淋巴瘤的诊疗规范及放疗概述(血液科+2015-05).pdfVIP

淋巴瘤的诊疗规范及 放疗概述 江苏省人民医院放疗科 孙新臣 2015-05 恶性淋巴瘤 • 霍奇金淋巴瘤（何杰金氏病） Hodgkin’s Lymphoma, HL (Hodgkin’s Disease, HD) • 非霍奇金淋巴瘤 Non- Hodgkin’s Lymphoma, NHL 霍奇金淋巴瘤 霍奇金淋巴瘤的诊断 •病史 ： –局部症状全身症状 •体格检查 •实验室检查 –常规血液学检查及血沉、LDH、骨穿/骨髓活检 •影像学检查 –CT 、PET/CT •病理学检查 –淋巴结或组织活检 （可粗针穿刺，细针穿刺病理不可靠） •其他检查 –剖腹探查 霍奇金淋巴瘤分期 Cotswold’s modification of the Ann Arbor staging classification Stage I Involvement of a single lymph node region or lymphoid structure (e.g. spleen, thymus, Waldeyer’s ring) Stage II Involvement of two or more lymph node regions on the same side of the diaphragm *(the mediastinum is single site: hilar lymph nodes should be considered to be lateralized and when involved on both sides constitute stage II disease). The number of anatomical regions involved should be indicated by a subscript ( e.g. II1) . Stage III Involvement of lymph node regions or lymphoid structures on both sides of the diaphragm III1 Subdiaphragmatic involvement limited to spleen, splenic hilar nodes, celiac nodes, or portal nodes III2 Subdiaphragmatic involvement includes paraaortic, iliac, or mesenteric nodes plus structures in III1 StageIV Involvement of extranodal site(s) beyond that designated as E Involvement of liver or bone marrow. 霍奇金淋巴瘤分期 Cotswold’s modification of the Ann Arbor staging classification A No symptoms B Unexplained weight loss of more than 10% of the body weight during the 6 months before staging investigation X *Bulky disease: 10cm maximum dimension of nod