眼部淋巴瘤临床表现、病理及MRI/CT影像分析

Features of clinical presentation, pathology and magnetic resonance or computed tomography imaging for ocular lymphoma

目的 探讨淋巴瘤在眼部分布特点及MRL/CT特征,提高该病影像诊断能力.方法 回顾性分析2007年6月至2012年9月来北京同仁医院以眼部症状就诊,经穿刺活检或手术经病理证实为眼部淋巴瘤、有完整的MRI/CT影像资料的73例患者,男47例、女26例.结果 淋巴瘤位于双眼24例,右眼23例,左眼26例（合计97侧）,常见于中老年男性患者,中位年龄（60±12）岁.病理上以B细胞淋巴瘤多见,其中黏膜相关淋巴瘤59例,弥漫大B细胞淋巴瘤7例;T细胞和其他类型比较少见,淋巴母细胞淋巴瘤3例,淋巴浆细胞淋巴瘤2例,滤泡性淋巴瘤和NKT淋巴瘤各1例.病变边缘清晰64侧,欠清晰17侧,模糊16侧.29侧病变表现为局限性肿块,分别位于结膜16.5％（16/97）、泪腺5.2％ （5/97）、眼睑3.1％ （3/97）、眼肌2.1％ （2/97）和泪囊3.1％ （3/97）;68侧表现为弥漫性病变,分别累及眶隔前区39.2％（38/97）、肌锥外区71.1％（69/97）、肌锥内区55.7％ （54/97）、眼球区46.4％ （45/97）、骨膜下区14.4％ （14/97）、肌锥区75.3％（73/97）、泪腺区39.2％（38/97）和视神经鞘区34.0％（33/97）.MRI（70例/94侧）显示T1WI呈等信号88/94侧,低信号6/94侧;T2WI呈等信号52/94侧,稍高信号40/94侧,混杂信号2/94侧.信号均匀67/94侧,不均匀27/94侧.增强扫描轻度强化27/94侧,中度强化67/94侧;强化均匀52/94侧,不均匀42/94侧.CT（21例/24侧）扫描显示18/24侧表现为等密度,6/24侧表现为稍高密度.均匀7/24侧,不均匀17/24侧.邻近骨质无变化16/24侧,受压变形6/24侧,骨质破坏2/24侧.病变常可累及周围结构,如眶尖（27/97侧,27.8％）、眶下裂（14/97侧,14.4％）、翼腭窝（10/97侧,10.3％）、眶上神经（8/97侧,8.2％）、海绵窦（8/97侧,8.2％）和面部软组织（6/97侧,6.2％）等.结论 眼部淋巴瘤主要发生于中老年男性患者,表现为多结构、多部位受累,MRI呈等/稍长T1和T2信号,增强扫描轻中度均匀/不均匀强化,周围骨质无明显变化.

Objective To explore the distribution and magnetic resonance imaging or computed tomography （MRI/CT） of lymphoma in orbit.Methods Retrospective analyses were conducted for 73 cases with ocular complaints at Beijing Tong＆#39;ren Hospital from June 2006 to September 2012.They were confirmed pathologically as lymphoma with complete MRI/CT records.Results Ocular adnexal lymphoma occurred predominantly in adults.There were 47 males and 26 females with a median age of （60 ± 12.0） years.The lesions were bilateral （n =24）,right side （n =23） and left side （n =26） respectively.The pathological types included mucosa-associated lymphoid tissue （MALT） lymphoma （n =59）,diffuse large B-cell lymphoma （DLBCL,n =7）,mantle cell lymphoma （MCL,n =3）,lymphoplasmacytic lymphoma （LPL,n =2） and follicular lymphoma and natural killer/T-cell lymphoma （FL and NKT,n =1） respectively.They had well-defined margins in 64 sides,less well-defined margins in 17 sides and ill-defined margins in 16 sides.And 29 sides of lesions presented as a regional mass within conjunctiva in 16/97 sides （16.5%）,lacrimal gland in 5/97 sides （5.2%）,eyelids in 3/97 sides （3.1%）,ocular muscle in 2/97 sides （2.1%） and lacrimal sac in 3/97 sides （3.1%）.Moreover,68 sides of lesion were diffusely distributed.The invaded sites included preseptal region in 38/97 sides （39.2%）,extraconal compartment in 69/97 sides （71.1%）,intraconal compartment in 54/97 sides （55.7%）,eyeball region in 45/97 sides （46.4%）,subperiosteum in 14/97 sides （14.4%）,cone compartment in 73/97 sides （75.3%）,lacrimal gland in 38/97 sides （39.2%） and sheath of optic nerve in 33/97 sides （34.0%）.And,on MRI scan,70 cases （94 sides） had isointensity in 88/94 sides,hypointensity in 6/94 sides on T1WI and isointensity in 52/94 sides,mild hypointensity in 40/94 sides or mixed signal in 2/94 sides on T2 WI.In addition,the signals were homogeneous in 67/94 sides and heterogeneous in 27/94 sides.After contrasting,these lesions showed mild contrast-enhancement （CE） in 27/94 sides,moderate CE in 67/94 sides with homogeneous CE in 52/94 sides and heterogeneous CE in 42/94 sides.On CT scan,21 cases （24 sides） had isodensity in 18/24 sides and mild hyperdensity in 6/24 sides with homogeneous in 7/24 sides and heterogeneous in 17/24 sides.Moreover,most adjacent bone show no change （16/24 sides）.Only 16/24 sides and 2/24 sides showed reformation or destruction respectively.At the same time,the lesions also involved other para-orbit structures,such as orbital apex （27/97 sides,27.8%）,fissure orbitalis inferior （14/97 sides,14.4%）,fossa pterygopalatina （10/97 sides,10.3%）,supraorbital nerve （8/97 sides,8.2%）,cavernous sinus （8/97 sides,8.2%） and facial soft tissue （6/97 sides,6.2%）,et al.Conclusion Ocular adnexal lymphoma occurs predominantly in male adults.And multiple strictures and sites are often involved.There is iso-/mild hyperintensity with mild-to-moderate homo-/heterogeneous CE and little change of adjacent bone on T1 WI and T2WI.