小儿胸腺T淋巴母细胞淋巴瘤/急性淋巴母细胞白血病临床特点及CT表现  

The CT Manifestations and Clinical Characteristics of T Lympho

作　　者：徐守军[1] 干芸根[1] 杨春兰[2] 曹娟[3] 李鹏[1] 向葵[1] 罗娜[1] XU Shoujun;GAN Yungen;YANG Chunlan(Department of Radiology,Shenzhen Children’s Hospital,Shenzhen,Guangdong Province 518026,P.R.China)

机构地区：[1]深圳市儿童医院放射科,518026 [2]深圳市儿童医院血液肿瘤科,518026 [3]深圳市儿童医院病理科,518026

出　　处：《临床放射学杂志》2023年第3期466-471,共6页Journal of Clinical Radiology

基　　金：深圳市医疗卫生三名工程项目资助(编号:SZSM202011005)。

摘　　要：目的探讨小儿胸腺T淋巴母细胞淋巴瘤/急性淋巴母细胞白血病(T-LBL/ALL)的临床特点及CT表现。方法回顾性分析9例T-LBL/ALL患儿临床资料。化疗前均行CT平扫及增强扫描。结果9例病灶均呈团块状。瘤体均较大,病灶最大径线为77~120 mm,平均(98±15)mm。CT平扫主要表现为以实性为主的不均质囊实性肿块,囊实性分界不清,瘤内钙化4例,瘤体包绕心包及大血管,呈“冰冻”纵隔表现。增强扫描多呈轻-中度不均匀渐进性强化,坏死区无强化,瘤内可有小血管穿行。病灶占位效应明显,多有心包积液、胸腔积液,可伴有大血管血栓形成及侧支循环开放,奇静脉、半奇静脉扩张,淋巴结转移等。临床多因上腔静脉压迫综合征就诊,伴有乳酸脱氢酶及血清神经元烯醇化酶升高,恶性程度较高,化疗可显著缓解。结论小儿T-LBL/ALL恶性程度较高,化疗可显著缓解;CT表现具有一定的特征性,对提高本病诊断的敏感度和准确度具有重要意义。Objective To investigate the CT manifestations and clinical characteristics of T lymphoblastic lymphoma/acute lymphoblastic leukemia(T-LBL/ALL)in children.Methods We conducted a retrospective analysis the case data of the 9 children with T-LBL/ALL(10 lesions)confirmed by pathologically.All 9 cases were examined with plain and enhanced CT scans before chemotherapy.Results All the lesions were lumpy.The tumors were all large,and the maximum diameter line of lesions ranged from 77mm to 120mm,with an average of(98±15)mm.The main findings were heterogeneous cystic solid masses,and the boundary between cystic and solid was not clear,calcification in 4 tumors,and the tumor surrounding the pericardium and great vessels,presenting a“frozen”mediastinum on Non-enhanced CT.Most showed mild to moderate uneven gradual enhancement after contrast-enhanced scanning,no enhancement in the necrotic area,and small blood vessels may cross the tumor.The effect of lesions placeholder effect was obvious,most with pericardial effusion and pleural effusion,A small number of children accompanied by thrombosis of large vessels and opening of collateral circulation,azygos and hemiazygos,lymph node metastasis and so on.Clinically,children were often treated for superior vena cava compression syndrome,accompanied by elevated LDH and NSE,with a high degree of malignancy,which could be significantly alleviated by chemotherapy.Conclusion In children with T-LBL/ALL,the degree of malignancy is high,chemotherapy can significantly alleviate;The CT findings have certain characteristics,which is of great significance to improve the sensitivity and accuracy of the diagnosis of this disease.

关 键 词：胸腺 T淋巴母细胞淋巴瘤 急性淋巴母细胞白血病 体层摄影术 X线计算机 

分 类 号：R736.3[医药卫生—肿瘤] R733.71[医药卫生—临床医学] R730.44