本文選題：扁桃體 + 彌漫大B細(xì)胞淋巴瘤��； 參考：《南京醫(yī)科大學(xué)》2017年博士論文

【摘要】：第一部分原發(fā)扁桃體彌漫大B細(xì)胞淋巴瘤29例臨床特點(diǎn)分析目的扁桃體是頭頸部非霍奇金淋巴瘤(NHL)好發(fā)部位,彌漫大B細(xì)胞淋巴瘤(DLBCL)是其最常見病理類型,本研究目的為總結(jié)原發(fā)扁桃體彌漫大B細(xì)胞淋巴瘤(PT-DLBCL)臨床特征、免疫表型及預(yù)后因素。方法回顧性分析2009年10月至2017年1月于我院就診的29例PT-DLBCL患者臨床資料。結(jié)果29例患者中,男性17例(58.6%),女性12例(41.4%),中位年齡58(16～86)歲。所有患者均因咽部不適,異物感(89.7%)或咽部疼痛(27.6%)就診。能明確細(xì)胞起源的28例患者中,生發(fā)中心B細(xì)胞(GCB)型占75%,非生發(fā)中心 B 細(xì)胞(non-GCB)型占 25%。Ann Arbor 分期 Ⅰ 期占 41.4%,Ⅱ期占 58.6%,無Ⅲ、Ⅳ期患者。中位隨訪時(shí)間39(3～89)個(gè)月,1例患者(3.4%)失訪。中位治療6(3～8)個(gè)療程后對(duì)28例患者進(jìn)行評(píng)估,其中20例(71.4%)達(dá)完全緩解(CR),7例(25%)達(dá)部分緩解(PR),1例(3.6%)患者疾病穩(wěn)定(SD)。3年及5年無進(jìn)展生存(PFS)均為82.5%,3年及5年總生存(OS)均為95.5%。年齡70歲(P=0.034)與短的PFS相關(guān);IPI2分(P=0.034)、LDH增高(P0.0001)、治療方案中未使用利妥昔單抗(P=0.034)與短的OS相關(guān)結(jié)論P(yáng)T-DLBCL分期早,大多數(shù)為GCB型,常見于老年�；颊邔�(duì)放化療敏感,預(yù)后較好,大多數(shù)患者治療后可獲得長(zhǎng)期生存。年齡70歲、LDH增高的患者預(yù)后相對(duì)較差,聯(lián)合免疫化療效果優(yōu)于單純化療。第二部分原發(fā)中樞神經(jīng)系統(tǒng)彌漫大B細(xì)胞淋巴瘤42例臨床特點(diǎn)分析目的分析原發(fā)中樞神經(jīng)系統(tǒng)彌漫大B細(xì)胞淋巴瘤(PCNS-DLBCL)的發(fā)病情況、臨床表現(xiàn)、治療效果及預(yù)后。方法收集2008年5月至2017年1月經(jīng)我院診治并有明確病理確診的42例PCNS-DLBCL患者的資料,對(duì)一般情況、臨床表現(xiàn)、中樞病變累及部位、病理免疫組化、實(shí)驗(yàn)室檢查、治療方案、療效及預(yù)后進(jìn)行分析。結(jié)果42例患者中,男性22例(52.4%),女性20例(47.6%),中位年齡61(13～77)歲。主要臨床表現(xiàn)為頭暈(33.3%)或肢體乏力或輕偏癱(35.7%)。病理類型均為彌漫大B細(xì)胞淋巴瘤(DLBCL)�？蛇M(jìn)行細(xì)胞起源分析的35例患者中,11例(31.4%)為生發(fā)中心B細(xì)胞(GCB)型,24例(68.6%)為非生發(fā)中心B細(xì)胞(non-GCB)型。后續(xù)未接受放化療的患者3例(7.1%),單純放療患者5例(11.9%),單純化療患者9例(21.4%)及化放療聯(lián)合治療患者25例(59.6%),4例(9.5%)患者接受自體造血干細(xì)胞。中位隨訪時(shí)間24(2-65)個(gè)月,中位總生存(OS)34(2～65)個(gè)月,預(yù)估5年OS為31.9%。年齡70歲是無進(jìn)展生存(PFS)及OS的不良預(yù)后因素(P0.0001,P=0.001),深部腦組織浸潤(rùn)與OS負(fù)相關(guān)(P=0.008),除手術(shù)外,使用聯(lián)合放化療的患者OS優(yōu)于未行放化療的患者(P=0.035)。結(jié)論P(yáng)CNS-DLBCL總體預(yù)后差。大于70歲,有深部腦組織浸潤(rùn)的患者預(yù)后相對(duì)更差�；熉�(lián)合放療或移植治療患者的治療效果優(yōu)于單純化療患者。第三部分原發(fā)乳腺?gòu)浡驜細(xì)胞淋巴瘤18例臨床特點(diǎn)分析目的分析原發(fā)乳腺?gòu)浡驜細(xì)胞淋巴瘤(PB-DLBCL)的臨床特點(diǎn)。方法收集我院2007年1月至2017年1月收治的18例PB-DLBCL患者資料,對(duì)患者癥狀、體征、免疫表型、預(yù)后因素及治療方案的選擇進(jìn)行分析。結(jié)果18例患者均因自覺乳腺腫塊就診,經(jīng)手術(shù)切除或腫塊穿刺后病理檢查明確診斷。15例(83.3%)免疫組織化學(xué)資料完全的患者中,生發(fā)中心B細(xì)胞(GCB)型4例(26.7%),非生發(fā)中心B細(xì)胞(non-GCB)型11例(73.3%)。18例患者中Ann Arbor分期Ⅰ期占44.4%,Ⅱ期占55.6%。1例患者(5.6%)至外院就診,失訪。余17例患者中位隨訪時(shí)間66(13～112)個(gè)月。2例患者(11.8%)死亡,均死于本病。5年無進(jìn)展生存(PFS)88.2%,5年總生存(OS)86.7%。年齡≥60歲(P=0.021)、分期調(diào)整國(guó)際預(yù)后指數(shù)(IPI)≥2分(P=0.006)以及β2-微球蛋白(β2-MG)增高(P=0.037)與PFS負(fù)相關(guān);年齡≥60歲(P=0.034)和分期調(diào)整IPI≥2分(P=0.012)與OS負(fù)相關(guān)。手術(shù)后未經(jīng)放化療治療的患者在確診16個(gè)月后死亡,接受放化療的患者至隨訪結(jié)束僅1例死亡。結(jié)論P(yáng)B-DLBCL與其它乳腺腫瘤相比,無特異性的臨床表現(xiàn),診斷依靠病理。手術(shù)后未行后續(xù)放化療治療的患者生存期短,手術(shù)后行放化療治療的患者可延長(zhǎng)生存。
[Abstract]:Part 1: clinical characteristics of 29 cases of primary tonsillar diffuse large B cell lymphoma. Tonsillar is a good location of non Hodgkin's lymphoma (NHL) in the head and neck. Diffuse large B cell lymphoma (DLBCL) is the most common pathological type. The purpose of this study is to summarize the clinical features of primary tonsil diffuse B cell lymphoma (PT-DLBCL) and the immune form. Methods and prognostic factors. Methods a retrospective analysis of the clinical data of 29 PT-DLBCL patients in our hospital from October 2009 to January 2017. Results of 29 cases, 17 men (58.6%), 12 women (41.4%), middle age 58 (16~86) years old. All patients were diagnosed with pharynx discomfort, foreign body sensation (89.7%) or pharynx pain (27.6%). The origin of cell origin could be clearly defined. Of the 28 patients, the primary B cell (GCB) cells accounted for 75%, the non germinal center B cell (non-GCB) accounted for 41.4%, 58.6%, no III, IV, 39 (3~89) months, 1 patients (3.4%). After middle treatment 6 (3~8) courses, 28 patients were evaluated, 20 cases (71.4) %) reached complete remission (CR), 7 (25%) reached partial remission (PR), 1 (3.6%) patients with disease stability (SD) were 82.5% for.3 and 5 years of progression free survival (PFS), 3 and 5 years (OS) were all 95.5%. age 70 years (P=0.034) associated with short PFS; IPI2 points (P =0.034) increased, and the treatment regimen did not use rituximab and short PT-DLBCL staging is early, most of them are GCB type and common in old age. Patients are sensitive to radiotherapy and chemotherapy, and the prognosis is better. Most patients can obtain long-term survival after treatment. The age of 70 years old, the prognosis of patients with increased LDH is relatively poor and the effect of combined immuno chemotherapy is better than that of chemotherapy alone. The second part of the primary central nervous system diffuse large B cell lymph nodes. Analysis of the clinical characteristics of 42 cases of tumor to analyze the incidence, clinical manifestation, therapeutic effect and prognosis of the primary central nervous system diffuse large B cell lymphoma (PCNS-DLBCL). Methods the data of 42 cases of PCNS-DLBCL patients with pathological diagnosis were collected from May 2008 to 2017 in 1 menstruation, and the general, clinical and central diseases were analyzed. In the 42 patients, 22 (52.4%), 20 women (47.6%) and 61 (13~77) age were found in 42 patients. The main clinical manifestations were dizziness (33.3%) or limb fatigue or hemiplegia (35.7%). The pathological types were diffuse large B cell lymphoma (DLBCL). Of the 35 cases of cell origin analysis, 11 (31.4%) were type of germinal center B cell (GCB), 24 (68.6%) was non germinal B cell (non-GCB), 3 (7.1%), 5 (11.9%), 9 (21.4%) patients with simple radiotherapy, 25 cases (59.6%) in combination therapy and radiotherapy. The patients received autologous hematopoietic stem cells. The median follow-up time was 24 (2-65) months, the median total survival (OS) was 34 (2~65) months, and the estimated 5 year OS was 70 years old for 31.9%. age (P0.0001, P=0.001), and the deep brain tissue infiltration and OS negative correlation (P=0.008). Except for the operation, the OS of the patients who used combined radiotherapy and chemotherapy was better than the failure. Patients with chemotherapy (P=0.035). Conclusion the overall prognosis of PCNS-DLBCL is poor. More than 70 years old, the patient with deep brain tissue infiltration is worse. The treatment effect of chemotherapy combined with radiotherapy or transplantation is better than that of patients with simple chemotherapy. The third part of primary breast diffuse large B cell neenoma is analyzed in 18 cases of clinical analysis of primary milk The clinical features of the adenoid diffuse large B cell lymphoma (PB-DLBCL). Methods 18 cases of PB-DLBCL patients were collected from January 2007 to January 2017 in our hospital. The symptoms, signs, immunophenotypes, prognostic factors and the choice of treatment options were analyzed. Results 18 patients were treated by self aware breast lumps and underwent surgical resection or mass puncture. Pathological examination clearly diagnosed.15 (83.3%) patients with complete immuno histochemical data, 4 cases (26.7%) of germinal center B cell (GCB), 11 cases of non germinal center B cell (non-GCB) type (73.3%).18 cases, Ann Arbor stage I accounted for 44.4%, phase II accounted for 55.6%.1 cases (5.6%) to external hospital and lost visit. The median follow-up time of the remaining 17 patients was 66 (3). 13~112).2 patients (11.8%) died, all died of non progressive survival (PFS) 88.2%, 5 years of total survival (OS) 86.7%. age over 60 years (P=0.021). The international prognostic index (P=0.006) and beta 2- microglobulin (P=0.006) and beta 2- microglobulin (P=0.037) were associated with PFS negative correlation in 5 years. 12) negative correlation with OS. Patients who did not undergo chemotherapy after surgery died after 16 months of diagnosis, and only 1 patients died at the end of the follow-up. Conclusion PB-DLBCL had no specific clinical manifestations compared with other breast tumors, and the diagnosis depended on the pathology. The patients who did not follow the follow-up chemotherapy after surgery were short of survival, after surgery. Patients treated with chemotherapy can prolong their survival.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R733.1

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