原发性肺非霍奇金淋巴瘤的影像学表现及其病理学基础对照研究  

Radiologic-Pathologic Study on Primary Pulmonary Non-Hodgkin's Lymphoma

作　　者：石荟[1] 韩一平[1] 李永怀[2] 肖毅[3] 马大烈[4] 李强[1] 

机构地区：[1]上海长海医院呼吸内科,上海200433 [2]安徽医科大学第一附属医院呼吸内科,安徽合肥230022 [3]上海长海医院影像科,上海200433 [4]上海长海医院病理科,上海200433

出　　处：《中国呼吸与危重监护杂志》2011年第2期171-175,共5页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的通过探讨原发性肺非霍奇金淋巴瘤(PPNHL)的影像学表现及病理学特征之间的关联性,以提高此病的诊断准确率。方法对照分析22例PPNHL患者的临床病理特征及其胸部CT表现。结果组织病理学示低级别分化淋巴瘤12例,均为黏膜相关淋巴组织型(MALT型)淋巴瘤,占54.5%,呈小淋巴样细胞的弥漫浸润。胸部CT检查除1例(8.3%)为多发病灶外,其余11例(91.7%)均呈外周单发病灶,主要沿支气管黏膜下蔓延,形成肺内结节或肿块影8例(66.7%),部分周边有"晕征";斑片状肺炎影4例(33.3%);伴支气管充气征者7例(58.3%)。中高级别分化淋巴瘤10例,占45.5%。胸部CT呈单发病灶者4例,占40%;多发性病灶6例,占60%。其中肺内结节或肿块影4例(40%),浸润影1例(10%),混合型5例(50%),伴单侧胸腔积液5例(50%),伴肺门/纵隔淋巴结肿大2例(20%),伴肺不张3例(30%),伴小叶间隔增厚等间质性改变2例(20%)。结论 PPNHL的病理学基础决定其影像学表现具有一定特征,低级别分化PPNHL以外周局灶性实变区、支气管充气征为其特征性改变。高级别分化淋巴瘤更多表现为肺间质改变为主或与结节病灶共存的混合型病变。认真分析其影像表现,在多数情况下有助于临床正确诊断。Objective To investigate the relevance of primary pulmonary non-Hodgkin's lymphoma(PPNHL) imaging with pathology features,so as to improve the diagnostic accuracy.Methods Twenty-two patients of PPNHL were scanned by chest computed tomography,and the results of clinical and pathology features were analyzed.Results The resulting pathologic examination showed that all patients in 12 cases of low-grade lymphoma had MALT lymphoma(54.5%),histologically with slightly atypical small lymphocyte proliferated.The radiological findings indicated unilateral peripheral lesion which extended along mucous membrane in 11 patients(91.7%) and multilateral lesion in only 1 patients(8.3%).CT features were ill-defined nodule or mass with halo sign(n=8,66.7%),patchy infiltrate(n=4,33.3%),and ill-defined consolidations with air-bronchograms(n=7,58.3%).The resulting pathologic examination showed that 10 patients were high and middle-grade lymphoma(45.5%).The radiological findings indicated unilateral lesion in 4 patients(40%) and multilateral lesion in 6 patients(60%).CT features were ill-defined nodule or mass(n=4,40%),patchy infiltrate(n=1,10%),mixed manifestation(n=5,50%),pleural effusion(n=5,50%),hilar and mediastinal lymph node enlargement(n=2,20%),atelectasis(n=3,30%),and pulmonary interstitial with interlobular septal thickening(n=2,20%).Conclusions The imaging features of PPNHL rely on its' basic pathology.Low-grade lymphoma is characterized by peripheral focal consolidation with air-bronchograms.High and middle-grade lymphoma is characterized by mixed manifestation of interstitial change and nodular focus.Analyzing CT features seriously may be helpful for diagnosis of PPNHL.

关 键 词：淋巴瘤 断层摄影 X线计算机 病理学 诊断 

分 类 号：R734.2[医药卫生—肿瘤]