病例报告

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

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  • 山东大学附属威海市立医院耳鼻喉科,山东 威海 264200
刘秀玲 E-mail:diaodeng000@163.com

收稿日期: 2023-09-11

  网络出版日期: 2024-05-30

Burkitt lymphoma presenting as unilateral tonsil enlargement in an adolescent:a case report and literature review

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  • Department of Otolaryngology, Weihai Municipal Hospital Affiliated to Shandong University, Shandong Weihai 264200, China.

Received date: 2023-09-11

  Online published: 2024-05-30

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。

本文引用格式

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 . DOI: 10.16150/j.1671-2870.2024.01.010

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.

参考文献

[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.
[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.
[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.
[4] GUIMAR?ES 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.
[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.
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