摘要
目的探讨原发性心脏弥漫大B细胞淋巴瘤(DLBCL)患者的临床特征及诊疗策略。方法选择2019年4月26日南京医科大学附属南京医院收治的1例61岁原发性心脏DLBCL男性患者为研究对象。采用回顾性分析方法,对本例患者病史、临床特征、影像学及病理学检查结果等临床资料进行分析。根据本例患者临床表现、影像学及病理学检查结果对其进行诊断与治疗。本研究对本例患者的随访截至2021年4月28日。本研究以"原发性心脏弥漫大B细胞淋巴瘤""primary cardiac diffuse large B-cell lymphoma"为中、英文关键词,检索中国知网数据库、万方数据知识服务平台及PubMed数据库中相关文献,总结与本研究原发性心脏DLBCL患者相关病例的诊疗资料。文献检索时间设定为2019年1月1日至2021年5月31日。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》要求,并且征得受试者及其家属知情同意。结果①本例患者因"反复胸闷、胸痛3 d"于当地医院就诊,发现心脏占位后转诊至南京医科大学附属南京医院心胸外科,既往无特殊病史。②患者于2019年4月26日入本院后再次突发胸闷、胸痛,伴面色苍白,一过性黑矇,心电监护结果示,心率为45次/min,血压为78 mmHg/45 mmHg(1 mmHg=0.133 kPa),血氧饱和度为70%。遂立即予积极抢救,但是患者仍反复发作,考虑患者为右心房占位导致右心室流出道梗阻,有急诊手术指征,于就诊当日对其进行体外循环下右心房占位切除术。术中见肿瘤位于三尖瓣后瓣及隔瓣交界处与冠状静脉窦之间,与心肌相互融合,阻挡三尖瓣瓣口开放及关闭,但是肿物与心肌组织融合,无法完全切除,遂沿肿瘤突起边缘部分切除肿物,以明确病变性质及解除肿物对三尖瓣活动的影响。术中肿物的免疫组织化学结果示,CD20(+)、CD79a(+)、配对盒蛋白(PAX)-5(+)、CD3(-)、CD5(-)、CD10(-)、多发性骨髓瘤癌基因(MUM)-1(-)、
Objective To investigate clinical symptoms,diagnosis and treatment strategies of patients with primary cardiac diffuse large B-cell lymphoma(DLBCL).Methods On April 26,2019,one case of 61 year-old male patient with primary cardiac DLBCL admitted to Nanjing First Hospital was selected as research subject.Clinical data such as medical history,clinical features,imaging and pathology and other examination results were retrospectively analyzed.Patient was diagnosed and treated according to their clinical manifestations,imaging and pathology examination results.The patient was followed up until April 28,2021.With"primary cardiac diffuse large B-cell lymphoma"as the key word in English and Chinese,relevant literature on primary cardiac DLBCL were searched in China National Knowledge Infrastructure database,Wanfang Data Knowledge Service Platform and PubMed database,and clinical characteristics,diagnosis,treatment and prognosis of patients reported in the literature were analyzed and summarized.Literature search period was from January 1,2019 to May 31,2021.This study was line with the requirements of the World Medical Association Declaration of Helsinki revised in 2013,and informed consent was obtained from the subject and their families.Results①This patient was referred to the Cardiothoracic Surgery Department of Nanjing First Hospital for"recurrent chest tightness and chest pain for 3 d"after consultation with a local hospital and was found to have a cardiac occupancy with no previous specific medical history.②The patient was admitted to our hospital on April 26,2019,and then he suddenly experienced chest distress and pain again,accompanied by pale face and amaurosis fugax.Results of electrocardiograph monitoring showed the heart rate was 45 times/min,the blood pressure was 78 mmHg/45 mmHg(1 mmHg=0.133 kPa),and the saturation of peripheral oxygen was 70%.Active rescue was given immediately,but the patient still had recurrent episodes.Considering that the right atrial mass of the patient might lead to right ventric
作者
杨丹
张秀群
沈恬
赵有财
李妙
徐燕丽
张学忠
胡明秋
Yang Dan;Zhang Xiuqun;Shen Tian;Zhao Youcai;Li Miao;Xu Yanli;Zhang Xuezhong;Hu Mingqiu(Department of Hematology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,Jiangsu Province,China;Department of Pathology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,Jiangsu Province,China;Department of Cardiovascular Ultrasound,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,Jiangsu Province,China)
出处
《国际输血及血液学杂志》
2023年第5期385-394,共10页
International Journal of Blood Transfusion and Hematology
基金
南京市卫生科技发展项目(YKK19082)。
