原发性宫颈NK/T细胞淋巴瘤继发周围神经淋巴瘤病1例  

Primary cervical NK/T-cell lymphoma with secondary peripheral nerve lymphomatosis:a case report

作　　者：庞丁华 肖国有[1] 柴华[1] PANG Dinghua;XIAO Guoyou;CHAI Hua(Department of Nuclear Medicine,Guangxi Medical University Cancer Hospital,Guangxi Clinical Key Construction Specialized Nuclear Medicine Department,Nanning 530021,China.)

机构地区：[1]广西医科大学附属肿瘤医院核医学科,广西临床重点建设专科核医学科,南宁530021

出　　处：《国际医学放射学杂志》2024年第5期610-613,共4页International Journal of Medical Radiology

基　　金：广西科技计划项目(桂科AB19110015);广西壮族自治区卫生健康委员会自筹经费科研课题(Z-A20230728);广西生物靶向诊治研究重点实验室开放课题(GXSWBX202203)。

摘　　要：目的探讨原发性宫颈NK/T细胞淋巴瘤(NKTCL)继发周围神经淋巴瘤病的影像学特点,以提高对该病的认识,为诊疗决策提供参考。方法回顾性分析1例原发性宫颈NKTCL病人诊治9个月期间的临床资料及CT、MRI、^(18)F-FDG PET/CT影像表现,并复习相关文献。结果病人以阴道流液为首发症状入院。治疗前CT检查发现宫颈明显增大,呈不规则软组织密度肿块影,大小约8.4 cm×6.8 cm×8.3 cm,密度均匀;MRI显示宫颈肿物T_(1)WI呈等信号、FS-T_(2)WI呈高信号、DWI呈高信号、相应ADC图呈低信号,增强扫描病灶呈明显均匀强化,累及阴道上段,双侧髂血管旁见多发淋巴结影;PET/CT显示宫颈肿物及左侧髂血管旁淋巴结代谢异常增高。治疗中PET/CT显示病灶代谢明显降低,范围明显缩小,疗效评价为完全缓解。治疗后继发周围神经淋巴瘤病,PET/CT显示颈椎C2/3水平右侧神经根和大腿左侧坐骨神经走行区域可见新发高代谢病灶,颈椎C2/3神经根处病灶穿刺病理结果为NKTCL浸润。结论原发性宫颈NKTCL的典型影像表现为病灶体积较大、代谢较高,但质地均匀,宫颈黏膜完整。影像学检查在治疗前评价、精准分期、疗效评估、复发监测及指导穿刺部位的选择中发挥着重要作用。Objective To explore the imaging characteristics of primary cervical NK/T-cell lymphoma(NKTCL)with secondary peripheral nerve lymphomatosis,improving understanding of the disease and providing a reference for diagnosis and treatment decision.Methods A retrospective analysis was conducted on the clinical data,CT,MRI,and ^(18)F-FDG PET/CT imaging findings of a patient with primary cervical NKTCL over a 9-month treatment period.Relevant literatures were also reviewed.Results The patient was admitted to hospital with vaginal fluid as the first symptom.Pre-treatment CT examination showed that the cervix was significantly enlarged,showing an irregular soft tissue mass with a size of approximately 8.4 cm×6.8 cm×8.3 cm and a uniform density.MRI displayed the cervical mass as isointense on T_(1)WI,hyperintense on FS-T_(2)WI and DWI,and hypointense on the corresponding ADC map.Enhanced scans showed marked homogeneous enhancement of the lesion,involving the upper vaginal segment,with multiple lymph nodes seen adjacent to the bilateral iliac vessels.PET/CT showed increased metabolism in cervical masses and left para-iliac lymph nodes.During treatment,PET/CT showed a significant reduction in metabolic activity and size,and the treatment was evaluated as achieving complete remission.Post-treatment,secondary neurolymphomatosis developed.PET/CT showed new hypermetabolic lesions in the right nerve root at the C2/3 level of cervical spine and along the course of the left sciatic nerve in the thigh.A biopsy of the C2/3 cervical spine nerve root lesion confirmed NKTCL infiltration.Conclusions The typical imaging manifestations of primary cervical NKTCL include a large,metabolically active but homogeneous mass with intact cervical mucosa.Imaging examination plays an important role in pre-treatment evaluation,accurate staging,treatment efficacy assessment,recurrence monitoring,and guiding biopsy site selection.

关 键 词：子宫肿瘤 NK/T细胞淋巴瘤 周围神经淋巴瘤病 体层摄影术 X线计算机 磁共振成像 正电子发射体层成像 

分 类 号：R814.42[医药卫生—影像医学与核医学] R445[医药卫生—放射医学] R737.33[医药卫生—临床医学]