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目的:探讨鼻腔鼻窦非霍奇金淋巴瘤不同组织学亚型的临床表现、影像学特征、免疫组织学类型及其早期诊断价值。方法:回顾性分析北京大学第三医院耳鼻咽喉科2010-2016年经手术及活检病理证实的15例鼻腔鼻窦非霍奇金淋巴瘤患者的临床、影像学和病理资料,并对不同病理分型的临床症状、影像学特点进行统计分析。结果:15例患者中NK/T淋巴瘤患者9例,中位年龄39岁,其中男5例,女4例;弥漫大B淋巴瘤患者6例,中位年龄64岁,其中男3例,女3例,组间年龄差异有统计学意义(P<0.05)。弥漫大B淋巴瘤按照病理学Han′s分型可分为生发中心型(1例)和非生发中心型(5例)。NK/T及弥漫大B淋巴瘤患者临床症状中鼻塞、复视、溢泪、突眼症状差异有统计学意义(均P<0.05)。不同病理类型2组间影像特点中肿物外侵下鼻甲及肿物外侵眼眶差异有统计学意义(均P<0.05)。NK/T淋巴瘤患者免疫组织化学检测结果中CD56(+)8例,CD3(+)5例,EBER(+)9例;生发中心型弥漫大B淋巴瘤患者(1例)免疫组织化学:Bcl-6(+)、CD10(+),MUM1(-);非生化中心型弥漫大B淋巴瘤患者Bcl-6(+)5例,MUM1(+)5例,CD10(-)5例。结论:(1)NK/T淋巴瘤在中国人鼻腔鼻窦非霍奇金淋巴瘤中发病率较高,与之对应弥漫大B淋巴瘤发病率较低,这与亚洲地区其他国家的发病率相似,但与西方国家的发病率差别较大;(2)早期出现复视、溢泪及突眼症状,并且影像学上出现眼眶外侵的鼻腔鼻窦肿瘤患者应高度怀疑弥漫大B淋巴瘤;肿瘤的早期诊断对早期治疗尤为重要;(3)组织病理学:NK/T淋巴瘤患者免疫组织化学结果中CD56及EBER阳性率较高;弥漫大B细胞淋巴瘤MUM1阳性率高。
Objective: To investigate the clinical manifestations, imaging features, types of immunohistology and their early diagnostic value of different histological subtypes of nasal sinus non-Hodgkin’s lymphoma. Methods: The clinical, imaging and pathological data of 15 cases of nasal sinus non-Hodgkin’s lymphoma confirmed by surgery and biopsy from 2010 to 2016 in the Third Hospital of Peking University were retrospectively analyzed. The clinical symptoms, imaging characteristics of statistical analysis. Results: Of the 15 patients, 9 were patients with NK / T lymphoma, the median age was 39 years old, including 5 males and 4 females; 6 patients with diffuse large B lymphoma, the median age was 64 years old, including 3 males and 3 females, 3 females, the age difference between groups was statistically significant (P <0.05). According to the pathological Han’s classification, diffuse large B lymphoma can be divided into germinal center type (1 case) and non-germinal center type (5 cases). The symptoms of nasal obstruction, diplopia, overflowing tears and exophthalmos in patients with NK / T and diffuse large B lymphoma had statistical significance (all P <0.05). There was significant difference in the orbital between the turbinate and the tumor invaded by the tumor in the imaging features of two pathological types (all P <0.05). There were 8 cases of CD56 (+), 5 cases of CD3 (+) and 9 cases of EBER (+) in patients with NK / T lymphoma by immunohistochemistry. The patients with germinal center type large lymphoma (1 case) There were 5 cases of Bcl-6 (+), 5 cases of MUM1 (+) and 5 cases of CD10 (-) Bcl-6 (+), CD10 (+) and MUM1 (-) in non-biochemical center type of diffuse large B lymphoma. Conclusions: (1) The incidence of NK / T lymphoma in Chinese non-Hodgkin’s lymphoma of the nasal sinuses is high, corresponding to the low incidence of diffuse large B-lymphoma, which is similar to the incidence in other countries in Asia , But with the incidence of Western countries vary greatly; (2) early diplopia, tearing and exophthalmos symptoms, and imaging orbital sinus invasion of patients with nasal sinus cancer should be highly suspected of diffuse large B lymphoma; tumor (3) Histopathology: The positive rate of CD56 and EBER in patients with NK / T lymphoma is high; the positive rate of MUM1 in diffuse large B-cell lymphoma is high.