Peng Fei,Yan Xueqiang,Liang Chong,et al.Clinical analysis of childhood lymphoma with cervical lymphadenopathy as an initial symptom[J].Journal of Clinical Pediatric Surgery,2024,(01):66-71.[doi:10.3760/cma.j.cn101785-202201029-013]
以颈部淋巴结肿大为首发症状的儿童淋巴瘤临床特征分析
- Title:
- Clinical analysis of childhood lymphoma with cervical lymphadenopathy as an initial symptom
- Keywords:
- Cervical Lymph Node; Hodgkin’s Lymphoma; Non-Hodgkin’s Lymphoma; Child; Blopsy
- 摘要:
- 目的 探讨以颈部淋巴结肿大为首发症状的儿童淋巴瘤临床特征,分析外科手术在儿童淋巴瘤诊疗中的作用。 方法 回顾性分析华中科技大学同济医学院附属武汉儿童医院普外科2013年1月至2021年1月收治的22例以颈部淋巴结肿大为首发症状的淋巴瘤患儿临床资料,总结患儿临床特点、诊治过程以及预后情况。 结果 本研究纳入的22例淋巴瘤患儿中,男14例、女8例,病程2周至6年4个月;肿大淋巴结直径2~10 cm,中位直径5 cm。14例表现为无痛性淋巴结增大,9例先发热后出现颈部淋巴结增大,8例伴有局部红肿、触痛。13例接受了抗感染治疗,其中3例淋巴结缩小,10例未见缓解。22例均通过淋巴结活检明确诊断,其中非霍奇金淋巴瘤16例,依据St.Jude NHL分期系统,Ⅱ期3例、Ⅲ期7例、Ⅳ期6例;霍奇金淋巴瘤6例,依据Ann Arbor分期系统,Ⅱ期4例、Ⅳ期2例。 结论 儿童颈部淋巴瘤临床症状不典型,易出现漏诊和误诊;对于颈部淋巴结增大超过2 cm,伴或不伴局部红肿、触痛,经保守治疗1周淋巴结未缩小或缩小不明显者,需考虑行淋巴结活检。
- Abstract:
- Objective To explore the clinical characteristics of childhood lymphoma (CL) with cervical lymphadenopathy as an initial symptom and examine the role of surgery in its management.Methods From January 2013 to January 2021,the relevant clinical data were retrospectively reviewed for 22 CL children with cervical lymphadenopathy as an initial symptom.Clinical features,diagnoses,treatments and outcomes were summarized.Results There were 14 boys and 8 girls with a disease course of 2 weeks to 76 months.The enlarged lymph nodes had a median diameter of 5(2-10) cm.There were painless lymph node enlargement (n=14),fever followed by cervical lymphadenopathy (n=9) and concurrent local redness,swelling and tenderness (n=8).Among 13 recipients of antibiotics,lymph nodes diminished (n=3) and showed no change (n=10).The diagnoses of non-Hodgkin’s lymphoma (NHL,n=16) and Hodgkin’s lymphoma (HL,n=6) were confirmed by biopsy.The stages of NHL were Ⅱ (n=3),Ⅲ (n=7) and Ⅳ (n=6) according to St Jude NHL staging system.And the stages of HL were Ⅱ (n=4) and Ⅳ (n=2) based upon Ann Arbor staging system.Conclusions Clinical symptoms of cervical lymphoma are generally atypical in children.It is prone to a missed or under diagnosis.Lymph node biopsy is indicated for cervical lymphadenopathy enlarging by more than 2 cm with or without local redness,tenderness and lymph nodes failing to shrink obviously after 1-week conservative treatment.
参考文献/References:
[1] Bleyer A,Viny A,Barr R.Cancer in 15-to 29-year-olds by primary site[J].Oncologist,2006,11(6):590-601.DOI:10.1634/theoncologist.11-6-590.
[2] 中华医学会儿科学分会血液学组,中国抗癌协会儿科专业委员会,《中华儿科杂志》编辑委员会.儿童非霍奇金淋巴瘤诊疗建议[J].中华儿科杂志,2011,49(3):186-192.DOI:10.3760/cma.j.issn.0578-1310.2011.03.006. Group of Hematology,Branch of Pediatrics,Chinese Medical Association;Specialty Committee of Pediatrics,Chinese Anti-Cancer Association;Editorial Board of Chinese Journal of Pediatrics:Diagnostic & Therapeutic.Recommendations for Pediatric non-Hodgkin’s Lymphoma[J].Chin J Pediatr,2011,49(3):186-192.DOI:10.3760/cma.j.issn.0578-1310.2011.03.006.
[3] Ward E,DeSantis C,Robbins A,et al.Childhood and adolescent cancer statistics,2014[J].CA Cancer J Clin,2014,64(2):83-103.DOI:10.3322/caac.21219.
[4] Bao PP,Zheng Y,Wang CF,et al.Time trends and characteristics of childhood cancer among children age 0-14 in Shanghai[J].Pediatr Blood Cancer,2009,53(1):13-16.DOI:10.1002/pbc.21939.
[5] 刘丁丁,钱晓云,刘永泽,等.84例原发头颈部淋巴瘤临床及病理特征分析[J].山东大学耳鼻喉眼学报,2018,32(6):48-51.DOI:10.6040/j.issn.1673-3770.0.2018.274. Liu DD,Qian XY,Liu YZ,et al.Analysis of clinicopathological features of primary head and neck lymphoma:a report of 84 cases[J].J Otolaryngol Ophthalmol Shandong Univ,2018,32(6):48-51.DOI:10.6040/j.issn.1673-3770.0.2018.274.
[6] Olu-eddo AN,Omoti CE.Diagnostic evaluation of primary cervical adenopathies in a developing country[J].Pan Afr Med J,2011,10:52.
[7] Cabe?adas J,Martinez D,Andreasen S,et al.Lymphomas of the head and neck region:an update[J].Virchows Arch,2019,474(6):649-665.DOI:10.1007/s00428-019-02543-7.
[8] Jaffe ES.Diagnosis and classification of lymphoma:impact of technical advances[J].Semin Hematol,2019,56(1):30-36.DOI:10.1053/j.seminhematol.2018.05.007.
[9] 魏博雄,张良良,陈路增,等.超声引导下淋巴结粗针穿刺活检对淋巴瘤和非淋巴瘤诊断价值及影响因素分析[J].中国超声医学杂志,2021,37(3):288-291. Wei BX,Zhang LL,Chen LZ,et al.Comparison of diagnostic value and influencing factors of ultrasound-guided core needle biopsy for lymphoma and non-lymphoma[J].Chin J Ultrasound Med,2021,37(3):288-291.
[10] Warshavsky A,Rosen R,Perry C,et al.Core needle biopsy for diagnosing lymphoma in cervical lymphadenopathy:meta-analysis[J].Head Neck,2020,42(10):3051-3060.DOI:10.1002/hed.26381.
[11] Assaf N,Nassif S,Tamim H,et al.Diagnosing lymphoproliferative disorders using core needle biopsy versus surgical excisional biopsy:three-year experience of a reference center in Lebanon[J].Clin Lymphoma Myeloma Leuk,2020,20(8):e455-e460.DOI:10.1016/j.clml.2019.11.013.
[12] Tu?aliu M,Mogoant? CA,Dobrea CM,et al.Clinical and histological aspects with therapeutic implications in head and neck lymphomas[J].Rom J Morphol Embryol,2015,56(2):499-504.
[13] 王丽,王智明.头颈部恶性淋巴瘤的研究进展[J].重庆医学,2019,48(1):131-133,137.DOI:10.3969/j.issn.1671-8348.2019.01.033. Wang L,Wang ZM.Research advances of head and neck malignant lymphoma[J].Chongqing Med,2019,48(1):131-133,137.DOI:10.3969/j.issn.1671-8348.2019.01.033.
[14] Arboleda LPA,de Mendon?a RMH,Lopez EEM,et al.Global frequency and distribution of head and neck cancer in pediatrics:a systematic review[J].Crit Rev Oncol Hematol,2020,148:102892.DOI:10.1016/j.critrevonc.2020.102892.
[15] Gaini RM,Romagnoli M,Sala A,et al.Lymphomas of head and neck in pediatric patients[J].Int J Pediatr Otorhinolaryngol,2009,73(Suppl 1):S65-S70.DOI:10.1016/S0165-5876(09)70013-8.
[16] 李萍,黄东生,张谊,等.儿童头颈部非霍奇金淋巴瘤21例临床分析[J].中国小儿血液与肿瘤杂志,2014,19(5):254-258.DOI:10.3969/j.issn.1673-5323.2014.05.008. Li P,Huang DS,Zhang Y,et al.Clinical analysis of non-Hodgkin’s lymphoma originated from head and neck in children:a report of 21 cases[J].J China Pediatr Blood Cancer,2014,19(5):254-258.DOI:10.3969/j.issn.1673-5323.2014.05.008.
[17] 娄凡,张铁松,明澄,等.儿童颈部淋巴结病变的临床分析[J].临床耳鼻咽喉头颈外科杂志,2020, 34(10):928-931.DOI:10.13201/j.issn.2096-7993.2020.10.014. Lou F,Zhang TS,Ming C,et al.Clinic analysis of cervical lymph node lesions in children[J].J Clin Otorhinolaryngol Head Neck Surg,2020,34(10):928-931.DOI:10.13201/j.issn.2096-7993.2020.10.014.
[18] Ryu KH,Lee KH,Ryu JH,et al.Cervical lymph node imaging reporting and data system for ultrasound of cervical lymphadenopathy:a pilot study[J].AJR Am J Roentgenol,2016,206(6):1286-1291.DOI:10.2214/AJR.15.15381.
[19] 林文金,薛恩生,林振湖,等.颈部淋巴结恶性风险分级诊断系统的初步构建[J].中华超声影像学杂志,2021,30(2):126-131.DOI:10.3760/cma.j.cn131148-20200816-00662. Lin WJ,Xue ES,Lin ZH,et al.Preliminary study of malignant risk classification system for cervical lymph node[J].Chin J Ultrasonogr,2021,30(2):126-131.DOI:10.3760/cma.j.cn131148-20200816-00662.
[20] Ludwig BJ,Wang J,Nadgir RN,et al.Imaging of cervical lymphadenopathy in children and young adults[J].AJR Am J Roentgenol,2012,199(5):1105-1113.DOI:10.2214/AJR.12.8629.
[21] Bosch X,Coloma E,Donate C,et al.Evaluation of unexplained peripheral lymphadenopathy and suspected malignancy using a distinct quick diagnostic delivery model:prospective study of 372 patients[J].Medicine (Baltimore),2014,93(16):e95.DOI:10.1097/MD.0000000000000095.
[22] Nixon S,Bezverbnaya K,Maganti M,et al.Evaluation of lymphadenopathy and suspected lymphoma in a lymphoma rapid diagnosis clinic[J].JCO Oncol Pract,2020,16(1):e29-e36.DOI:10.1200/JOP.19.00202.
[23] Celenk F,Baysal E,Aytac I,et al.Incidence and predictors of malignancy in children with persistent cervical lymphadenopathy[J].Int J Pediatr Otorhinolaryngol,2013,77(12):2004-2007.DOI:10.1016/j.ijporl.2013.09.022.
[24] 杨娇,吕麟亚,章均,等.临床表现为软组织感染的非霍奇金淋巴瘤15例分析[J].中华小儿外科杂志,2017,38(2):107-112.DOI:10.3760/cma.j.issn.0253-3006.2017.02.007. Yang J,Lyu LY,Zhang J,et al.Clinical manifestations of non-Hodgkin’s lymphoma mimicking as soft tissue infection:a report of 15 cases[J].Chin J Pediatr Surg,2017,38(2):107-112.DOI:10.3760/cma.j.issn.0253-3006.2017.02.007.
[25] Dickson PV,Davidoff AM.Malignant neoplasms of the head and neck[J].Semin Pediatr Surg,2006,15(2):92-98.DOI:10.1053/j.sempedsurg.2006.02.006.
[26] 闫学博,孙妍,张松,等.超声引导下穿刺活检对儿童浅表淋巴结的诊断价值[J].临床超声医学杂志,2021,23(4):313-315.DOI:10.3969/j.issn.1008-6978.2021.04.021. Yan XB,Sun Y,Zhang S,et al.Application value of superficial lymph node biopsy guided by ultrasound in children[J].J Clin Ultrasound Med,2021,23(4):313-315.DOI:10.3969/j.issn.1008-6978.2021.04.021.
[27] 张更臣,李俊来,黎晓林,等.超声引导下经皮穿刺活检对颈部淋巴结病变的诊断价值[J].中国超声医学杂志,2014,30(4):295-298. Zhang GC,Li JL,Li XL,et al.Value of ultrasound-guided percutaneous core-needle biopsy for diagnosing neck lymphadenopathy[J].Chin J Ultrasound Med,2014,30(4):295-298.
[28] 吕敏,侯良超,林琼琼,等.细针穿刺细胞学检查在门诊诊断儿童颈部肿块的应用价值[J].临床小儿外科杂志,2014,13(1):58-59,70.DOI:10.3969/j.issn.1671-6353.2014.01.017. Lyu M,Hou LC,Lin QQ,et al.Application of fine needle aspiration cytology in outpatient diagnosis of neck masses in children[J].J Clin Ped Sur,2014,13(1):58-59,70.DOI:10.3969/j.issn.1671-6353.2014.01.017.
[29] 曹兵生,张华,梁建琴,等.超声引导下穿刺活检对颈部淋巴结病变的诊断价值[J].临床超声医学杂志,2010,12(4):268-270.DOI:10.3969/j.issn.1008-6978.2010.04.016. Cao BS,Zhang H,Liang JQ,et al.Diagnostic value of ultrasound-guided percutaneous biopsy for neck lymphadenopathy[J].J Clin Ultrasound Med,2010,12(4):268-270.DOI:10.3969/j.issn.1008-6978.2010.04.016.
[30] 中华医学会儿科学分会血液学组,中国抗癌协会儿科专业委员会.儿童霍奇金淋巴瘤的诊疗建议[J].中华儿科杂志,2014,52(8):586-589.DOI:10.3760/cma.j.issn.0578-1310.2014.08.008. Group of Hematology,Branch of Pediatrics,Chinese Medical Association;Professional Committee of Pediatrics,China Anti-Cancer Association:Diagnostic and Therapeutic Recommendations for Hodgkin’s Lymphoma in Children[J].Chin J Pediatr,2014,52(8):586-589.DOI:10.3760/cma.j.issn.0578-1310.2014.08.008.
[31] 王小琴,刘良发.102例头颈部淋巴瘤的临床分析[J].临床耳鼻咽喉头颈外科杂志,2020,34(2):177-180.DOI:10.13201/j.issn.1001-1781.2020.02.019. Wang XQ,Liu LF.Clinical analyses of head and neck lymphomas:a report of 102 cases[J].J Clin Otorhinolaryngol Head Neck Surg,2020,34(2):177-180.DOI:10.13201/j.issn.1001-1781.2020.02.019.
[32] 中华医学会儿科学分会肿瘤学组,中华医学会儿科学分会血液学组,中国抗癌协会小儿肿瘤专业委员会,等.儿童和青少年侵袭性成熟B细胞非霍奇金淋巴瘤诊疗专家共识[J].中华儿科杂志,2020,58(10):790-795.DOI:10.3760/cma.j.cn112140-20200723-00745. Groups of Oncology & Hematology,Branch of Pediatrics,Chinese Medical Association;Specialty Committee of Pediatric Oncology,Chinese Anti-Cancer Association:Expert Consensus on Managing Children and Adolescents with Aggressive Mature B-cell non-Hodgkin Lymphoma[J].Chin J Pediatr,2020,58(10):790-795.DOI:10.3760/cma.j.cn112140-20200723-00745.
[33] Mauz-K?rholz C,Metzger ML,Kelly KM,et al.Pediatric Hodgkin lymphoma[J].J Clin Oncol,2015,33(27):2975-2985.DOI:10.1200/JCO.2014.59.4853.
[34] Ha CS,Shadle KM,Medeiros LJ,et al.Localized non-Hodgkin lymphoma involving the thyroid gland[J].Cancer,2001,91(4):629-635.
备注/Memo
收稿日期:2022-1-14。
基金项目:湖北省自然科学基金一般面上项目(2022CFB470)
通讯作者:段栩飞,Email:alendxf@hotmail.com