationship to myoepithelial sialadenitis[J].Hum Pathol,1988,19:766-776.
[19] WOZNIAK R,BECKWITH L,RATECH H,et al.Maltoma of thethyroid in a man with Hashimoto's thyroiditis[J].J Clin Endocrinol Metab,1999,84:1206-1209.
[20] HOFFMANN M,W?HRER S,BECHERER A,et al.18F-Fluoro-deoxy-glucose positron emission tomography in lymphoma of mucosa-associated lymphoid tissue:histology makes the difference[J].Ann Oncol,2006,17:1761-1765.
[21] BARRINGTON S F,MIKHAEEL N G,KOSTAKOGLU L,et al.Role of imaging in the staging and response assessment of lymphoma:consensus of the International Conference on Malignant Lymphomas Imaging Working Group[J].J Clin Oncol,2014,32:3048-3058.
[22] WOTHERSPOON A C,FINN T M,ISAACSON P G.Trisomy 3 in low-grade B-cell lymphomas of mucosa-associated lymphoid tissue[J].Blood,1995,85:2000-2004.
[23] OTT G,KATZENBERGER T,GREINER A,et al.The t(11;18)(q21;q21) chromosome translocation is a frequent and specific aberration in low-grade but not high-grade malignant non-Hodgkin's lymphomas of the mucosa-associated lymphoid tissue(MALT-)type[J].Cancer Res,1997,57:3944-3948.
[24] AUER I A,GASCOYNE R D,CONNORS J M,et al.t(11;18)(q21;q21) is the most common translocation in MALT lymphomas[J].Ann Oncol,1997,8:979-985.
[25] RINALDI A,MIAN M,CHIGRINOVA E,et al.Genome-wide DNA profiling of marginal zone lymphomas identifies subtype-specific lesions with an impact on the clinical outcome[J].Blood,2011,117:1595-1604.
[26] THIEBLEMONT C.Clinical presentation and management of marginal zone lymphomas[J].Hematol Am Soc Hematol Educ Program,2005,23:307-313.
[27] TANIMOTO K,KANEKO A,SUZUKI S,et al.Long-term follow-up results of no initial therapy for ocular adnexal MALT lymphoma[J].Ann Oncol,2006,17:135-140.
[28] SUH C,HUH J,ROH J L.Extranodal marginal zone B-cell lymphomaof mucosa-associated lymphoid tissue arisingin the extracranial head and neck region:A high rateof dissemination and disease recurrence[J].Oral Oncol,2008,44:949-955.
[29] 徐鹏程,周心一,周晨,等.腮腺黏膜相关淋巴组织淋巴瘤的临床特点分析[J].临床耳鼻咽喉头颈外科杂志,2017,30(1):61-64.
[30] KIESEWETTER B,LUKAS J,KUCHAR A,et al.Clinical features,treatment and outcome of mucosa-associated lymphoid tissue(MALT)lymphoma of the ocular adnexa:single center experience of 60 patients[J].PLoS One,2014,9:e104004.