青少年单侧扁桃体增大诊断伯基特淋巴瘤1例并文献复习

doi:10.16150/j.1671-2870.2024.01.010

摘要/Abstract

摘要：

伯基特淋巴瘤属于高侵袭性B细胞非霍奇金淋巴瘤，特点是快速生长，原发于扁桃体的伯基特淋巴瘤少见。大部分病例早期无明显特异性表现，临床表现多样，儿童患者表现更不典型，易误诊、漏诊。本文报道我院1例单侧扁桃体增大，最终确诊为伯基特淋巴瘤（Burkitt lymphoma，BL）的青少年患者。对于短期内扁桃体增大较快、扁桃体不对称(Brodsky分级，双侧扁桃体大小差异≥2度)，临床以局部症状为主，无明显全身症状，颈部多未触及肿大淋巴结，实验室检查无异常者，需及时完善颈部CT或MRI检查，或者进一步完善PET/CT检查，结合其影像学检查结果不能排除可疑恶性肿瘤征象时，尤其是PET/CT检查SUVmax值较高时，应行扁桃体活检。早期发现、早期诊断，有助于改善Burkitt淋巴瘤患者的预后。本例患者诊断及时、准确，手术切除左侧扁桃体缓解了局部症状，术后病理确诊后及时完善化疗，治疗效果良好，目前处于长期跟踪随访。

关键词: 腭扁桃体, 青少年, 伯基特淋巴瘤

Abstract:

Burkitt lymphoma is a highly aggressive B-cell non-Hodgkin lymphoma characterized by rapid growth, and Burkitt lymphoma originating in the tonsil is rare. Most of the cases have no obvious specific symptoms in the early stage, and the clinical symptoms are varied. Children’s symptoms are more atypical, which are easy to be misdiagnosed and missed. We report a case of adolescent with unilateral tonsil enlargement in our hospital, who was diagnosed with Burkitt lymphoma (BL). For patients with rapid enlargement of the tonsils in a short period, asymmetry of the tonsils (Brodskyscale tonsil size difference ≥ 2 degrees), mainly local symptoms but without obvious systemic symptoms, and rare enlarged lymph nodes in the neck, and no obvious abnormalities in laboratory tests, CT or MRI examination of the neck, or further PET/CT examination should be completed in time. When suspected malignant tumors revealed on imaging, especially high value of SUVmax on PET/CT, tonsil biopsy should be performed. Early detection. Early diagnosis can improve the prognosis of Burkitt lymphoma. In this case, the diagnosis was timely and accurate. Surgical resection of the left tonsil alleviated local symptoms in this cas, and chemotherapy treatment was timely completed after postoperative pathology. Efficacy of surgery combined with chemotherapy is good for the patient and long-term follow-up is available.

Key words: Palatine tonsil, Adolescent, Burkitt's lymphoma

中图分类号:

刘秀玲, 孙艳艳. 青少年单侧扁桃体增大诊断伯基特淋巴瘤1例并文献复习[J]. 诊断学理论与实践, 2024, 23(01): 77-82.

LIU Xiuling, SUN Yanyan. Burkitt lymphoma presenting as unilateral tonsil enlargement in an adolescent:a case report and literature review[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(01): 77-82.

图/表 4

图1

图2

图3

表1

8例儿童及青少年BL临床表现及诊断治疗

病例	文献	国家	性别	年龄（岁）	术前症状	查体	活检方式	病理结果	治疗
1	本文	中国	男	12	发音含糊，咽部不适2 d	左侧扁桃体Ⅲ°，超越中线，扁桃体表面见白色假膜附着，组织颜色发暗，右侧扁桃体Ⅰ°，咽腔狭窄	左侧扁桃体切除术	伯基特淋巴瘤Ⅲ期	化疗
2	武小芳等2023	中国	男	3	睡眠打鼾3个月，扁桃体增大20天	右侧扁桃体Ⅲ°，表面有灰白色坏死样物	右侧扁桃体切除术	伯基特淋巴瘤Ⅱ期	ABA3疗程化疗
3	Spini R等2021	西班牙	女	14	咽痛3周抗生素治疗无效	左扁桃体肥大，超越中线，同侧软腭隆起内侧有溃疡区域，触诊时硬度较低。	左侧扁桃体切除术	伯基特淋巴瘤	静脉、口腔和鞘内治疗
4	Toader C等2016	罗马尼亚	男	5	睡眠呼吸暂停、单侧扁桃体增大3周	腺样体肥大和左扁桃体Ⅱ°，实验室检测在正常范围内。	双侧扁桃体切除术	伯基特淋巴瘤期Ⅰ期(Murphy分型)	治疗以化疗为主，包括给予鞘内化疗
5	CuestasG等2015	西班牙	男	7	打鼾3周	双侧扁桃体肥大	双侧扁桃切除体	伯基特淋巴瘤	静脉，口腔和鞘内联合治疗在3个月内进行了4个周期
6	Banthia V等2003		男	14	轻度吞咽困难2周	右侧大的无压痛扁桃体肿块伴黏膜溃疡	右侧扁桃体切除术	伯基特淋巴瘤	环磷酰胺、长春新碱、阿霉素、甲氨蝶呤和鞘内阿糖胞苷
7	Kraus M等 1990	以色列	男	10	咽痛2周	左侧扁桃体肿大，可见中央坏死区域被发炎和水肿的扁桃体组织包围。左上颈动脉及下颌下淋巴结肿大，轻度压痛。无肝脾肿大，全身检查正常	左扁桃体切除术	伯基特淋巴瘤	阿霉素、环磷酰胺、长春新碱、强的松和鞘内甲氨蝶呤联合化疗6个疗程
8	Poulsen等1982	丹麦	男	2	轻微吞咽困	右侧扁桃体旁2 cm×3 cm×2 cm肿物	右侧扁桃体切除术	伯基特淋巴瘤	椎管内给予环磷酰胺、长春新碱、强的松以及甲氨蝶呤化疗，中枢神经系统进行预防性放射治疗

表1

参考文献 21

[1]	JIANG R, ZHANG H M, WANG L Y, et al. Ultrasound features of primary non-Hodgkin's lymphoma of the palatine tonsil: a case report[J]. World J Clin Cases, 2021, 9(28):8470-8475. doi: 10.12998/wjcc.v9.i28.8470 pmid: 34754855
[2]	ROKKJAER M S, KLUG T E. Malignancy in routine tonsillectomy specimens: a systematic literature review[J]. Eur Arch Otorhinolaryngol, 2014, 271(11):2851-2861. doi: 10.1007/s00405-014-2902-0 pmid: 24481924
[3]	MOHAMMADIANPANAH M, DANESHBOD Y, RAMZI M, et al. Primary tonsillar lymphomas according to the new World Health Organization classification: to report 87 cases and literature review and analysis[J]. Ann Hematol, 2010, 89(10):993-1001. doi: 10.1007/s00277-010-0970-9 pmid: 20440503
[4]	GUIMARÃES A C, DE CARVALHO G M, BENTO L R, et al. Clinical manifestations in children with tonsillar lymphoma: a systematic review[J]. Crit Rev Oncol Hematol, 2014, 90(2):146-151. doi: 10.1016/j.critrevonc.2013.12.005 pmid: 24387945
[5]	ADIL E A, MEDINA G, CUNNINGHAM M J. Differen-tiating tonsil cancer from benign tonsillar hypertrophy[J]. J Pediatr, 2018,197:309.
[6]	AKYLDZ L. Burkitt's lymphoma; head and neck neoplasms; palatine tonsil[J]. Praxis of Otorhinolaryngology, 2014:135-138.
[7]	任洪涛, 鲍慧铮, 于昊, 等. 伯基特淋巴瘤治疗研究进展[J]. 白血病·淋巴瘤, 2018, 27(4):206-208.
	REN H T, BAO H Z, YU H, et al. Progress of Burkitt lymphoma treatment[J]. J Leuk Lymphoma, 2018, 27(4)206-208.
[8]	DIEBOLD J, JAFFE E S, RAPHAEL M, et al. Burkitt lymphoma[M]// JAFFE E S, HARRIS N L, STEIN H, et al. Pathology and genetics of tumours of haematopoietic and lymphoid tissues. World Health Organization (WHO) Classification of Tumours. Lyon: IARC Press, 2001:181-185.
[9]	AZAMAR A, TORRE-GONZÁLEZ C, JUÁREZ-VILLEGAS L, et al. Asymmetric palatine tonsil in a pediatric patient: Is it always a malignant neoplasm?[J]. Bol Med Hosp Infant Mex. 2021;78(5):461-466.
[10]	SEELISCH J, DE ALARCON P A, FLERLAGE J E, et al. Expert consensus statements for Waldeyer's ring involvement in pediatric Hodgkin lymphoma: The staging, evaluation, and response criteria harmonization (SEARCH) for childhood, adolescent, and young adult Hodgkin lymphoma (CAYAHL) group[J]. Pediatr Blood Cancer, 2020, 67(9)e28361.
[11]	CUESTAS G, MARTÍNEZ FONT A, DEMARCHI M V, et al. Palatine tonsil lymphoma in children with tonsillar asymmetry. Case report[J]. Arch Argent Pediatr, 2015, 113(4):e219-e222.
[12]	ADIL E A, MEDINA G, CUNNINGHAM M J. Pediatric tonsil cancer: a national and institutional perspective[J]. J Pediatr, 2018,197:255-261.
[13]	JONES G H, BURNSIDE G, MCPARTLAND J, et al. Is tonsillectomy mandatory for asymmetric tonsils in children? A review of our diagnostic tonsillectomy practice and the literature[J]. Int J Pediatr Otorhinolaryngol, 2018,110:57-60.
[14]	HWANG M S, KAYE K E, WAXMAN J A, et al. What is the best management of asymptomatic unilateral tonsillar enlargement?[J]. Laryngoscope, 2015, 125(11):2438-2440.
[15]	ZHANG C X, LIANG L, ZHANG B, et al. Imaging anatomy of Waldeyer's ring and PET/CT and MRI fin-dings of oropharyngeal non-Hodgkin's lymphoma[J]. Asian Pac J Cancer Prev, 2015, 16(8):3333-3338.
[16]	GONZÁLEZ Y I, NAZAR M G, CALLEJAS C C, et al. Tumores amigdalinos aspectos clenicose histopatológicos[J]. Rev Otorrinolaringol Cir Cabeza Cuello, 2004:6422.
[17]	TOADER C, TOADER M, STOICA A, et al. Tonsillar lymphoma masquerading as obstructive sleep apnea - pediatric case report[J]. Rom J Morphol Embryol, 2016, 57(2 Suppl):885-891.
[18]	魏小芳, 陈巧琳, 冯友繁, 等. TCF3调控linc00152在伯基特淋巴瘤中发挥致癌作用的功能和机制研究[J]. 中华全科医学, 2023, 21(12): 2045-2048.
	WEI XF, CHEN QL, FENG YF, et al. Functional and mechanistic of TCF3 regulating linc00152 on carcinogenic effects in Burkitt's lymphoma[J]. Chin J General Prac, 2023, 21(12): 2045-2048.
[19]	张梦, 金玲, 杨菁, 等. 儿童伯基特淋巴瘤186例临床特征及疗效分析[J]. 中华儿科杂志, 2018, 56(8):605-610.
	ZHANG M, JIN L, YANG J, et al. Clinical and prognostic analysis of 186 children with Burkitt's lymphoma[J]. Chin J Pediatr, 2018, 56(8):605-610.
[20]	陈光浦. Burkitt 淋巴瘤的个案报道及文献综述[D]. 杭州: 浙江大学医学部, 2009.
	CHEN G P. Case report and literature review of Burkitt lymphoma[D]. Hangzhou: Hangzhou Zhejiang University Health Science Center, 2009.
[21]	郭佳, 朱易萍, 高举, 等. 儿童成熟B细胞非霍奇金淋巴瘤/急性淋巴细胞白血病43例临床及预后分析[J]. 中国实验血液学杂志, 2016, 24(1):72-79.
	GUO J, ZHU Y P, GAO J, et al. Clinical and Prognostic analysis of 43 Children with Mature B-cell Non-Hodgkin's Lymphoma/Acute Lymphoblastic Leukemia[J]. J Exp Hematol, 2016, 24(1):72-79.