【摘要】 目的:探讨鼻腔鼻窦淋巴瘤延迟诊断的原因并提出相应的防范措施。方法:回顾性分析南京医科大学第一附属医院耳鼻咽喉科2016年1月至2024年12月收治的36例鼻腔鼻窦淋巴瘤患者的临床资料，并对延迟诊断的原因进行总结分析。结果:36例患者均为非霍奇金淋巴瘤(non-Hodgkin’s lymphoma, HL),其中最常见的组织类型为结外NK/T细胞淋巴瘤(Extranodal NK/T-cell lymphoma, ENKTL)23例(63.8%),延迟诊断16例(69.6%)。其次为弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma, DLBCL)8例(22.2%),延迟诊断5例(62.5%)。ENKTL最常见的临床表现为鼻塞(87.0%);病变部位主要位于下鼻甲(60.9%)及鼻中隔(30.4%);内镜下主要表现为新生物(65.2%),黏膜广泛糜烂坏死(17.4%)、局部结痂/糜烂/肿胀(17.4%),其中局部结痂/糜烂/肿胀组发病到首次活检时间显著长于新生物组(P<0.05);MRI考虑淋巴瘤7例(46.7%)显著高于CT考虑淋巴瘤2例(9.5%)(P<0.05);组织病理学多见淋巴组织增生/浸润且多数伴异型及坏死(79.4%);诊断延迟患者中初步诊断以鼻炎、鼻窦炎(50.0%)多见。DLBCL最常见的临床表现为眼部症状(50.0%)、鼻塞(50.0%)及头面部胀痛(50.0%);病变主要位于筛窦(75.0%)、眼眶(50.0%)及上颌窦(37.5%);内镜下主要表现为鼻腔新生物(62.5%);CT及MRI考虑淋巴瘤/恶性肿瘤分别为62.5%及71.4%;组织病理学多见中-大淋巴细胞弥漫浸润；诊断延迟患者中初步诊断以鼻面部感染(40.0%)多见。结论:鼻腔鼻窦淋巴瘤以ENKTL及DLBCL为常见类型，因临床表现的非特异性、早期影像学特征不典型及活检局限性等原因存在延迟诊断风险。ENKTL需重点关注局部结痂/糜烂/肿胀表现者，结合CT及MRI进行综合判断并及时行组织活检，DLBCL则应侧重影像学检查，未来研究应聚焦于早期筛查与诊断工具的应用，以进一步提高诊断效率。更多还原

【Abstract】 Objective: To identify factors leading to delayed diagnosis of nasal cavity and paranasal sinus lymphoma(NSL) and to propose preventive strategies. Methods: A retrospective analysis of clinical data from 36 patients with lymphoma of sinonasal cavities admitted to the Otolaryngology Department of the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2024 was conducted. Results: Among 36 patients with non-Hodgkin’s lymphoma(NHL), the most common type was extranodal NK/T-cell lymphoma(ENKTL) in 23 cases(63.8%), with a delayed diagnosis in 16 cases(69.6%). The second most common type was diffuse large B-cell lymphoma(DLBCL) in 8 cases(22.2%), with a delayed diagnosis in 5 cases(62.5%). The main clinical presentation of ENKTL was nasal obstruction(87.0%), primarily affecting the inferior turbinate(60.9%) and nasal septum(30.4%). Endoscopic findings included neoplasms(65.2%), extensive mucosal erosion and necrosis(17.4%), and local scabbing/erosion/swelling(17.4%). Patients in the local scabbing/erosion/swelling group had significantly longer intervals from onset to diagnosis than those in the neoplasms group(P<0.05). MRI considered lymphoma in 7 cases(46.7%), significantly higher than CT, which considered lymphoma in 2 cases(9.5%)(P<0.05). Pathology often revealed lymphoid hyperplasia/infiltration with atypia and necrosis(79.4%). Common initial misdiagnoses for delayed patients included rhinitis and sinusitis(50.0%). For DLBCL, the most common clinical symptoms included ocular symptoms(50.0%), nasal obstruction(50.0%), and facial pain/swelling(50.0%), with lesions primarily in the ethmoid sinus(75.0%), orbit(50.0%), and maxillary sinus(37.5%). Endoscopy primarily revealed neoplasms(62.5%). CT and MRI suggested lymphoma/malignant tumors to be 62.5% and 71.4%, respectively. Pathological findings frequently indicated intermediate to large cell diffuse infiltration and are often misdiagnosed as facial infections(40.0%) for delayed patients. Conclusion: Nasal cavity and sinus lymphoma, primarily ENKTL and DLBCL, often face delayed diagnosis. For ENKTL, clinicians should focus on patients with local crusting/erosion/swelling, combining CT and MRI for comprehensive assessment and timely tissue biopsy. For DLBCL, imaging examinations should be prioritized. Future research should focus on developing early screening and diagnostic tools to enhance efficiency.更多还原