颈胸交界区淋巴结肿瘤病变MDCT表现特征及其解剖、病理学基础

MDCT Features and Anatomic-pathological Basis of Lymphoid Neoplasm in Cervico-thoracic Junctional Region

为了明确颈胸交界区淋巴源性肿瘤病变的MDCT影像表现特点、解剖及病理学基础,回顾性收集经病理证实的下颈部和上胸部的淋巴源性肿瘤病变69例(其中淋巴瘤41例,转移瘤28例),分析病变的MDCT表现特点及分布规律,阐明影像学表现与解剖、病理学的相关性。发现淋巴瘤41例中,病灶主要分布于颈外侧浅部21例(51.2%),颈深静脉链区27例(65.9%),锁骨上区31例(75.6%),上纵隔气管旁19例(46.3%),主动脉弓旁23例(56.1%),主肺动脉窗22例(53.7%),前上纵隔17例(41.5%),隆突下11例(26.8%),上纵隔食管旁7例(17.1%);淋巴结转移瘤28例,原发肿瘤为鼻咽癌5例、甲状腺癌7例、肺癌10例和食管癌6例,大多数循淋巴回流方向逐级转移,少部分跳跃式转移,主要分布于颈静脉链周围区23例(82.1%),锁骨上窝区21例(75%),上纵隔气管旁17例(60.7%),前上纵隔18例(64.3%),主动脉弓旁10例(35.7%),肺动脉窗11例(39.2%),上纵隔食管旁8例(28.6%)。因此,颈胸交界区域淋巴源性肿瘤病变可同时累及下颈部和上胸部,其影像学表现及优势解剖分布与其解剖、病理特点密切相关。

To determine the relevance between MDCT features and anatomic-pathological basis of lymphoid neoplasm in cervico-thoracic junctional region, we performed a retrospective analysis of 69 patients with lymphoid neoplasm （lymphoma： 41 patients＋ metastatic tumor： 28 patients） involving the cervico-thoracic junctional region for MDCT features and distribution of lesions. The relevance between MDCT features and the anatomic-pathological basis in this region were evaluated. Among all the 41 patients with lymphoma, 29 with NHL （70.7%）, 12 with HD （29.3 %）. The lymphomatous lymphadenopathy mainly located in superficial lateral cervix （51.2 %, 21/41） , deep jugular chain （65.9%, 27/41）,supraclavicular fossa（75.6%, 31/41）, paratrachea space in anterior mediastinum （46.3 N, 19/41）, around aortic arch （56. 1 %, 23/41）, aortopulmonary window （53.7 %, 22/41）, upper anterior mediastinum （41.5%, 17/41）, subcarinal space （26.8%, 11/41） and paraesophageal space （17. 1%, 7/41）. 28 pa- tients had metastatic lymphoid tumor. The primary tumor were nasopharynx tumor （5 patients）, thyroid cancer （7 patients）, lung cancer （10 patients）, and esophageal cancer （6 patients）. Most metastasis took stage by stage in the way of lymphatic return, but a minority of cases migrated jumpily. The main metastatic sites were： beside jugular chain （82. 1%）, supraclavicular fossa （75%）, paratracheal in anterior mediastinum （60.7%）, upper anterior medi- astinum （64. 3%）, beside aortic arch （35.7%）, aortopulmonary window （39.2%）, and paraesophageal space （28. 6%）. So lymphoid neoplasms in cervico-thoracic junctional region were involving both lower cervix and upper thorax simultaneously. The MDCT features and main distribution of lesions correlated with the anatomic-pathological characteristics in this region.