原发性肾上腺非霍奇金淋巴瘤（附9 例报告）

目的:探讨原发性肾上腺淋巴瘤(Primary Adrenal Lymphoma,PAL)的临床特点、提高对PAL的认识。方法:回顾分析解放军总医院1995年12月至2007年6月收治的9例PAL的临床表现、实验室检查、影像学特点、组织病理类型以及治疗方法等临床资料,并结合国内外文献进行分析。结果:9例患者中,1例因常规体检发现,8例因腹痛、腹胀或腰痛就诊发现;其中单侧3例,双侧6例,实验室检查无明显异常,影像学检查仅发现肾脏肿瘤,但术后病理组织学诊断为非霍奇金淋巴瘤(non-Hodgkin’s lymphoma,NHL),其中8例弥漫大B细胞淋巴瘤,1例T细胞淋巴瘤;7例患者术后均接受了CHOP或RCHOP方案化疗为主的综合治疗,2例常规治疗;随访至2010年2月,1例弥漫性大B细胞淋巴瘤患者存活4年,1例在术后3年2个月死亡,余7均在2年内死亡。结论:PAL是一种罕见的、恶性程度较高的肿瘤,临床表现和影像学检查缺乏特异性,组织病理学及免疫组织化学是明确诊断的好方法。术前确诊肾上腺原发性非霍奇金淋巴瘤可避免手术,联合化疗应为治疗首选。

Primary Adrenal Non-Hodgkin's Lymphoma: Report of 9 Cases

Objective: To investigate the clinical characteristics of primary adrenal non-Hodgkin’s lymphoma(PAL),so as to improve comprehension of that unusual lesions.Methods: Nine cases of patients with a confirmed diagnosis of PAL were retrospectively reviewed.The clinical presentation,laboratory examination,imaging characteristics,histopathology types and treatment were analyzed.Results: 1 case was occasionally detected by health examination and 8 patients complained of stomachache,abdominal distension or lumbago.3 patients were unilateral lymphoma,and other patients were bilateral.There was non-apparent abnormality in the check of laboratory.The adrenal tumors were found by imaging examination,but the diagnosis of non-Hodgkin’s lymphoma(NHL) was confirmed by histopathological examination.8 cases were diffuse B-cell origin lymphoma and 1 case was T-cell origin lymphoma.They all received CHOP or RCHOP chemotherapy.Follow up over in February,2010,1 patient has been alive for 4 years and 1 patient died postoperative 3 years and 2 months,other 7 cases died within 2 years.Conclusions: PAL is a rare malignancy.The presenting symptoms and imaging modalities of PAL were nonspecific and misdiagnosis rate was high.The definitive diagnosis of PAL depended on histopathology and immunohisto-chemistry of adrenal tissue.Surgical operative could be avoided if the diagnosis was made preoperative.The primary management in the treatment of PAL was combination chemotherapy.