原发性乳腺淋巴瘤

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(编校:李鹏超)

原发性乳腺淋巴瘤

张斌豪,任　予,何建军

Prim a ry breast ly m phom a

ZHANG B in-hao,REN Yu,HE J ian-jun

D epart m ent of O ncology,First Hospital of X i’an J iaotong U niversity,X i’an710061,China.

【Abstract】Malignant ly mphoma is a syste m ic disease,and is mainly p resented in ly mph nodes.M alignant ly mphoma

of the breast is uncommon in the clinic experience,and most of them are secondly breast ly mphoma(S BL).Pri m ary

breast ly mphoma(P BL)is a rare conditi on,accounting f or only0.04%-0.53%of breast malignancies and0.38%

-0.70%of malignant ly mphoma.They are more likely t o be p resented in right breast of women over50,and bilateral

case is rare.The maj ority cases are B-cell ly mphomas.The ideol ogy has not been pared with breast

cancer,the clinical p resentati on and i m aging of P BL have no s pecialty.The maj ority of P BL are diagnosed by bi op sy or

post operative pathol ogical findings.P BL have been reported t o have a high l ocal and distant recurrence rate,and the

p r ognosis is poor.The combined therapy regi m en,the main part of which is CHOP che motherapy,is the main strea m.

Radical surgery is t o be avoided.C NS p r ophylaxis in the early stage is recommended by many scholars.

【Key words】breast;p las macytic;ly mphoma

Modern Oncol ogy2009,17(06):1191-1194【指示性摘要】恶性淋巴瘤为一全身性疾病,好发于淋巴结。结外器官发病率低,其中以消化道、肺等部位相

对多见。乳腺恶性淋巴瘤临床少见,且以转移性肿瘤(Secondly breast ly mpho ma,S BL)为主。原发性乳腺恶性

淋巴瘤(Pri m ary breast ly mphoma,P BL)极少见,仅占乳腺恶性肿瘤的0.04%-0.53%,占恶性淋巴瘤

的0.38%-0.70%。P BL多见于50岁以上妇女,以B细胞来源为主,右侧多见,少数为双侧发病。病因尚不

明确。与乳腺癌相比,临床表现和影像学检查均无特异性。确诊主要依靠细针穿刺或术后病理检查。预后

差,易早期局部复发或远处转移。现有研究趋向于以CHOP方案化疗为主的综合治疗方案,避免采用扩大的

手术治疗。很多学者建议早期鞘内注射化疗。

【关键词】乳腺;浆细胞;淋巴瘤

【中图分类号】R733.4 【文献标识码】A 【文章编号】1672-4992-(2009)06-1191-04

1　流行病学

恶性淋巴瘤是来源于淋巴网状组织与免疫关系密切的

恶性肿瘤,主要发生在淋巴结,也可发生在淋巴结外和非淋

巴组织。乳腺恶性淋巴瘤临床少见,且以BL为主。有报道

S BL在乳腺转移癌中最常见[1-2]。而P BL极少见,仅占乳腺

【收稿日期】　2008-08-12

【修回日期】　2009-02-02

【作者单位】　西安交通大学第一附属医院肿瘤中心乳腺甲状腺肿

瘤外科,陕西　西安　710061

【作者简介】　张斌豪(1982-),男,江西新余人,医师,主要从事肿

瘤外科临床与研究工作。

【通讯作者】　何建军(1962-),男,陕西乾县人,教授,主要从事肿

瘤外科临床与研究工作。

S恶性肿瘤的0.04%-0.53%,占恶性淋巴瘤的0.38%-

0.70%[1,3-8]。P BL占所有结外淋巴瘤的2.2%[1,8-10]。

绝大部分发生在女性,男性罕见[4,11-13]。但也有男性

P BL的报道[14]。好发年龄在40-60岁。现有报道最小16

岁,最大者78岁[4,12,15-16]。V igli otti等[16]报道的7例患者中

位年龄58.8岁。P BL病变多为单侧,以右侧为主,但原因不

明[4-5,12,17]。但也有双侧发病的报道[5],Kristen等[18]报道的

病例中有4例为双侧。年轻女性的P BL多为成淋巴细胞的

或Burkitt淋巴瘤,多双侧发病,妊娠或哺乳期多见[13,16]。

Enver等[5]报道1例双侧P BL,并将P BL分2类:一类为单侧

发病,年龄与乳腺癌相同;另一类为双侧发病,年轻、妊娠或

泌乳期多见。此例以左侧肿瘤巨大,但最后确诊是通过右侧

活检。