关键词：骨肿瘤；淋巴瘤；诊断；化学疗法；辅助；放射疗法；辅助
【摘要】目的 探讨原发性骨恶性淋巴瘤的诊断标准、治疗方法和预后的关系。方法 回顾性分析此瘤36例，均无特殊的临床与影像学表现，原发于骨骼而无任何其他组织起源的证据。均经病检，特别是免疫组化检测，确诊为原发性骨恶性淋巴瘤。B细胞源性24例(核裂细胞型11例，无核裂细胞型8例，混合型5例)，T细胞源性12例(多形T细胞型6例，淋巴母细胞型3例，透明T细胞型3例)。结果 手术治疗19例，术后放疗9例，化疗6例。诊断性活检术17例，确诊后单用放疗6例，单用化疗6例，放、化疗4例，住院期间死亡1例。出院后随访2～14年，获得随访结果31例，2年内死亡12例，现存活19例，五年与10年生存率分别为37.5%(12/32)与15.6%(5/32)。结论 病检和免疫组化是确诊与分型的重要手段。治疗以放、化疗为主，辅以手术，可根据免疫表型选择不同的化疗方案。
Clinical Review of 36 Cases of Primary Malignant Lymphoma of Bone
HU Yunzhou, HU Jiang, ZENG Jiancheng, et al.
Department of Orthopaedics, First University Hospital, West China University of Medical Sciences, Chengdu 610041
【 Abstract 】 Objective Study on diagnostic criterion and the relationship between treatment and prognosis of primary malignant lymphoma of bone to improve the level of diagnosis and treatment. Methods Thirty- six cases of primary lymphoma of bone were reviewed. All were confirmed by histological examination and immunohistochemical staining: They were of B- cell origin in 24 cases (cleaved cell in 11, noncleaved cell in 8, mixed type in 5), T- cell origin in 12 cases (multimorphologic T- cell in 6, lymphoblast in 3, and clear T- cell type in 3). Results Surgery was performed in 19 cases (after operation, radiotherapy 9, chemotherapy 6), biopsy 17 (among them, radiotherapy 6, chemotherapy 6,radiotherapy plus chemotherapy 4, One died in hospital). Follow- up was available in 31 cases (death within two years 12 cases, survival 19 cases). The 5 year and 10 year survival rates were, 37.5% (12/32) and 15.6% (5/32), respectively. Conclusions Histological examination and immunohistochemical staining are important in diagnosis and subclassification of primary malignant lymphoma of bone. Radiotherapy and chemotherapy are main treatment for this tumor, and surgery is an adjuvant measure. Different protocols of chemotherapy could be chosen according to different immunotypes.
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