原发性肝淋巴瘤的超声诊断与鉴别诊断

Ultrasound diagnosis and differential diagnosis of primary hepatic lymphoma

目的探讨原发性肝淋巴瘤的超声诊断价值。方法总结经手术或超声引导下穿刺后病理证实的40例原发性肝淋巴瘤患者的超声表现及诊断。结果结节型肝淋巴瘤35例：单发23例（57．5％），多发12例（30．0％）；弥漫型5例（12．5％）。单发及多发性病例的超声声像图表现相似，88．6％（31／35）表现为低回声病灶；弥漫型病例声像图表现为肝肿大，弥漫性回声不均匀，似“慢性肝病”或“脂肪肝”。超声对52．5％（21／40）的病例不能判断良恶性。结论原发性肝淋巴瘤临床及超声表现无特异性。当声像图表现为非常见的原发性肝癌及肝血管瘤等典型声像图或图像疑似肝转移性肿瘤但无原发肿瘤存在时，应注意与之鉴别；当患者不明原因发热伴弥漫性肝肿大时不要轻易诊断“慢性肝病”或“脂肪肝”，应注意排除该病的可能。

Objective To investigate the diagnostic value of ultrasound in primary hepatic lym- phoma （PHL）. Methods The ultrasonic and clinical features in 40 cases of PHL were analyzed retro- spectively. All cases were pathologically confirmed by surgical operation or ultrasound-guided biopsy. Results The most common presentation of PHL was a solitary lesion which occurred in 57.5% （23/ 40） of patients, followed by multiple lesions in 30.0% （12/40）, and diffuse infiltration patterns in 12.5 % （5/40）. The first two types were usually shown on ultrasound as hypoechoic lesions with sur- rounding normal liver parenchyma in 88.6% （31/35） of cases. The diffuse pattern presented as dif- fuse hepatomegaly without nodules in the liver parenchyma. There were 52.5% （21/40） of the lesions which could not be diagnosed either as benign or malignant by ultrasound. Conclusions The clinical presentations and imaging features of PHL are non-specific. PHL should be considered as a differential diagnosis in cases of liver metastases when no primary tumour is apparent, or when sonographic find- ings show atypical features of primary liver carcinoma or hemangioma. When patients with unex- plained fever and diffuse hepatomegaly, PHL should be considered and precaution should be taken to prevent to misdiagnose these patients as having fatty liver＂ or ＂chronic liver disease＂.