【摘要】 目的 对原发性肠道非霍奇金淋巴瘤穿孔患者的临床及病理特征、诊治、预后进行探讨。 方法 回顾性分析1999年1月-2008年12月诊治的17例原发性肠道非霍奇金淋巴瘤穿孔患者的临床资料。 结果 B细胞型9例，T细胞型8例。17例原发肠道非霍奇金淋巴瘤穿孔患者的穿孔部位:大肠7例，小肠7例，回盲部3例。所有患者均行手术治疗。除2例穿孔前行化疗的患者以外，其余患者术前均未明确诊断。有14例获得随访结果，6例术后3个月内死亡，术后接受化疗者7例，1、2、3年生存率分别为41.2%、 23.6%、11.7%，仅1例生存期超过5年。 结论 原发性肠道非霍奇金淋巴瘤穿孔术前诊断困难，预后极差。【Abstract】 Objective To analyze the clinical features, diagnosis, therapy and prognosis of primary intestinal non-hodgkin′s lymphoma perforation. Methods The clinical data of 17 patients with the primary intestinal non-Hodgkin′s lymphoma perforation from January 1999 to December 2008 were retrospectively analyzed. Results Nine patients had intestinal B-cell lymphoma, and eight had intestinal T-cell lymphoma. The sites of perforation were as follows: colon and rectum in 7 (41.2%), ileum and jejunum in 7 (41.2%), and ileocecal junction in 3 (17.6%). All patients had undergone the operations. The disease was not diagnosed before the operation in all of the patients except for the Two patients had a history of systemic chemotherapy before perforation. A total of 14 patients were followed up, in whom six died within three months after the operation; the survival rate 1, 2, and 3 years after the operation was 41.2%, 23.6%, and 11.7%, respectively in seven patients who had undergone the systemic chemotherapy before the operation; one patients lived more than 5 years. Conclusion The diagnosis of primary colonic malignant lymphoma perforation is difficult; the prognosis is miserable.
【摘要】 目的 探讨原发性中枢神经系统淋巴瘤(PCNSL)的CT及MRI表现特征,以提高术前对该病的影像诊断能力。方法 分析2008年1月—2009年8月华西医院16例经病理证实PCNSL患者的CT、MRI资料及病理资料。结果 病理检查均为B细胞来源的弥漫性大B细胞性淋巴瘤。16例PCNSL 29个病灶,单发11例(69%)，多发5例(31%)18个病灶。病灶好发部位依次是大脑半球临近蛛网膜下腔12个(41.4%)、脑室周围深部白质7个(24.1%)、胼胝体3个(10.3%)。有5例病变CT平扫表现为等或略高于脑实质密度影,无出血和钙化；MRI平扫75.9%(19/25)的病灶T1WI呈等低信号,T2WI等稍低信号,类似“脑膜瘤”样信号,均未见血管流空；增强后病灶大都均匀实质团块状或结节状强化,典型的可出现“尖角征”、“握拳征”,3例可见小囊变,呈“硬环征”。结论 CT对PCNSL的定性诊断作用有限,MRI具有一定特征性表现者,多可作出正确的诊断,但确诊有赖于病理。
【摘要】 目的 探讨超声在诊断颈部转移性与淋巴瘤性淋巴结中的应用价值。 方法 2007年1月-2008年12月对经病理证实的102例患者120个颈部淋巴结，应用二维超声、能量多普勒显像（PDI）分为两组:转移性淋巴结68个，淋巴瘤性淋巴结52个。对淋巴结长短比（L/S）、结构及血流分布状态进行分析。 结果 两组淋巴结门消失、局部液化灶、中央血流率比较差异有统计学意义（Plt;0.05），两组出现淋巴结形态不规则、皮质回声减低、淋巴门型血流、周围型血流率比较差异有统计学意义（Plt;0.05）。两组的L/S≤2淋巴结无统计学差异（Pgt;0.05）。 结论 超声检查对颈部转移性淋巴结与淋巴瘤性淋巴结的鉴别诊断有较高价值。【Abstract】 Objective To explore the application value of the ultrasound in diagnosis of metastatic and lymphoma lymph nodes of the neck. Methods From January 2007 to December 2008, 120 neck lymph nodes of 102 patients confirmed by pathology were divided into two groups, including 68 metastatic lymph nodes and 52 lymphoma lymph nodes. The reports of two groups were performed using two-dimensional ultrasonography and power Doppler imaging (PDI). The long-short axis ratio (L/S), structure, blood flow pattern of lymph nodes were studied. Results The rate of the lymph door disappearance, inner liquefacient position and central blood stream in two groups had statistical difference (Plt;0.05). The rate of irregular form, diminution of cortical resonance, blood stream of lymph door and peripheral flow in two groups had statistical difference (Plt;0.05), but the difference of their L/S≤2 had no statistical significance (Pgt;0.05). Conclusion The ultrasonography is a valuable method for diagnosing between neck metastatic nodes and lymphoma lymph nodes.
Objective To investigate the relevance of primary pulmonary non-Hodgkin’s lymphoma ( PPNHL) imaging with pathology features, so as to improve the diagnostic accuracy. Methods Twenty-two patients of PPNHL were scanned by chest computed tomography, and the results of clinical and pathology features were analyzed. Results The resulting pathologic examination showed that all patients in 12 cases of low-grade lymphoma had MALT lymphoma( 54. 5% ) , histologically with slightly atypical small lymphocyte proliferated. The radiological findings indicated unilateral peripheral lesion which extended along mucous membrane in 11 patients ( 91. 7% ) and multilateral lesion in only 1 patients ( 8. 3% ) . CT features were illdefined nodule or mass with halo sign ( n =8, 66. 7%) , patchy infiltrate ( n = 4, 33. 3% ) , and ill-defined consolidations with air-bronchograms ( n =7, 58. 3% ) . The resulting pathologic examination showed that 10 patients were high and middle-grade lymphoma ( 45. 5% ) . The radiological findings indicated unilateral lesion in4 patients ( 40%) and multilateral lesion in 6 patients( 60% ) . CT features were ill-defined noduleor mass ( n =4, 40% ) , patchy infiltrate ( n = 1, 10% ) , mixed manifestation ( n =5, 50% ) , pleural effusion ( n =5, 50% ) , hilar and mediastinal lymph node enlargement ( n =2, 20% ) , atelectasis ( n =3, 30%) , and pulmonary interstitial with interlobular septal thickening ( n=2, 20% ) . Conclusions The imaging features of PPNHL rely on its’ basic pathology. Low-grade lymphoma is characterized by peripheral focal consolidation with air-bronchograms. High and middle-grade lymphoma is characterized by mixed manifestation of interstitial change and nodular focus. Analyzing CT features seriously may be helpful for diagnosis of PPNHL.
Objective To sum up experiences in diagnosis and treatment for thyroid malignancy. Methods Clinical records of 8 patients diagnosed as Hashimoto’s disease associated with thyroid malignancy by histologic examination at our hospital from Jan. 1998 to Dec. 1998 were analyzed. Results There were 1 male and 7 females with average age of 37.6 years. The incidence of Hashimoto’s disease associated with thyroid cancer and malignant lymphoma were 7.7% and 2.6%, respectively. No operative mortality and complication was found. Conclusion Hashimoto’s disease is not uncommon. The combined thyroid cancer is small with papillary carcinoma predominance and the prognosis is good. If it is complicated with malignant lymphoma, the thyroid is rapidly enlarged with pain and dyspnea.
【摘要】 目的 采用系统评价方法，评估干扰素（IFN）治疗蕈样霉菌病（MF）的疗效及安全性。 方法 计算机检索截止2010年5月的Cochrane协作网系统评价方法，纳入所有比较IFN与其他方法治疗MF的随机对照试验及临床对照试验进行质量评价，采用RevMan 5.0.24软件进行Meta分析。 结果 共纳入6篇符合标准的已发表文献，包括142例受试者。Meta分析结果显示: IFN-α单独使用对MF的疗效优于安慰剂组[OR=69.36，95%CI（3.71～1 296.64）]及地精丹方剂[OR=35.53，95%CI（1.78～710.56）]；而IFN-α与胸腺肽[OR=15.11，95%CI（0.71～322.61）]及IFN-α+阿维A酯[OR=3.10，95%CI（0.79～12.12）]的临床疗效差异无统计学意义；IFN-γ联合窄谱中波紫外线（NB-UVB）治疗与单用NB-UVB的临床疗效差异无统计学意义[OR=15.00，95%CI （0.46～485.32）]。90%的患者出现轻度“流感样症状” 的不良反应，多可缓解及消退。 结论 IFN是目前治疗MF的一线用药，疗效确切且大部分患者耐受性较好。【Abstract】 Objective To evaluate the clinical efficacy and side effects of interferon (IFN) in the treatment of mycosis fungoides (MF) with the method of systematic review. Methods According to the Cochrane reviewer’s handbook, all the clinical controlled trials involving mycosis fungoides being treated with interferon were retrieved. The Cochrane Collaboration’s software RevMan 5.0.24 was used for meta-analysis. Results Only six papers including 142 patients met the inclusion criteria. Meta-analyses indicated the results as follows: IFN-α monotherapy was more effective than placebo [OR=69.36,95% CI (3.71-1 296.64)] and a traditional Chinese medicine (Di-jing-dan) [OR=35.53,95% CI (1.78-710.56)], but no significant difference was found between INF-α and thymic peptide [OR=15.11, 95% CI (0.71-322.61)], and between IFN-α monotherapy and IFN-α combined with etretinate therapy [OR=3.10, 95% CI (0.79-12.12)]; and there was no significant difference between the efficacy of IFN-γ combined narrowband ultraviolet B (NB-UVB) therapy and that of single NB-UVB therapy [OR=15.00, 95% CI (0.46-485.32)]; Influenza-like side effects occurred to 90% of all the patients, which were usually slight and easy to release. Conclusion Although there are some mild side effects, interferon is safe to treat MF.