【作者】 刘娟；

【导师】 梅同华；

【作者基本信息】 重庆医科大学 ， 临床医学（专业学位）， 2018， 硕士

【摘要】 目的:探讨原发性肺淋巴瘤(Primary pulmonary lymphoma,PPL)的临床特征、误诊原因及防范措施。方法:对重庆医科大学附属第一医院曾误诊的12例原发性肺淋巴瘤的临床资料进行回顾性分析,并结合相关文献分析其误诊原因。结果:12例患者中,10例表现出呼吸道症状,其中咳嗽8例,咳痰6例,胸痛3例,胸闷3例,发热1例。2例因无症状由体检发现。胸部CT表现为结节肿块影9例,肺叶或段实变2例,其内可见空气支气管征,多发结节影1例,部分合并胸腔积液。经外科手术肺组织活检确诊者6例,经纤支镜肺活检确诊者3例,经CT引导下经皮肺穿刺活检确诊者2例,经胸壁肿物活检确诊者1例。12例患者全部经病理证实,其中有10例同时行免疫组化。12例患者均误诊,误诊时间最短为1月,最长为7年,平均约9月。结论:PPL多以咳嗽、咳痰、胸痛等为首发症状,部分可无症状因体检发现。胸部CT可表现为多种类型,其中以结节肿块型多见。外科手术肺组织活检为主要取材确诊方法,其次为纤支镜肺活检、CT引导下经皮肺穿刺活检,通过其他方法取材确诊者仅少数。提高对该病的认识,选择适当的方法获得足够组织病理标本,并结合临床、免疫组化等及早明确诊断,可减少漏误诊。更多还原

【Abstract】 Objective:Investigating the clinical characteristics,misdiagnosis reasons and preventive measures of primary pulmonary lymphoma(PPL).Methods:The clinical data of 12 cases of primary pulmonary lymphoma,which had been misdiagnosed in the First Affiliated Hospital of Chongqing Medical University,were studied.The causes of misdiagnosis were analyzed with the review of the literature.Results:Among the 12 patients,10 manifested respiratory symptoms including cough in 8 patients,expectoration in 6 patients,chest pain and chest tightness each in 3 patients,one of these patients experienced fever.Two cases were found by physical examination because of asymptomatic symptoms.Chest computed tomography showed 9 cases of nodular mass,2 cases of solid type,which air bronchogram can be seen,and 1 case had multiple nodules,some cases can combine with pleural effusion.6 cases were confirmed by surgical lung biopsy,3 cases were diagnosed by bronchoscopic lung biopsy,2 cases were diagnosed by CT-guided percutaneous lung biopsy,and 1 case was confirmed by biopsy of chest wall tumor.All 12 patients were confirmed by pathologically,ten of these do the immunohistochemistry at the same time.12 cases were misdiagnosed,the shortest misdiagnosis time is 1 month and the longest is 7 years,the average time is about 9 months.Conclusion:PPL mostly has cough,sputum,and chest pain as the first symptoms,and some of them may be asymptomatic asymptomatic finding by physical examination.Radiographic manifestations varied,the most common type of nodular mass.Surgical lung biopsy is the main method of get the organization to diagnosis,next are bronchoscopic lung biopsy and CT-guided percutaneous lung biopsy,only a few patients confirmed by other methods.Improve the understanding of the disease,choose the appropriate method,and early access to sufficient histopathological specimens,combine with clinical and immunohistochemical to make a diagnosis earlier can reduce misdiagnosis.更多还原