原发性输尿管霍奇金淋巴瘤一例并文献复习

发布时间：2018-04-11 15:46

本文选题：输尿管 + 淋巴瘤　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的提高对原发性结外霍奇金淋巴瘤的认识，提高该疾病的治愈率及生活质量。方法前瞻性分析在山西大医院淋巴肿瘤科确诊的原发性输尿管霍奇金淋巴瘤一例。本例患者为男性，64岁，，主因“尿频、排尿不尽、尿等待3个月，加重1周”住院。住院后于泌尿外科行超声及CT（Computed tomography,计算机断层扫描）检查显示：右侧肾盂及输尿管上段积水扩张，右侧输尿管下段管壁增厚、管腔狭窄，腹主动脉周围多发肿大淋巴结，考虑输尿管癌并淋巴结转移可能。此例患者行手术治疗，右侧输尿管镜检术中转右侧输尿管探查术，术中分离下段输尿管大约10cm，可见输尿管周围结节状增生组织，质地较硬；纵向切开输尿管约3cm，可见输尿管壁增厚，未见明显新生物，横向切取1cm输尿管送病检。双J管置入，常规留置潘氏引流管，结束手术。术后病理报告：输尿管壁增厚，粘膜层及浆膜层可见多量嗜酸性粒细胞、中性粒细胞、小淋巴细胞及浆细胞，另见体积较大细胞散在分布，胞质丰富，核大，单核为主，核型不规则，染色质粗，核仁明显，略嗜酸。免疫组化结果：CD30（+）、CD68部分细胞（+）、LCA部分弱（+）、Ki67约10%（+）、CD15（—）、PAX5（—）。该例患者病理诊断为原发性输尿管霍奇金淋巴瘤,混合细胞型。予ABVD（pirarubicin bleomycin vincristine dacarbazine,吡柔比星博来霉素长春新碱达卡巴嗪）方案行八周期的化疗。结果患者经八周期ABVD方案化疗后，尿频、排尿不尽、尿等待症状消失。全身PET-CT(Position emission tomography-Computed tomography,正电子发射—计算机体层显像)检查：全身扫描未见高代谢影。评估疾病达完全缓解，临床治愈。已随访6个月，目前患者生活质量良好，食欲好，体重增加15kg，无病生存。结论原发性输尿管霍奇金淋巴瘤临床上十分罕见。中老年人多发。男性发病率高于女性，临床表现无特异性，容易误诊为输尿管癌和肉瘤。病灶组织手术活检可明确病理诊断，治疗不宜选择输尿管癌术式，经化疗可达治愈,而且保留肾脏，提高了生活质量。影响该病的预后因素很多，与年龄、病程、组织类型、临床分期和手术解除梗阻是否及时有关。
[Abstract]:Objective to improve the understanding of primary extranodular Hodgkin's lymphoma and improve the cure rate and quality of life.Methods A case of primary ureteral Hodgkin's lymphoma diagnosed by lymphatic oncology department of Shanxi Hospital was analyzed prospectively.This patient is 64 years old male, mainly because of frequent urination, inexhaustible urination, waiting for 3 months, aggravated 1 week hospitalization.Consider the possibility of ureteral carcinoma with lymph node metastasis.This patient underwent surgical treatment and the right ureteroscopy turned to right ureter exploration during the operation. The lower ureter was separated from the lower ureter about 10 cm during the operation. The nodular hyperplasia tissue around the ureter was visible and the texture was hard.Longitudinal incision of ureter about 3 cm, ureteral wall thickening, no obvious new organisms, transverse resection of 1cm ureter for examination.Double J tube was inserted, and Pen's drainage tube was routinely placed, and the operation was ended.The pathological report showed that the ureteral wall was thickened, and many eosinophils, neutrophils, small lymphocytes and plasma cells were found in the mucosal and serous layers, and the larger cells were scattered, the cytoplasm was abundant, the nucleus was large, and the mononuclear cells were dominant.The karyotype is irregular, chromatin is thick, nucleolus is obvious, slightly acidophilic.Immunohistochemical results showed that some of the CD68 cells were weak (about 10%).This patient was pathologically diagnosed as primary ureteral Hodgkin's lymphoma, mixed cell type.ABVD(pirarubicin bleomycin vincristine dacarbazine, imarubicin vincristine and dacarbazine were given eight cycles of chemotherapy.Results after eight cycles of ABVD regimen, the patients had frequent urination, inexhaustible urination and disappeared urine waiting symptoms.PET-CT(Position emission tomography-Computed tomography (positron emission-computer tomography): no hypermetabolic imaging was found.To evaluate the complete remission and clinical cure of the disease.The patients had been followed up for 6 months and had good quality of life, good appetite, weight gain of 15 kg and disease-free survival.Conclusion Primary ureteral Hodgkin's lymphoma is rare clinically.The middle and old people are more common.The incidence of ureteral carcinoma and sarcoma in males is higher than that in females.The pathological diagnosis could be confirmed by surgical biopsy of the lesion, and the operation method of ureteral carcinoma should not be chosen in the treatment, and the kidney could be cured by chemotherapy, and the quality of life was improved.There are many prognostic factors related to age, course of disease, tissue type, clinical stage and surgical relief of obstruction.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.13

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