摘要目的 探讨原发性乳腺淋巴瘤(primary lymphoma of breast,PLB)的组织学类型构成及预后相关因素.方法 回顾性分析2006年10月至2016年10月115例PLB的临床病理资料、组织形态学及免疫组织化学EliVision法染色结果,总结其基本资料、临床表现、病理类型及预后.结果患者女性为主(113/115),中位年龄52岁(27~81岁),表现为乳腺无痛性进行性增大结节.10例(8.7%)伴有B症状.肿物主要局限于乳腺(80.9%,93/115),22例伴有同侧腋窝淋巴结肿大,乳腺肿块平均直径3.0 cm(范围0.5~9.0 cm),均为单侧乳腺受累,左右侧无差异.106例(92.2%)为非霍奇金成熟B细胞淋巴瘤,主要为弥漫大B细胞淋巴瘤(DLBCL,64.3%)和黏膜相关淋巴组织结外边缘区(MALT)淋巴瘤(17.4%).5例(4.4%)成熟T/NK细胞淋巴瘤,包括结外鼻型NK/T细胞淋巴瘤(1.7%)、非特殊类型外周T细胞淋巴瘤(0.9%)、皮下脂膜炎样T细胞淋巴瘤(0.9%)及未分类型(0.9%).幼稚淋巴细胞淋巴瘤表现为淋巴母细胞性淋巴瘤4例(3.5%).根据Ann Arbor分期标准,ⅠE期93例(ⅠEB期6例),ⅡE期22例(ⅡEB期4例).115例中92例获得随访资料,中位随访时间36个月(1~122个月),13例死亡,5年总生存率为85.3%;B症状是影响患者预后的因素之一(P<0.05),而组织学类型与预后没有相关性(P>0.05).结论 PLB较为少见,以无痛性肿块为主要临床表现,其与乳腺癌鉴别较困难,组织学类型较多,其中DLBCL最多见,其次是MALT淋巴瘤,T细胞淋巴瘤罕见.PLB肿瘤分期早,预后较好,但伴发B症状者预后较差.

abstractsObjective To investigate the pathological types and prognostic factors of primary lymphoma of breast (PLB).Methods The clinical pathological data of 115 cases of PLB during October 2006 to October 2016 were retrospectively analyzed, and the basic clinical and pathological data, pathology types and the immunohistochemical slides by EliVision two-step method for staining were summarized.Results Almost all the patients were women (113/115), and the median age was 52 years old (range:27 to 81 years old).The main symptom was painless progressive mass in breast.Ten cases (8.7%) showed B symptoms.The masses were mainly confined to the unilateral breast (80.9%,93/115), of which 22 cases showed axillary lymph nodes enlargement in the same side.The average diameter of masses was 3.0 cm (range from 0.5 to 9.0 cm).There is no differences between the sides (left or right).Pathologically, 106 cases (92.2%) were mature non-Hodgkin's B-cell lymphomas, of which there were mainly diffuse large B cell lymphoma (DLBCL,64.3%) and mucosa associated lymphoid tissue (MALT) extranodal marginal lymphoma (17.4%).Five cases (4.4%) were mature T/NK cell lymphomas, including extranodal nasal NK/T cell lymphoma (1.7%), peripheral T-cell lymphoma non-specific type (0.9%), subcutaneous panniculitis-like T cells lymphoma (0.9%) and undivided (0.9%).Four cases were lymphoblastic lymphoma.According to Ann Arbor staging criteria, 93 cases were stage ⅠE (6 cases were stage ⅠEB), 22 cases were stage ⅡE (4 cases were stage ⅡEB).Ninety-two cases were followed 1 to 122 months (median:36 months).The five-year overall survival rate was 85.3%, and 13 patients dead.B symptom was one of the factors that affect the prognosis (P<0.05), but the pathological type has no relationship with the prognosis (P>0.05).Conclusions PLB is relatively rare,the main clinical manifestation is painless mass, which is difficult to distinguish with breast carcinoma.The most common type is DLBCL, followed by MALT lymphoma, while T cell lymphoma is rarely seen.PLB is early stage tumor with good prognosis, while patients with B symptom turn out to suffer worse prognosis.