儿童原发扁桃体弥漫大B细胞淋巴瘤1例并文献复习

doi:10.6040/j.issn.1673-3770.0.2021.366

摘要/Abstract

摘要： 目的探讨儿童原发扁桃体弥漫大B细胞淋巴瘤的临床表现、诊断策略、病理检查及免疫组化特点。方法回顾2021年1月收治的一例原发扁桃体弥漫大B细胞淋巴瘤的患儿临床资料,通过中国知网CNKI和万方数据库检索国内关于儿童原发扁桃体恶性B细胞淋巴瘤的相关文献,并进行数据分析。结果患儿,男,10岁4个月,因咽部不适5个月,伴软腭部溃疡1个月入院,入院后完善相关检查,后行咽部及颈部病损活检术,病理报告显示,(颈部肿块、扁桃体)结合HE及免疫组织化学标记,考虑B细胞源性淋巴瘤,倾向弥漫大B细胞淋巴瘤。后转入肿瘤外科行5次CCCG-BNHL-2015 方案的化学治疗。后恢复平稳,后再次复查检查左侧颈部淋巴结肿大、扁桃体肿大,予以左侧扁桃体活检提示慢性肥大性扁桃体炎,目前随访观察中。回顾既往文献报道及本例的共10例有详细临床资料报道的原发扁桃体恶性B淋巴瘤的患儿,多以咽部不适、扁桃体肿大、睡眠打鼾等症状为主,伴或不伴颈部淋巴结肿大。病理检查提示恶性B细胞淋巴瘤,免疫组化表达CD20、MUM1、BCL-6和BCL-2等,术后接受化学方案治疗和长期随访观察。结论儿童原发扁桃体弥漫大B细胞淋巴瘤较少见,术前症状多为扁桃体肿大,多伴有颈部淋巴结肿大、鼻咽部不适等症状,容易误诊,需结合病理检查及免疫组化明确诊断。治疗上采用化学方案治疗,早期诊断,多学科综合治疗,可提高临床治疗率。

关键词: 儿童, 扁桃体, 弥漫大B细胞淋巴瘤, 临床治疗

Abstract: Objective To investigate the clinical manifestations, diagnostic strategy, pathological examination and immunohistochemical characteristics of primary large B-cell lymphoma of tonsil in children. Methods The clinical data of a child with primary large B-cell lymphoma of the tonsil admitted to our hospital in January 2021 were reviewed. Relevant domestic literatures on primary malignant B-cell lymphoma of the tonsil in children were searched through CNKI and Wanfang database, and the data were analyzed. Results Children Male, April 10, may because of the pharynx ministry unwell, January admission with the soft palate of ulcer, perfect relevant inspection after admission, the pharynx and neck lesions after biopsy and pathology report shows:(neck lump, tonsil)combined with HE and immunohistochemical markers, consider B cell lymphoma that tends to diffuse large B cell lymphoma. Then transferred to the tumor surgery department of our hospital for 5 times of CCCG-BNHL-2015 chemotherapy regimen.After that, the stability was recovered, and the left neck lymph node enlargement and tonsil enlargement were examined again. The left tonsil biopsy suggested chronic hypertrophic tonsillitis..Follow-up observation is currently under way.Reviewing this case and 10 cases of primary malignant B lymphoma of tonsil reported in the literature with detailed clinical data, most of them were characterized by pharyngeal discomfort, tonsil enlargement, sleep snoring and other symptoms, with or without cervical lymph node enlargement.Pathological examination indicated malignant B-cell lymphoma with immunohistochemical expression of CD20, MUM1, Bcl-6 and Bcl-2, and chemotherapy was performed after surgery. with followed up for a long time. Conclusion Primary large B-cell lymphoma of the tonsil in children is rare. Preoperative symptoms are mostly tonsil enlargement and cervical lymph node enlargement, accompanied by nasopharyngeal discomfort and other symptoms. It is easy to be misdiagnosed, and a definite diagnosis should be made by pathological examination and immunohistochemistry. Early diagnosis and multidisciplinary comprehensive treatment can improve the clinical treatment rate.

Key words: Children, Tonsil, Primary large B-cell lymphoma, Clinical treatment

中图分类号:

R766

赵兴贺,樊明月,窦训武,贾广彪. 儿童原发扁桃体弥漫大B细胞淋巴瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 120-124.

ZHAO Xinghe, FAN Mingyue, DOU Xunwu, JIA Guangbiao. Primary large B-cell lymphoma of tonsil in children: a case report and document review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 120-124.

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