原发性结外淋巴瘤的超声诊断价值

The value of ultrasonography in diagnosis of primary extranodal lymphoma

目的总结原发性结外淋巴瘤的超声表现特征及诊断价值,为早期确诊原发性结外淋巴瘤提供临床依据。方法回顾性分析20例原发性结外淋巴瘤患者的临床表现、病理免疫组化结果与超声检查结果等资料,所有患者均经手术或超声引导下穿刺活检确诊。患者以腹痛不适(10/20)或触及肿块(10/20)为临床症状就诊,病变部位行常规超声检查并评价病变处的彩色血流信号分级,检查胃部患者口服胃窗造影剂400 ml。结果 20例患者中原发性胃淋巴瘤9例(45%,9/20),超声表现为胃壁局限性不规则增厚;肠道淋巴瘤5例(25%,5/20),超声表现为腹腔内较大的异常低回声区;甲状腺淋巴瘤2例(10%,2/20),超声表现为网格状低回声区;肝、乳腺、肾上腺、阴茎淋巴瘤各1例(各5%,1/20),超声均表现为病变部位的低回声病灶。肿块体积范围(长径×宽径×厚径)在12 mm×7 mm×6 mm^95 mm×80 mm×71 mm之间。彩色多普勒成像示血流分级以Ⅰ、Ⅱ级居多(90%,18/20)。病理类型均为非霍奇金淋巴瘤,以B细胞淋巴瘤多见(50%,10/20)。结论原发性结外淋巴瘤超声表现复杂多样,缺乏特征,易被误诊。多数病例表现为低回声、形态规则的低血流分级病变,此现象在原发性结外淋巴瘤首诊中具有一定的警示作用,应引起重视。

Objective To explore the features of the primary extranodal lymphoma （PENL） on ultrasound and evaluate the diagnostic value in early detection of PENL. Methods Twenty patients enrolled in this study were confirmed as primary extranodal lymphoma by surgery or ultrasound-guided biopsy. The clinical examinations, pathological immunohistochemical results and ultrasound findings were collected and retrospectively analyzed. Patients visited clinic for abdominal pain （10/20） or touching masses （10/20）. All the lesions were assessed by ultrasonography with routine scan and color Doppler flow imaging （CDFI） grading. Patients who received stomach scan had taken 400 ml special contrast agent before ultrasound exam. Results In the 20 primary extranodal lymphoma patients, 9 cases （45%, 9/20） were gastric lymphomawith irregular thickening of the stomach wall; 5 intestinal lymphoma cases （25%, 5/20） with large abdominal hypoechoic mass, 2 thyroid lymphoma cases （10%, 2/20） with hypoechoic lesion with internal reticulation. There was only 1 case （5%, 1/20 respectively） for liver, breast, adrenal and penis respectively, with low echo intensity. Ultrasonography showed the hypoechoic lesions, ranging from 12 mm X 7 mm X 6 mm-95 mm X 80 mm X 71 mm in size. CDFI grading were class I or II for most cases （90%, 18/20）. Pathology was non-Hodgkin lymphoma in all 20 cases, with diffuse large B-cell lymphoma in half （50%, 10/20）. Conclusions Primary extranodal lymphomas lacks specific clinical symptoms and is often misdiagnosed. However ultrasonography showed some characteristics, which were hypoechogenecity, low CDFI grading and regular shape. Therefore ultrasonography can provide necessary information for the early diagnosis of primary extranodal lymphoma.