多浆膜腔积液、Warburg效应——弥漫性大B细胞淋巴瘤1例报告并文献复习

doi:10.6040/j.issn.1671-7554.0.2016.026

摘要/Abstract

摘要： 目的探讨以多浆膜腔积液、Warburg效应为临床表现的弥漫性大B细胞淋巴瘤(DLBCL)的临床诊断与治疗。方法回顾性分析以多浆膜腔积液、Warburg效应为主要临床表现患者1例,男,51岁,因腹痛、腹胀1个月,右侧胸痛7 d入院,行CT、PET-CT、内科胸腔镜检查。通过系统检索中国知网和Pubmed等中英文数据库,纳入2010至2016年有关大B细胞淋巴瘤、 large B-cell lymphoma、低血糖、高乳酸、肿瘤、hypoglycemia、 lactic acidosis、 tumor等关键词的文献,并进行文献复习。结果 CT检查示胸腔、腹腔积液,超声心动图示少量心包积液;PET-CT示双侧胸膜、腹膜葡聚糖高摄取率;入院后多次血糖检测低于正常,最低至1.17 mmol/L,血乳酸异常升高;胸水乳酸脱氢酶 5 158 U/L,CA-125 3 251 U/mL;胸水细胞学检查见原幼淋巴样细胞;胸腔镜活检病理确诊DLBCL。随之给予化疗3周期,症状缓解。检索文献605篇,共报道3 981例DLBCL,累及1处及以上浆膜腔者108例(2.71%),多浆膜腔累及者30例(0.75%);低血糖、高乳酸血症个案报道15例,均为国外文献报道,15例中非霍奇金淋巴瘤13例, 其中DLBCL 4例, Burkitt淋巴瘤3例, T细胞淋巴瘤2例,另有4例未提及淋巴瘤具体分型。结论以多浆膜腔积液、Warburg效应为临床表现的DLBCL较少见,胸腔镜检查对多浆膜腔积液疾病的诊断及其鉴别诊断颇具优势。

关键词: 高乳酸, 多浆膜腔积液, Warburg效应, 低血糖, 弥漫性大B细胞淋巴瘤

Abstract: Objective To explore the clinical diagnosis and treatment of a case of diffuse large B-cell lymphoma(DLBCL), presenting as multiple serous effusion complicated with Warburg effect. Methods Clinical data of a DLBCL case were retrospectively analyzed. A 51-year-old male was admitted due to abdominal pain and distension for 1 month, and right chest pain for 7 days. CT scan, PET-CT scan and thoracoscopy were conducted. Databases including CKNI and Pubmed were searched for relevant studies published during 2010 and 2016 with key words such as “large B-cell lymphoma, hypoglycemia, lactic acidosis, tumor”. Results CT scan showed pleural effusion and ascites, and echocardiography suggested slight pericardial effusion. PET-CT scan indicated high uptake ratio of 18-fluoro-2-deoxyglucose(18-FDG)of both bilateral pleura and peritoneum. Blood glucose tests showed the patient had low sugar at a minimum of 1.17 mmol/L, while blood lactic acid was abnormally high. The LDH in pleural effusion was 5 158 U/L, and CA-125 was 3 251 U/L. Cytological examination of pleural effusion found lymphoblasts and prolymphocytes. Thoracoscopic biopsy of the pleura confirmed the diagnosis of DLBCL. Remission was observed after 3 cycles of chemotherapy. Totally 605 studies involving 3 981 DLBCL patients were included in the literature review. Of all cases, 山东大学学报 (医学版)54卷7期 -韩康康,等.多浆膜腔积液、Warburg效应——弥漫性大B细胞淋巴瘤1例报告并文献复习 \=-108 presented serous effusion, and 30 involved multiple serous cavities. Of the 15 cases presenting both hypoglycemia and lactic acidosis, 13 were NHL cases(4 were confirmed DLBCL; 3 were Burkitt lymphoma; 2 were T cell lymphoma, and 4 were not mentioned). Conclusion DLBCL characterized by multiple serous effusion complicated with Warburg effect is rather rare in clinical practice. Thoracoscopy is effective for the diagnosis and differentiation of similar lymphomas presenting multiple serous effusion.

Key words: Diffuse large B-cell Lymphoma, Lactic acidosis, Hypoglycemia, Multiple serous effusion, Warburg effect

中图分类号:

R551.2

韩康康,崔立伟,彭程,薛玉文,肖伟. 多浆膜腔积液、Warburg效应——弥漫性大B细胞淋巴瘤1例报告并文献复习[J]. 山东大学学报（医学版）, 2016, 54(7): 80-87.

HAN Kangkang, CUI Liwei, PENG Cheng, XUE Yuwen, XIAO Wei. Multiple serous effusion complicated with Warburg effect: a case report of diffuse large B-cell lymphoma and literature review[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(7): 80-87.

参考文献

[1] Moller MB, Pedersen NT, Christensen BE. Diffuse large B-cell lymphoma: clinical implications of extranodal versus nodal presentation: a population-based study of 1575 cases[J]. Br J Haematol, 2004, 124(2): 151-159.
[2] Harris NL, Jaffe ES, Stein H, et al. A revised European-American classification of lymphoid neoplasms: a proposal from the intemational lymphoma study group[J]. Blood, 1994, 84(5): 1361-1392.
[3] Harris NL, Jaffe ES, Diebold J, et al. World Health Organization classification of neoplastic disense of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November, 1997[J]. J Clin Oncol, 1999, 17(12): 3835-3849.
[4] Diebold J, Anderson JR, Annitage JO, et al. Diffuse large B-cell lymphoma: a clinicopathologic analysis of 444 cases classified according to the updated Kiel classification[J]. Leuk Lymphoma, 2002, 43(1): 97-104.
[5] Das DK. Serous effusion in malignant lymphoma: a review[J]. Diagn Cytopathol, 2006, 34(5): 335-347.
[6] 许霞, 庞宗国, 张尚福, 等. 血管内大B细胞淋巴瘤(尸体解剖结果及文献复习)[J]. 中国现代神经疾病杂志, 2007, 7(2): 134-140.
[7] Warburg O, Wind F, Negelein E. The metabolism of tumors in the body[J]. J Gen Physiol, 1927, 8(6): 519-530.
[8] Buppajarntham S, Junpaparp P, Kue-A-Pa P. Warburg effect associated with transformed lymphoplasmacytic lymphoma to diffuse large B-cell lymphoma[J]. Am J Emerg Medi, 2013, 31(6): 9995-9996.
[9] Kroemer G, Pouyssegur J. Tumor cell metabolism: cancers Achilles heel[J]. Cancer Cell, 2008, 13(6): 472-482.
[10] Ward PS, Thompson CB. Signaling in control of cell growth and metabolism[J]. Cold Spring Harb Perspect Biol, 2012, 4(7): 6783.
[11] Jaffe ES, Harris NL, Stein H, et al. World Health Organization classification of tumor. Pathology & Genetics, Tumors of hematopoietic and lymphoid tissues[M]. Lyon: International Agency for Research on Cancer Press, 2001: 10-13.
[12] Li J, Zhao S, Wang JX, et al. CD20-negative diffuse large B cell lymphoma: a comprehensive analysis of 695 cases[J]. Tumor Biol, 2016, 37(3): 3619-3637.
[13] Shi Y, Hou Y, Hu Q, et al. A rare case of HHV-8-positive/HIV-negative/EBV-negative primary effusion lymphoma in a renal transplant recipient[J]. Cytopathology, 2012, 23(2): 137-139.
[14] Carbone A, Gloghini A, Cozzi MR, et al. Expression of MuMl/IRF4 selectively clusters with primary effusion lymphoma among lymphomatous effusions. Implications for disease histogenesis and pachogenesis[J]. Br J Haemacol, 2000, 111(1): 247-257.
[15] Iglesias P, Diez JJ. Management of endocrine disease: a clinical update on tumor-induced hypoglycemia[J]. Eur J Endocrinol, 2014, 170(4): 147-157.
[16] Bodnar TW, Acevedo MJ, Pietropaolo M. Management of non-islet-cell tumor hypoglycemia: a clinical review[J]. J Clin Endocrinol Metab, 2014, 99(3): 713-722.
[17] Dimitriadis GK, Gopalakrishnan K, Rao R, et al. Severe paraneoplastic hypoglycemia secondary to a gastrointestinal stromal tumour masquerading as a stroke[J]. Endocrinol Diabetes Metab Case Rep, 2015: 150062. doi:10.1530/EDM-15-0062.
[18] Kojima G, Terada KY, Miki N, et al. Non-islet cell tumor hypoglycemia associated with recurrent carcinosarcoma of the ovary[J]. Endocr Pract, 2013, 19(4): 83-87.
[19] Khowaja A, Johnson-Rabbett B, Bantle J, et al. Hypoglycemia mediated by paraneoplastic production of Insulin like growth factor-2 from a malignant renal solitary fibrous tumor-clinical case and literature review[J]. BMC Endocr Disord, 2014, 14: 49-54. doi:10.1186/1472-6823-14-49.
[20] Hino N, Nakagawa Y, Ikushima Y, et al. A case of a giant phyllodes tumor of the breast with hypoglycemia caused by high-molecular-weight insulin-like growth factor II[J]. Breast Cancer, 2010, 17(2): 142-145.
[21] Elhomsy GC, Eranki V, Albert SG, et al. “Hyper-Warburgism,” A cause of asymptomatic hypoglycemia with lactic acidosis in a patient with non-Hodgkins lymphoma[J]. J Clin Endocrinol Metab, 2012, 97(12): 4311-4316.
[22] Martinez-Outschoorn UE, Whitaker-Menezes D, Valsecchi M, et al. Reverse warburg effect in a patient with aggressive B-cell lymphoma: Is lactic acidosis a paraneoplastic syndrome?[J]. Semin Oncol, 2013, 40(4): 403-418.
[23] Strum SB, Adalsteinsson O, Black RR. Case Report: Sodium dichloroacetate(DCA)inhibition of the “Warburg Effect” in a human cancer patient: complete response in non-Hodgkins lymphoma after disease progression with rituximab-CHOP[J]. J Bioenerg Biomembr, 2013, 45(3): 307-315.
[24] Glasheen JJ, Sorensen MD. Burkitts lymphoma presenting with lactic acidosis and hypoglycemia-a case presentation[J]. Leuk Lymphoma, 2005, 46(2): 281-283.
[25] Durg J, Fiedler W, de Wit M, et al. Lactic acidosis and hypoglycemia in a patient with high-grade non-Hodgkins lymphoma and elevated circulating TNF-α[J]. Ann Hematol, 1996, 72(2): 97-99.
[26] Luscri N, Mauer M, Sarafoglou K, et al. Lactic acidosis and hypoglycemia with all relapse following engrafted bone marrow transplant[J]. Pediatr Blood Cancer, 2009, 53(2): 223-225.
[27] Comite GD, Dagna L, Piatti PM, et al. Hypoglycemia and lactic acidosis in a malt non-Hodgkins lymphoma[J]. Leuk Lymphoma, 2002, 43(6): 1341-1342.
[28] Raes EA, Benoit DD, Depuydt PO, et al. Early recognition of malignant acidosis in clinical practice: Report on 6 patients with haematological malignancies[J]. Acta Clinica Belgica, 2012, 67(5): 347-351.
[29] Makino H, Noda K, Inagaki Y, et al. Lactic acidosis and hypoglycemia associated with acute leukemia[J]. Jpn J Med, 1985, 24(3): 257-262.
[30] Rastogi MV, Desai N, Quintos JB. Non-islet-cell tumor hypoglycemia and lactic acidosis in a child with congenital HIV and Burkitt’s lymphoma[J]. J Pediatr Endocrinol Metab, 2008, 21(8): 805-810.
[31] Padilla GF, Garibay MA, Hummel HN, et al. Fulminant non-Hodgkin lymphoma presenting as lactic acidosis and acute liver failure: case report and literature review[J]. Acta Gastroenterol Latinoam, 2009, 39(2): 129-134.
[32] Abrahamian H, Pecherstorfer M, Vesely M, et al. Recurrent hypoglycemia and lactate acidosis in non-Hodgkins lymphoma[J]. Dtsch Med Wochenschr, 1991, 116(38): 1428-1432.
[33] Juffermans NP, Rijneveld AW, Zweegman S, et al. Two patients with lactic acidosis and hypoglycaemia as initial presentation of a lymphoma[J]. Ned Tijdschr Geneeskd, 2006, 150(50): 2770-2773.
[34] Sakuraba M, Masuda K, Hebisawa A, et al. Diagnostic value of thoracoscopic pleural biopsy for pleurisy under local anaesthesia[J]. ANZ J Surg, 2006, 76(8): 722-724.

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