咽淋巴环非霍奇金淋巴瘤的影像学特征及临床意义

Imaging Features of Waldeyer's Ring in Non Hodgkin's Lymphoma and Its Clinical Significance

背景与目的:咽淋巴环是非霍奇金淋巴瘤(non-HodgkinslymphomaNHL)常见的结外侵犯部位,早期临床及影像学表现均与该部位常见的鳞状上皮癌相似,常引起误诊。为了提高对本病影像特点的认识,本文拟分析有关资料,探讨咽淋巴环NHL的影像学特点及临床意义。方法:回顾性分析149例经病理确诊的咽淋巴环NHL的CT和MRI表现。结果:病理分型:B细胞来源占65.8%,T和NK/T细胞占34.2%。病变部位:发生于扁桃体的最多见,其次为鼻咽扁桃体等多部位受累。CT和MRI表现:(1)病变形态为肿块型81例、浸润性36例、溃疡型7例及混和型25例,其中肿块型以B细胞NHL多见,浸润型以NK/T细胞多见。(2)肿块型多表现为CT密度和MRI信号均匀。(3)病变以局限在咽粘膜间隙多见,咽旁间隙等深层结构及颅底骨质侵犯少。(4)总的颈淋巴结受累率52.3%,其中B细胞65.3%,和NK/T细胞27.5%,后者明显低于前者(P<0.05)。结论:多部位多中心起源、大肿块、咽壁弥漫浸润性增厚、颅底及深层结构侵犯少是咽淋巴环NHL典型的影像学特征;不同的免疫表型又有一定的特点。CT和MRI在咽淋巴环NHL的诊断、临床分期有重要的参考价值。

BACKGROUND &OBJECTIVE: Waldeyers ring is the most vulnerable site outside lymph nodes in non Hodgkins lymphoma (NHL). Its imaging features in NHL of early stage were similar with those of squamous epithelial cancer, which often leads to misdiagnosis. This study was to discuss imaging features of Waldeyers ring in NHL, and its clinical significance. METHODS: CT and MRI performances of 149 patients with pathologically diagnosed Waldeyers ring NHL were retrospectively analyzed. RESULTS: Among 149 cases of Waldeyers ring NHL, 98 (65.8%) were B cell origin, and 51 (34.2%) were T cell or NK/T cell origin; tonsil was the most vulnerable site followed by nasopharyngeal tonsil and other positions. CT and MRI showed that 81 were focal nodules or masses (commonly in B cell NHL), 36 were diffuse infiltrating growth (commonly in NK/T cell NHL), 7 were pure ulcer, and 25 were mixed type. The lesions of focal masses are characterized with even CT density and MRI signals. The lesions usually localized in pharynx mucosa clearance, but rarely in deep space, such as parapharyngeal space, and in skull base. Among 78 cases with involved cervical lymph nodes, 64 were B cell origin, and 14 were NK/T cell origin (P< 0.05). CONCLUSION: Multiple positions and centers origin, huge masses, diffuse infiltration growth, and less involvement in deep space and skull base are typical imaging features of Waldeyers ring NHL; CT and MRI may be helpful to diagnose, clinical classifying, and treating Waldeyers ring NHL.