目的 探讨巨淋巴结增生症(castleman’s disease,CD)的临床特点及外科治疗方法。 方法 分析2005年10月至2010年3月首都医科大学附属北京友谊医院收治9例巨淋巴结增生症患者的临床资料,其中男7例、女2例,平均年龄51.8岁。出现临床症状2例,包括咳嗽、胸闷、发热、乏力、盗汗等,其他为体检发现。9例患者术前均行胸部X线片、胸部CT、单光子发射计算机断层成像术(SPECT) 和腹部B超检查。接受手术切除治疗。 结果 在临床分型中,单中心型CD 5例,多中心型CD 4例;病理分型中,透明血管型6例,浆细胞型1例,混合型2例。由于瘤体血供丰富,术中出血较多,平均出血量514.4 ml,最多2 500 ml。5例单中心型CD患者均生存,无复发;多中心型CD 4例,随访3~5年,4例均生存,其中2例分别于术后1年、3年后复发,再次行手术切除,术后病理结果与第1次手术相同。 结论 CD的诊断主要依靠影像及病理学,而最后确诊还应以病理学为准。无论哪种类型的CD外科切除均为有效的治疗方法,单中心型CD手术切除病变可达到彻底治愈的目的,而多中心型CD手术切除后仍有复发可能,应适当联合化疗、放疗等其他治疗手段。
Citation:
王飞,郑鑫,高志. 巨淋巴结增生症的临床特点及外科治疗. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(2): 232-234. doi: 10.7507/1007-4848.20130067
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Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
1. |
5 Sato N, Kondo S, Saito K, et al. Hyaline vascular-type Castleman’s disease in the hepatoduodenal ligament:report of a case. Surg Today,
2006, 36 (7):647-650.
|
2. |
8 Bowne WB, Lewis JJ, Filippa DA, et al. The management of
unicentric and multicentric Castleman’s disease:a report of 16 cases and a review of the literature. Cancer, 1999, 85 (3):706-717.
|
3. |
9 Chronowski GM, Ha CS, Wilder RB, et al. Treatment of unicentric
and multicentric Castleman disease and the role of radiotherapy. Cancer, 2001, 92 (3):670-676.
|
4. |
localized and multicentric Castleman disease. Ann Intern Med, 1998, 128 (8):657-662.
|
5. |
14 Harada N, Sayama K, Tanaka K, et al. Long-term treatment with a humanized anti-interleukin-6 receptor antibody (tocilizumab),
improving interstitial pneumonia in a patient with multicentric Castleman
disease. Nihon Kokyuki Gakkai Zasshi, 2010, 48 (2):145-150.
|
6. |
15 Akashi A, Hazama K, Miyoshi S, et al. An analysis of video-assisted
thoracoscopic resection for mediastinal masses in 150 cases. An overview of the pansternal approach, histology, and complications. Surg Endosc, 2001, 15 (10):1167-1170.
|
7. |
Castleman B, Iverson L, Menendez VP. Localized mediastinal lymphnode hyperplasia resembling thymoma. Cancer, 1956, 9 (4):822-830.
|
8. |
Frizzra G. Castleman’s disease and related disorders. Semin Diagno Pathol, 1988, 5 (4):346-351.
|
9. |
Shahidi H, Myers JL, Kvale PA. Castleman’s disease. Mayo Clin Proc, 1995, 70 (10):969-977.
|
10. |
Seo HY, Kim EB, Kim JW, et al. Complete remission in a patient with human herpes virus-8 negative multicentric Castleman disease using CHOP chemotherapy. Cancer Res Treat, 2009, 41 (2):104-107.
|
11. |
Luppi M, Barozzi P, Maiorana A, et al. Human herpevirus-8 DNA sequences in human immunodeficiency virus-negative angioimmunoblastic lymphadenopathy and benign lymphadenopathy with giant germinal center hyperplasia and increased vascularity. Blood, 1996, 87 (9):3903.
|
12. |
Casper C. The aetiology and management of Castleman disease at 50 years:translating pathophysiology to patient care. Br J Haematol, 2005, 129 (1):3-17.
|
13. |
Herrada J, Cabanillas F, Rice L, et al. The clinical behavior of.
|
14. |
Ruco LP, Gearing AJ, Pigott R, et al. Expression of ICAM-1, VCAM-1 and ELAM-1 in angiofollicular lymph node hyperplasia (Castleman’s disease):evidence for dysplasia of follicular dendritic reticulum cells. Histopathology, 1991, 19 (6):523-528.
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15. |
周乃康, 王波, 梁朝阳, 等. 胸内Castleman病的外科治疗. 解放军医学杂志, 2006, 31 (2):159-161.
|
16. |
Ko SF, Hsieh MJ, Ng SH, et al. Imaging spectrum of Castleman’s disease. Am J Roentgenol, 2004, 182 (3):769-775.
|
17. |
Roviaro G, Varoli F, Nucca O, et al. Videothoracoscopic approach to primary mediastinal pathology. Chest, 2000, 117 (4):1179-1183.
|
18. |
李启英, 项颖. 多中心型 (浆细胞型)巨大淋巴结增生症1例及文献复习. 重庆医学, 2009, 38 (10):1271-1272.
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- 1. 5 Sato N, Kondo S, Saito K, et al. Hyaline vascular-type Castleman’s disease in the hepatoduodenal ligament:report of a case. Surg Today,
2006, 36 (7):647-650.
- 2. 8 Bowne WB, Lewis JJ, Filippa DA, et al. The management of
unicentric and multicentric Castleman’s disease:a report of 16 cases and a review of the literature. Cancer, 1999, 85 (3):706-717.
- 3. 9 Chronowski GM, Ha CS, Wilder RB, et al. Treatment of unicentric
and multicentric Castleman disease and the role of radiotherapy. Cancer, 2001, 92 (3):670-676.
- 4. localized and multicentric Castleman disease. Ann Intern Med, 1998, 128 (8):657-662.
- 5. 14 Harada N, Sayama K, Tanaka K, et al. Long-term treatment with a humanized anti-interleukin-6 receptor antibody (tocilizumab),
improving interstitial pneumonia in a patient with multicentric Castleman
disease. Nihon Kokyuki Gakkai Zasshi, 2010, 48 (2):145-150.
- 6. 15 Akashi A, Hazama K, Miyoshi S, et al. An analysis of video-assisted
thoracoscopic resection for mediastinal masses in 150 cases. An overview of the pansternal approach, histology, and complications. Surg Endosc, 2001, 15 (10):1167-1170.
- 7. Castleman B, Iverson L, Menendez VP. Localized mediastinal lymphnode hyperplasia resembling thymoma. Cancer, 1956, 9 (4):822-830.
- 8. Frizzra G. Castleman’s disease and related disorders. Semin Diagno Pathol, 1988, 5 (4):346-351.
- 9. Shahidi H, Myers JL, Kvale PA. Castleman’s disease. Mayo Clin Proc, 1995, 70 (10):969-977.
- 10. Seo HY, Kim EB, Kim JW, et al. Complete remission in a patient with human herpes virus-8 negative multicentric Castleman disease using CHOP chemotherapy. Cancer Res Treat, 2009, 41 (2):104-107.
- 11. Luppi M, Barozzi P, Maiorana A, et al. Human herpevirus-8 DNA sequences in human immunodeficiency virus-negative angioimmunoblastic lymphadenopathy and benign lymphadenopathy with giant germinal center hyperplasia and increased vascularity. Blood, 1996, 87 (9):3903.
- 12. Casper C. The aetiology and management of Castleman disease at 50 years:translating pathophysiology to patient care. Br J Haematol, 2005, 129 (1):3-17.
- 13. Herrada J, Cabanillas F, Rice L, et al. The clinical behavior of.
- 14. Ruco LP, Gearing AJ, Pigott R, et al. Expression of ICAM-1, VCAM-1 and ELAM-1 in angiofollicular lymph node hyperplasia (Castleman’s disease):evidence for dysplasia of follicular dendritic reticulum cells. Histopathology, 1991, 19 (6):523-528.
- 15. 周乃康, 王波, 梁朝阳, 等. 胸内Castleman病的外科治疗. 解放军医学杂志, 2006, 31 (2):159-161.
- 16. Ko SF, Hsieh MJ, Ng SH, et al. Imaging spectrum of Castleman’s disease. Am J Roentgenol, 2004, 182 (3):769-775.
- 17. Roviaro G, Varoli F, Nucca O, et al. Videothoracoscopic approach to primary mediastinal pathology. Chest, 2000, 117 (4):1179-1183.
- 18. 李启英, 项颖. 多中心型 (浆细胞型)巨大淋巴结增生症1例及文献复习. 重庆医学, 2009, 38 (10):1271-1272.