鼻型NK/T细胞淋巴瘤与慢性鼻窦炎的鉴别诊断要点  

Key points for differential diagnosis between nasal NK/T-Cell lymphoma and chronic rhinosinusitis

作　　者：董怿[1] 崔顺九[1] 黄谦[1] 孙炎[1] 刘云福[2] DONG Yi;CUI Shunjiu;HUANG Qian;SUN Yan;LIU Yunfu(Department of Otolaryngology Head and Neck Surgery,Key Laboratory of Otolaryngology Head and Neck Surgery(Ministry of Education),Capital Medical University,Beijing,100730,China;Department of Otolaryngology Head and Neck Surgery,Department of Radiology,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730 [2]首都医科大学附属北京同仁医院放射科,北京100730

出　　处：《中国耳鼻咽喉头颈外科》2024年第10期642-646,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：北京同仁医院院基金(2023-YJJ-PY-003)。

摘　　要：目的对比鼻型自然杀伤细胞/T细胞淋巴瘤(natural killer/T-cell lymphoma,NKTL)及慢性鼻窦炎(CRS)的临床特点,分析鉴别诊断要点。方法收集和对比29例鼻型NKTL及54例CRS病例资料,包括病史、临床表现、影像学资料。结果NKTL组症状出现时间较短(P<0.001),更常见涕中带血症状(P=0.002),鼻甲及鼻中隔黏膜弥漫肿胀(P<0.001)和鼻腔内结构破坏体征(P=0.024),MRI更多见下鼻甲(P=0.034)、鼻中隔(P<0.001)、鼻咽部(P=0.002)及颅底(P=0.024)受累,“铸形样”改变或鼻外浸润。CRS组更多见嗅觉减退症状(P<0.001),中鼻道肿胀及鼻腔内肿物(P均<0.001),CT更常见鼻窦骨质增生(P=0.002)。结论鼻型NKTL与CRS比较,症状持续较短、常见鼻腔弥漫肿胀伴鼻腔内外结构破坏,MRI多见下鼻甲、鼻中隔、鼻咽部和颅底受累,“铸形样”改变和“跳跃式”浸润。OBJECTIVE To compare the clinical characteristics of natural killer/T-cell lymphoma(NKTL),and chronic rhinosinusitis(CRS),analyzing key points for differential diagnosis.METHODS Data from 29 nasal NKTL cases and 54 CRS cases were collected and compared,including medical history,clinical presentations,and imaging data.RESULTS The NKTL group had a shorter duration of symptom appearance(P<0.001)and more frequent symptoms of bloody nasal discharge(P=0.002).There was diffuse mucosal swelling of the turbinates and nasal septum(P<0.001),and signs of structural destruction within the nasal cavity(P=0.024).MRI more frequently showed involvement of the inferior turbinate(P=0.034),nasal septum(P<0.001),nasopharynx(P=0.002),and skull base(P=0.024),with cast-like changes or extranasal infiltration.The CRS group more frequently reported symptoms of olfactory reduction(P<0.001),swelling in the middle nasal meatus,and nasal masses(P<0.001).CT more commonly showed sinus bone hyperplasia(P=0.002).CONCLUSION Compared to CRS,nasal NKTL has a shorter symptom duration,commonly presents with diffuse nasal swelling and structural destruction both inside and outside the nasal cavity.MRI frequently shows involvement of the inferior turbinate,nasal septum,nasopharynx,and skull base,along with cast-like features and skip infiltration.

关 键 词：诊断 鉴别 磁共振成像 体层摄影术 X线计算机 内窥镜检查 自然杀伤细胞/T细胞淋巴瘤 

分 类 号：R739.62[医药卫生—肿瘤] R765.41[医药卫生—临床医学]