以干咳为唯一症状的原发性肺黏膜相关淋巴组织淋巴瘤1例并文献复习

doi:10.3969/j.issn.1004-583X.2023.07.007

摘要/Abstract

摘要：

目的回顾原发性肺黏膜相关淋巴组织淋巴瘤( pulmonary mucosa-associated lymphoid tissue lymphoma,MALT lymphoma)的临床、影像及病理特点,分析误诊原因。方法对1 例经病理确诊的原发性肺MALT淋巴瘤的病例资料进行回顾性分析。结果该患者因反复干咳就诊,外院给予抗炎治疗,患者自觉症状有所好转。后症状反复,就诊江苏省中医院,经胸部CT及MRI 检查诊断为多中心起源肺腺癌或炎性肉芽肿;行CT引导下经皮肺穿刺活检,术后病理诊断为原发性肺MALT淋巴瘤。结论原发性肺MALT淋巴瘤通常无特异性临床表现,影像学检查难以确诊,抗炎治疗无效时建议活检,有助于避免误诊误治。

关键词: 淋巴瘤, B细胞, 边缘区, 肺, 干咳

Abstract:

Objective To review the clinical, imaging, and pathological features of primary pulmonary mucosa-associated lymphoid tissue lymphoma (MALT lymphoma) and analyze the causes of misdiagnosis. Methods A case of primary pulmonary MALT lymphoma confirmed by pathology was analyzed retrospectively. Results The patient had a recurrent dry cough, which was relieved after anti-inflammatory treatment at a local hospital. But then the symptoms recurred, so the patient came to Jiangsu Provincial Hospital of Traditional Chinese Medicine. After chest CT and magnetic resonance imaging (MRI), the patient was diagnosed with multicentric adenocarcinoma or inflammatory granuloma. CT-guided percutaneous lung biopsy was performed, and finally, primary pulmonary MALT lymphoma was diagnosed by pathology. Conclusion Primary pulmonary MALT lymphoma usually has no specific clinical manifestations and is difficult to be diagnosed by imaging examination. The biopsy is recommended when anti-inflammatory therapy is ineffective, which is helpful to avoid misdiagnosis and mistreatment.

Key words: lymphoma, B-cell, marginal zone, lung, dry cough

中图分类号:

R733.4

杨巍, 何晨冬. 以干咳为唯一症状的原发性肺黏膜相关淋巴组织淋巴瘤1例并文献复习[J]. 临床荟萃, 2023, 38(7): 623-627.

Yang Wei, He Chendong. Primary pulmonary mucosa-associated lymphoid tissue lymphoma with dry cough as the only symptom: A case and literature review[J]. Clinical Focus, 2023, 38(7): 623-627.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.07.007

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I7/623

图/表 2

图1 患者胸部CT及MRI影像学表现 a~d. 胸部CT显示两肺多发斑片状高密度影,边界尚清,形态不规则,病灶内部可见充气支气管影;e. DWI显示右肺病灶呈高信号;f. T2WI显示病灶呈高信号;g. T1WI显示病灶呈等低信号;h. T1WI增强扫描病灶呈明显强化。

Fig.1 Chest CT and MRI findings of the patient a-d. Chest CT showed multiple patchy high-density shadows with a clear boundary and irregular shape in both lungs, air bronchograms were noted; e. DWI showed high signal in the right lung lesion; f. T2WI showed hyperintense areas; g. T1WI showed isointense and hypointense areas; h. T1WI enhanced scanning showed obvious enhancement

图2 肺部病变病理学表现 a. 肺活检组织中淋巴细胞增生(苏木精-伊红染色,×40); b. CD20阳性(×20); c. bcl-2阳性(×20)

Fig.2 Pathological finding of the lung a. Lymphocyte proliferation in lung biopsy tissue (hematoxylin-eosin staining, ×40); b. CD20 positive (×20); c. bcl-2 positive (×20)

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