25例眼眶淋巴瘤的临床特点及预后分析
Clinical,radiological and pathological features of orbital lymphoma and its prognosis: A series of 25 cases
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摘要: 目的 探讨眼眶淋巴瘤的临床表现、影像学特征及预后,以期减少眼眶淋巴瘤的误诊。方法 回顾分析2012年8月-2019年10月解放军总医院第一医学中心(24例)和北京协和医院(1例)诊治的眼眶淋巴瘤患者的临床资料,分析其临床表现及影像学特点,以及手术、放疗和(或)化疗等综合治疗效果,并随访预后。结果 25例(28眼)眼眶淋巴瘤患者中男性17例(68%),女性8例(32%),年龄31 ~ 84岁,病程15 d ~ 20年,22例为单侧发病。最常见的临床表现是眼部肿块(26/28)和眼球突出(21/28),影像学上较少引起骨质破坏,罕见突破眼球壁向眼内生长。病理分型上黏膜相关淋巴组织(mucosa associated lymphoid tissue,MALT)淋巴瘤15例(18眼);弥漫性大B细胞淋巴瘤6例,其中2例由MALT淋巴瘤转化;NK/T细胞淋巴瘤2例;浆细胞瘤1例;滤泡性淋巴瘤1例。经过放疗和(或)化疗,4例MALT淋巴瘤复发(4/15),其中1例死亡(1/15);3例原发性弥漫性大B细胞淋巴瘤复发(3/4),其中2例死亡(2/4);2例NK/T细胞淋巴瘤均于半年内死亡(2/2);2例转化性弥漫性大B细胞淋巴瘤、浆细胞瘤及滤泡性淋巴瘤均未见复发。结论 眼眶淋巴瘤类型多样,MALT淋巴瘤最常见,其发病缓慢,预后较好;弥漫性大B细胞淋巴瘤及NK/T细胞淋巴瘤发病较急,预后差。Abstract: Objective To investigate the clinical and imaging features and prognosis of orbital lymphoma so as to reduce misdiagnosis. Methods Clinical data about 25 patients with orbital lymphoma diagnosed and treated in the first medical center of Chinese PLA General Hospital (24 cases) and Peking Union Medical College Hospital (1 case) from August 2012 to October 2019,were analyzed retrospectively.The patients were treated with surgery,radiotherapy and/or chemotherapy and the clinical features and the prognosis were analyzed. Results Among the 25 cases (28 eyes),there were 17 males (68%) and 8 females (32%) with the age ranging from 31 to 84 years.The disease course ranged from 15 days to 20 years.The orbital masses in most of the patients (22 cases) was unilateral.Ocular masses (26/28) and exophthalmos (21/28) were main manifestations.Radiographic results showed orbital bone erosion and destruction in few cases.Mucosa associated lymphoid tissue (MALT) lymphoma (15/25) was the most common patholotical type,followed by diffuse large B cell lymphoma (DLBCL,6/25),NK/T cell lymphoma (NKTCL,2/25),follicular lymphoma (FL,1/25) and plasmacytoma (1/25).After local radiotherapy and/or systemic chemotherapy,4 MALT lymphoma cases (4/15)relapsed and 1 case (1/15) died;3 primary DLBCL cases (3/4) relapsed and 2 cases (2/4) died;2 NKTCL cases (2/2) died within half a year;2 cases with transformed DLBCL,one case of FL and one case of plasmacytoma did not progressed. Conclusion There are many types of orbital lymphoma.MALT lymphoma is the most common type with slow progressing and good prognosis,while diffuse large B cell lymphoma and NK / T lymphoma are aggressive with poor prognosis.
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