口腔颌面部恶性淋巴瘤37例临床分析
|
摘要
研究目的：通过回顾分析口腔颌面部恶性淋巴瘤的临床特点、诊断、治疗和预后，提高口腔颌面外科医生对恶性淋巴瘤的认识，达到早期临床诊断。方法：对37例口腔颌面部恶性淋巴瘤患者的临床资料进行回顾性研究。结果：37例口腔颌面部恶性淋巴瘤中，男∶女=1.31∶1，中位年龄55岁。发病部位依次为颌下、颏下7例、上颌部7例，腭部6例，腮腺5例，舌根部5例，颈上部4例，颊部2例，牙龈1例。37例全部是NHL，B细胞淋巴瘤27例(72.97％)，T／NK细胞淋巴瘤9例(24.32％)，1例未确定细胞来源。首次就诊均误诊为炎症和相应部位的良、恶性肿瘤。主要采用综合治疗。结论：口腔颌面部恶性淋巴瘤首诊中易被误诊和漏诊；组织活检以明确诊断；综合治疗是本病的主要治疗手段。
Objective: By studying retrospectively the clinical characteristics, diagnosis , treatment and prognosis of malignant lymphoma in oral and maxillofacial region, to enhance surgeon's recognition of the disease, lead to early clinical diagonosis. Methods: Clinical data of 37 cases were obtained from patient files. Each patient's complete record were reviewed. Results: Of a total of 37 cases malignant lymphoma recorded in a 5-year period, the ratio of male/female was 1:31 (21/16), and median age of the patients was 55 (range, 8-82 years old). Affected anatomic sites included: submaxillary and submentum (7), maxilla(7), palate(6), salivary gland(5),root of tongue(5), neck(4), cheek(2), gingival(1). All of the cases are NHL, B cell lymphoma 27 (72.97%) , T/NK cell lymphoma
9 (24.32%), one case's cell origin was uncerten. All of them was misdiagnosed for inflammation and corresponding sites benign or malignant tumor at first visit. Combined therapy was chief treatment method. Conclusion: ① Oral and maxillofacial malignant lymphoma was often misdiagnosed for other common oral diseases. ②Early diagnosis depended on a thorough examination and biopsies from suspected lesions. ③Chemotherapy combined with radiotherapv and operation is proved to be the most efficient therapeutic means. ④If discovered and treated early, malignant lymphoma in oral and maxillofacial regions has an better prognosis.
Objective: By studying retrospectively the clinical characteristics, diagnosis , treatment and prognosis of malignant lymphoma in oral and maxillofacial region, to enhance surgeon's recognition of the disease, lead to early clinical diagonosis. Methods: Clinical data of 37 cases were obtained from patient files. Each patient's complete record were reviewed. Results: Of a total of 37 cases malignant lymphoma recorded in a 5-year period, the ratio of male/female was 1:31 (21/16), and median age of the patients was 55 (range, 8-82 years old). Affected anatomic sites included: submaxillary and submentum (7), maxilla(7), palate(6), salivary gland(5),root of tongue(5), neck(4), cheek(2), gingival(1). All of the cases are NHL, B cell lymphoma 27 (72.97%) , T/NK cell lymphoma
9 (24.32%), one case's cell origin was uncerten. All of them was misdiagnosed for inflammation and corresponding sites benign or malignant tumor at first visit. Combined therapy was chief treatment method. Conclusion: ① Oral and maxillofacial malignant lymphoma was often misdiagnosed for other common oral diseases. ②Early diagnosis depended on a thorough examination and biopsies from suspected lesions. ③Chemotherapy combined with radiotherapv and operation is proved to be the most efficient therapeutic means. ④If discovered and treated early, malignant lymphoma in oral and maxillofacial regions has an better prognosis.
引文
[1] 顾晓明，张皖清，希杨等．颌面颈部恶性淋巴瘤-附88例报告．口腔颌面外科杂志，1998；8(3)157-159
[2] 庄奇新，顾一峰，朱莉莉等，口咽部恶性淋巴瘤的CT和MRI诊断，中国医学计算机成像杂志，2004：10(3)166-169
[3] 吴鹏强，赵春燕，韩丽英．淋巴瘤患者血清乳酸脱氢酶检测的临床意义．泸州医学院学报，2006；29(1)：22-23
[3] 郭传膑，马大权．涎腺恶性淋巴瘤的研究现状．北京口腔医学，2000；8(2)93-97
[4] 林曲，吴祥元．血清LDH水平对非霍奇金氏淋巴瘤的预后作用初探．癌症，1999，18(2)：216-217．
[5] Morra E. The biological markers of non-Hodekin's lymphomas: their role in diagnostic assessment and therapeutic strategy. Int. J. Biol. Markers, 1999; 14: 149-153
[6] Massimo F, Umberto V, Pier LZ, et al. Prognosis of follicular lymphoma: a predictive model based on a retrospective analysis of 987 cases. Blood, 2000195: 783-789
[7] Morra E. The biological markers of non-Hodekin's lymphomas: their role in diagnostic assessment and therapeutic strategy. Int. J. Biol. Markers, 1999; 14: 149-153
[8] Massimo F, Umberto V, Pier LZ, et al. Prognosis of follicular lymphoma: a predictive model based on a retrospective analysis of 987 cases. Blood, 2000;95: 783-789
[1] 任金马，蓝绍颖．恶性淋巴瘤的流行病学研究进展．南通医学院学报，2003：23(4)523-524
[2] 孙琦，陈辉树．恶性淋巴瘤的病因学研究进展．国际输血及血液学杂志，2006；29(5)398-402
[3] 庄奇新，顾一峰，朱莉莉等，口咽部恶性淋巴瘤的CT和MRI诊断，中国医学计算机成像杂志，2004；10(3)166-169
[4] 朱梅刚．免疫组化在恶性淋巴瘤诊断中的正确应用与评价．临床与实验病理学杂志，2004；20(4)476-478
[5] 韦萍，周小鸽，王翠芝．基因重排检测在恶性淋巴瘤诊断中的应用．临床和实验医学杂志，2005；4(4)233-236
[6] 李晓兰，许方，马荣．细针穿刺细胞形态学与流式细胞学诊断非霍奇金淋巴瘤的意义．山西医科大学学报，2005：36(6)726-728
[7] Benboubker L, Valat C, Linassier C, et al. A new serologic index for low-grade non Hodgkin's lymphoma based on initial CA125 and LDH serum levels. Ann Oncol, 2000, 11: 1485-1490
[8] Morra E. The biological markers of non-Hodekin's lymphomas: their role in diagnostic assessment and therapeutic strategy. Int. J. Biol. Markers, 1999; 14: 149-153
[9] Ozgnroglu M, Tuma H, Demir G, et al. Usefulness of the epithelial tumor marker CA125 in non-Hodgkin's lymphoma. Am J Clin Oncol, 1999; 22: 615-618
[10] 李大启，李公宝，王宝珍，等．非霍奇金淋巴瘤患者血清肿瘤坏死因子的水平与预后．中华肿瘤杂志，1997；19(4)：293-295
[11] 王德军，朱军．恶性淋巴瘤的血清肿瘤标志．白血病．淋巴瘤：14(6)335-338
[12] 赵维萍．恶性淋巴瘤的放射治疗．山东医药，2002；42(6)52-53
[13] 虞荣善．造血干细胞移植治疗恶性淋巴瘤的进展．浙江临床医学，2004；6(9)737-738
[14] JIANG Wen-Qi. Advancement of Biotherapy for Malignant Lymphoma. Chinese Journal of Cancer, 2005; 24(8): 1027-1032
[15] 李利亚，唐劲天．恶性淋巴瘤基因治疗的新进展．中日友好医院学报，2001；15(2)111-113
[16] 林曲，吴祥元．血清LDH水平对非霍奇金氏淋巴瘤的预后作用初探．癌症，1999，18(2)：216-217
[17] Massimo F, Umberto V, Pier LZ, et al. Prognosis of follicular lymphoma: a predictive model based on a retrospective analysis of 987 cases. Blood, 2000; 95: 783-789
[2] 庄奇新，顾一峰，朱莉莉等，口咽部恶性淋巴瘤的CT和MRI诊断，中国医学计算机成像杂志，2004：10(3)166-169
[3] 吴鹏强，赵春燕，韩丽英．淋巴瘤患者血清乳酸脱氢酶检测的临床意义．泸州医学院学报，2006；29(1)：22-23
[3] 郭传膑，马大权．涎腺恶性淋巴瘤的研究现状．北京口腔医学，2000；8(2)93-97
[4] 林曲，吴祥元．血清LDH水平对非霍奇金氏淋巴瘤的预后作用初探．癌症，1999，18(2)：216-217．
[5] Morra E. The biological markers of non-Hodekin's lymphomas: their role in diagnostic assessment and therapeutic strategy. Int. J. Biol. Markers, 1999; 14: 149-153
[6] Massimo F, Umberto V, Pier LZ, et al. Prognosis of follicular lymphoma: a predictive model based on a retrospective analysis of 987 cases. Blood, 2000195: 783-789
[7] Morra E. The biological markers of non-Hodekin's lymphomas: their role in diagnostic assessment and therapeutic strategy. Int. J. Biol. Markers, 1999; 14: 149-153
[8] Massimo F, Umberto V, Pier LZ, et al. Prognosis of follicular lymphoma: a predictive model based on a retrospective analysis of 987 cases. Blood, 2000;95: 783-789
[1] 任金马，蓝绍颖．恶性淋巴瘤的流行病学研究进展．南通医学院学报，2003：23(4)523-524
[2] 孙琦，陈辉树．恶性淋巴瘤的病因学研究进展．国际输血及血液学杂志，2006；29(5)398-402
[3] 庄奇新，顾一峰，朱莉莉等，口咽部恶性淋巴瘤的CT和MRI诊断，中国医学计算机成像杂志，2004；10(3)166-169
[4] 朱梅刚．免疫组化在恶性淋巴瘤诊断中的正确应用与评价．临床与实验病理学杂志，2004；20(4)476-478
[5] 韦萍，周小鸽，王翠芝．基因重排检测在恶性淋巴瘤诊断中的应用．临床和实验医学杂志，2005；4(4)233-236
[6] 李晓兰，许方，马荣．细针穿刺细胞形态学与流式细胞学诊断非霍奇金淋巴瘤的意义．山西医科大学学报，2005：36(6)726-728
[7] Benboubker L, Valat C, Linassier C, et al. A new serologic index for low-grade non Hodgkin's lymphoma based on initial CA125 and LDH serum levels. Ann Oncol, 2000, 11: 1485-1490
[8] Morra E. The biological markers of non-Hodekin's lymphomas: their role in diagnostic assessment and therapeutic strategy. Int. J. Biol. Markers, 1999; 14: 149-153
[9] Ozgnroglu M, Tuma H, Demir G, et al. Usefulness of the epithelial tumor marker CA125 in non-Hodgkin's lymphoma. Am J Clin Oncol, 1999; 22: 615-618
[10] 李大启，李公宝，王宝珍，等．非霍奇金淋巴瘤患者血清肿瘤坏死因子的水平与预后．中华肿瘤杂志，1997；19(4)：293-295
[11] 王德军，朱军．恶性淋巴瘤的血清肿瘤标志．白血病．淋巴瘤：14(6)335-338
[12] 赵维萍．恶性淋巴瘤的放射治疗．山东医药，2002；42(6)52-53
[13] 虞荣善．造血干细胞移植治疗恶性淋巴瘤的进展．浙江临床医学，2004；6(9)737-738
[14] JIANG Wen-Qi. Advancement of Biotherapy for Malignant Lymphoma. Chinese Journal of Cancer, 2005; 24(8): 1027-1032
[15] 李利亚，唐劲天．恶性淋巴瘤基因治疗的新进展．中日友好医院学报，2001；15(2)111-113
[16] 林曲，吴祥元．血清LDH水平对非霍奇金氏淋巴瘤的预后作用初探．癌症，1999，18(2)：216-217
[17] Massimo F, Umberto V, Pier LZ, et al. Prognosis of follicular lymphoma: a predictive model based on a retrospective analysis of 987 cases. Blood, 2000; 95: 783-789