| Background and purpose:Pulmonary lymphoid tissue tumor is a rare malignant tumor of the lung.According to the primary lesions or forms of invasion of lung lymphoma,they can be divided into two types: primary pulmonary lymphoma(PPL)and secondary pulmonary lymphoma(SPL).Primary pulmonary lymphoma is rare,accounting for only 0.3% of all primary lung malignancies,accounting for less than 1% of all NHL,and 3%-4% of extranodal non-Hodgkin's lymphoma.Its incidence is low.Among them,MALT lymphoma is the pathological type with the largest proportion.Secondary pulmonary lymphoma is an intrapulmonary infiltration of lymphoma in other parts of the body.SPL is more common clinically than PPL.It usually has multiple systems and multiple organs involved,resulting in corresponding extrapulmonary manifestations.However,the pathological data of secondary lymphoma in the lung is relatively scarce,and there are few reports in the literature at home and abroad.And the two types of clinical symptoms,imaging findings,pathological features,etc.are not specific,the diagnosis is difficult.Missed diagnosis and misdiagnosis often occur in clinical practice.This article analyzes the clinical,imaging,pathological,therapeutic and prognostic factors of 75 patients with pulmonary lymphoma,in order to provide a clinical reference for the early diagnosis,reasonable treatment and related prognostic factors of this disease.Thereby strengthening the understanding of such diseases,reducing missed diagnosis,misdiagnosis,so as not to delay treatment,while reducing unnecessary examination and cost of patients.Methods:A retrospective analysis of 75 patients with pulmonary lymphoma(9 cases of primary pulmonary lymphoma and 66 cases of secondary pulmonary lymphoma)diagnosed during the period from January 2011 to December 2018 in our hospital.The clinical symptoms,biochemical parameters,imaging features,pathological types,and treatment options of 75 patients with confirmed pulmonary lymphoma were analyzed by single factor and multi-factor data,and the survival data of patients were followed up to analyze the relevant factors for prognosis impact.Results:1.Pulmonary lymphoma,male incidence was higher than female.Male to female ratio 1.14:1.The median age of onset was 57 years(19-78 years).There were 33people(44.0%)aged >60 years old and 42 people(56.0%)aged ?60 years old.The number of people with an IPI score of 0-2 was 39(52%),and the number of 3-5 was36(48%).There were 9 cases(12.0%)with primary pulmonary lymphoma were collected in this study,the median age of onset was 60 years old,and 7 cases were underlying diseases,accounting for 77.8%.Among them,pulmonary MALT lymphoma was the most common pathological type(66.7%).The clinical manifestations were cough and expectoration(4/6,66.7%).And there were 2 cases without any clinical manifestations at the time of diagnosis,accounting for 33.3%.Imaging studies were more common with patchy images(4/6,66.7%)and multiple nodules(2/6,33.3%),which might be associated with air bronchoscopy(1/6,16.7%).There were 3 cases(33.3%)of pulmonary IVLBCL and the main clinical symptoms were dyspnea(3/3,100%),cough(2/3,66.7%)and fever(3/3,100%).Radiography showed ground glass(3/3,100%),interlobular thickening(3/3,100%)and nodular shadow(2/3,66.7%).2.There were 66 cases(88.0%)of secondary pulmonary lymphoma,and the median age of onset was 57 years old.35 patients had a history of previous basic diseases,accounting for 53.0%.Clinical manifestations were common with respiratory symptoms such as cough(29/66,43.9%),dyspnea(17/66,25.8%)and B symptoms(31/66,47.0%).Imaging studies were more common with multiple nodules(29/66,43.9%)and morphological changes(23/66,34.8%),with mediastinal and hilar lymphadenopathy in 32 cases(48.5%),and air bronchus in 5 cases(7.6%).There were53 cases(80.3%)of NHL in SPL,8 cases(12.1%)of HL,and 5 cases(7.6%)of lymphoma with unknown pathological classification.Among the 53 NHLs,39 cases(59.1%)were B-derived lymphoma,and the most common pathological type was DLBCL(22cases,33.3%),followed by follicular lymphoma in 7 cases(10.6%).There were 14 cases(21.2%)of T-cell lymphoma,and the number of peripheral T-cell lymphoma and Angioimmunoblastic T-cell lymphoma were more common,with 4cases(6.1%)of each.3.Univariate analysis suggested that the poor prognostic factors including: age >60 years old,with B symptoms,absolute lymphocyte count / absolute cell count(LMR)< 1.91,?2-microglobulin(?2-MG)increased(? 2286 ug / L),lactic dehydrogenase(LDH)increased(? 248 IU/L),and IPI score 3-5 points.The P values were 0.007,0.023,0.038,0.004,0.006,<0.001.Multivariate analysis showed that the IPI score was an independent prognostic factor.4.The prognosis of pulmonary lymphoma was related to the pathological type.Among the 9 patients with PPL,6 cases with pulmonary MALT lymphoma had a good prognosis with a 5-year survival rate of 83.3%.Three patients with pulmonary IVLBCL had a 1-year survival rate of 33.3%.Survival was compared between different pathological types of NHL and HL.The survival rate was 61.29% in the NHL group and the average survival time was 27.2 months.In the HL group,the survival rate was 87.50% and the average survival time was 37.6 months.P=0.133,and there was no statistically significant difference.However the survival rate and mean survival time trend showed that the HL group had a better prognosis.There were 48 cases of B cell lymphoma in 62 cases of NHL,the survival rate was 75.00%,and the average survival time was 29.5 months.And there were 14 cases of T cell lymphoma,the survival rate was 14.29%,and the average survival time was 19.1months.P<0.001,the difference was statistically significant.It was suggested that the prognosis of B cell lymphoma was better than that of T cell.In 22 cases of pulmonary DLBCL,7 cases of germinal center,which the average survival time was 37.7 months;15 cases of non-germinal center,the average survival time was 20.1 months.P=0.029,the difference was statistically significant,suggesting that the prognosis of the germinal center source was superior to that of the non-germinal center.5.37 patients with B cell-derived NHL received CHOP or CHOP-like chemotherapy alone.The survival rate was 92.86%,and the average survival time was21.9 months.The R-CHOP or R-CHOP-like targeted therapy was performed in 23 patients.The survival rate was 73.91%,and the average survival time was 29.4months.P=0.344,suggesting that the difference between two groups was not statistically significant.Conclusion:1.Pulmonary lymphoma,male incidence was higher than female.Clinical symptoms were more common with respiratory symptoms and systemic symptoms.More than half of the patients had underlying diseases.Imaging examinations were mainly real shadows and nodules,with or without air bronchoscopy.And SPL were mainly mediastinal and hilar node enlargement.None of the above performances were specific.2.PPL was rare,and the most common pathological type was MALT.SPL was more common in clinical practice.DLBCL was the most common pathological type,followed by follicular lymphoma.3.Univariate analysis suggested that the poor prognostic factors including: age >60 years old,with B symptoms,LMR < 1.91,?2-microglobulin increased,lactic dehydrogenase increased,and IPI score 3-5 points.Multivariate analysis showed that the IPI score was an independent prognostic factor.4.The prognosis of pulmonary lymphoma was related to the pathological type.Primary pulmonary MALT lymphoma had a good prognosis with a 5-year survival rate of 83.3%.In pulmonary NHL,B cell-derived lymphoma had a better prognosis than T cell-derived.In pulmonary DLBCL,the source of the germinal center had a better prognosis than the source of the non-generating center. |
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