病例报告：大分割放射治疗（6 Gy × 6次）联合临时气管造口术对一只化疗期间进展的喉部B细胞淋巴瘤猫的姑息获益

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中文摘要

一只12岁已绝育雌性缅因猫被诊断为颈部T细胞丰富型B细胞淋巴瘤。在改良L-CHOP方案化疗期间，该猫出现与喉部病变相关的进行性上气道阻塞。初始CT提示连续性喉部受累，随访影像显示严重喉部狭窄。为稳定气道，实施了紧急临时气管造口术，随后对喉部病变的穿刺活检结果最符合弥漫性大B细胞淋巴瘤。为处理阻塞性肿块，开始进行大分割姑息性放射治疗（6 Gy × 6次；总剂量36 Gy）。治疗期间观察到肿瘤逐渐缩小，至第四次分割时，气管造口管成功拔除，且未再发生气道阻塞。放射治疗开始后17天的随访CT显示未见可见喉部病变，且在猫于第27天因临床怀疑全身性疾病进展死亡之前，未再出现呼吸道症状或气道阻塞。本病例提示，对于化疗期间进展的猫喉部B细胞淋巴瘤，大分割放射治疗联合临时气管造口术可能快速有效地缓解肿瘤引起的上气道阻塞。

英文摘要

A 12-year-old spayed female Maine Coon cat was diagnosed with cervical T-cell-rich B-cell lymphoma. During modified L-CHOP-based chemotherapy, the cat developed progressive upper airway obstruction associated with a laryngeal lesion. Initial CT suggested contiguous laryngeal involvement, and follow-up imaging revealed severe laryngeal narrowing. An emergency temporary tracheostomy was performed for airway stabilization, and subsequent punch biopsy of the laryngeal lesion was most consistent with diffuse large B-cell lymphoma. Hypofractionated palliative radiation therapy (6 Gy × 6 fractions; total dose 36 Gy) was initiated to address the obstructive mass. Progressive tumor shrinkage was observed during treatment, and by the fourth fraction the tracheostomy tube was successfully removed without recurrence of airway obstruction. Follow-up CT 17 days after radiation therapy initiation showed no visible laryngeal lesion, and no respiratory signs or airway obstruction recurred before the cat died on day 27 following clinically suspected systemic disease progression. This case suggests that hypofractionated radiation therapy, in combination with temporary tracheostomy, may provide rapid and effective relief of tumor-induced upper airway obstruction in cats with laryngeal B-cell lymphoma progressing during chemotherapy.