原发性乳腺淋巴瘤的影像学及临床病理学特征  

Mammographic, magnetic resonance imaging and clinicopathological characteristics of primary breast lymphoma

作　　者：张盛箭[1] 何慕真[2] 郑璐琳[1] 顾雅佳[1] 彭卫军[1] 

机构地区：[1]复旦大学附属肿瘤医院放射诊断科 复旦大学上海医学院肿瘤学系,200032 [2]福建省立医院放射科,福州350000

出　　处：《中华肿瘤杂志》2016年第7期521-525,共5页Chinese Journal of Oncology

基　　金：上海市自然科学基金（15ZRl407700）

摘　　要：目的 探讨原发性乳腺淋巴瘤的乳腺X线、磁共振成像（MRI）及临床病理学特征。方法 回顾性分析32例经活检或手术病理证实的原发性乳腺淋巴瘤的临床病理特征和影像学资料。32例患者均为女性，年龄为（50±10）岁。结果 32例患者中，双侧乳腺多发病灶5例，单侧病灶27例。临床表现为无痛性肿块25例，病灶短期内迅速增大6例。17例患者行乳腺X线检查，表现为等、高密度、圆形、边界清楚肿块9例，非对称性致密7例，1例患者未发现异常。29例行MRI检查，共发现病灶37个，平扫T1WI呈等、低信号，T2WI呈稍高或高信号；增强MRI主要为肿块型强化（25个），其中边界清楚或不规则24个，均匀强化19个；其余12例非肿块强化病灶内信号多不均匀（8个）。增强MRI显示，可见肿瘤血管穿行征16个，伴有皮肤增厚14个，腋窝淋巴结肿大19个。14例患者的时间－信号强度曲线主要为Ⅲ型（7例）。结论 原发性乳腺淋巴瘤X线及MRI表现有一定特征性，但确诊仍需病理学确诊，早期诊断有利于临床选取合适的治疗方案。Objective To analyze the mammographic, MRI, and clinicopathological characteristics of primary breast lymphoma （PBL）. Methods Clinicopathological characteristics were retrospectively reviewed and analyzed in 32 patients with histopathologically proven PBL. All cases were female （mean age, 50 years; median age 46 years; range, 30-68 years）. Results In the 32 cases, there were bilateral tumors in 5 cases and 27 cases of unilateral involvement. The patients presented with a painless mass in 25 cases and with pain in 7 cases. Rapid enlargement was observed in 6 cases. Mammograms of 17 tumors showed a round, circumscribed mass with high density or iso-density in 9, asymmetry in 7 and no abnormality was found in one. 37 lesions were detected on dynamic contrast-enhanced magnetic resonance imaging （ DCE- MRI） in 29 patients, among which 25 （67.6%） lesions appeared as enhancing masses and 12 （32.4%） lesions as non-mass enhancements. All lesions showed iso- or hypo-intense signal on the T1WI and hyper- intense signal on the T2W1. Analysis of the enhancing masses based on the 2013 ACR BI-RADS lexicon revealed that among the mass descriptors in 25 lesions, the most common features were circumscribed or irregular margin in 24 （ 96.0% ） and homogeneous internal pattern in 19 （ 76.0% ）. Of the 12 non-mass enhancing lesions, the most common descriptors included regional or multiple regional distribution in 6 （50.0%）, and heterogeneous internal pattern in 8 （66.7%）. The tumors showed early enhancement with penetrating vessels on DCE-MRI in 16 lesions, associated with skin thickening in 14, and axillary lymphadenopathy in 19. The time-signal intensity curve （TIC） in 14 patients was mainly of type Ⅲ （7/14, 50.0% ）. Conclusions Some imaging features may alert the diagnosis of primary breast lymphoma, but final diagnosis depends on histopathology. Early diagnosis is helpful for selecting appropriate treatment regimens.

关 键 词：淋巴瘤 乳腺肿瘤 肿瘤 多原发性 放射摄影术 磁共振成像 

分 类 号：R737.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R730.44