原发性胸腺淋巴瘤的CT诊断

CT diagnosis of primary thymic lymphoma

目的:探讨原发胸腺淋巴瘤(PTL)的CT表现及诊断价值。方法:回顾性分析1992年3月-2013年4月临床资料齐全且经病理证实的15例原发胸腺淋巴瘤CT表现,所有病例均经CT平扫加增强扫描,并与相同病例的侵袭性胸腺瘤及胸腺癌CT表现进行对照研究。结果:15例原发胸腺淋巴瘤中霍奇金淋巴瘤(HL)8例(8/15)、弥漫性大B细胞淋巴瘤5例(5/15)、T细胞淋巴母细胞淋巴瘤2例(2/15),女性9例(9/15)、男性6例(6/15);发病年龄<40岁13例(13/15),与侵袭性胸腺瘤(5/15)及胸腺癌(3/15)比较(P<0.05)。原发胸腺淋巴瘤CT平扫示肿块向两侧生长11例(11/15),结节状突起、分叶状生长8例(8/15),密度均匀6例(6/15),三者分别与侵袭性胸腺瘤、胸腺癌比较差异无显著统计学意义。原发胸腺淋巴瘤CT增强扫描示包绕血管征11例(11/15),分别与侵袭性胸腺瘤(2/15)、胸腺癌(4/15)比较(P<0.05);瘤内小囊肿状改变7例(7/15),分别与侵袭性胸腺瘤(1/15)、胸腺癌(0/15)比较(P<0.05);强化值<20HU10例(10/15),与胸腺癌(1/15)比较(P<0.05)。结论:原发胸腺淋巴瘤好发年轻女性,CT增强扫描具有一定的特征表现,据之可与侵袭性胸腺瘤及胸腺癌鉴别。

Objective：To investigate the CT manifestations of primary thymic lymphoma （PTL）and their diagnostic value.Methods：The CT data of 15 cases of pathologically confirmed PTLs were collected from March 1992 to April 2013. All cases had plain and contrast-enhanced CT scans and were compared with the invasive thymoma and thymic carcinoma. Results：Of the 15 cases of PTLs,8 were Hodgkin′s lymphoma （HL）（8/15）,5 were diffuse large B-cell lymphoma （5/15） and 2 were T-cell lymphoblastic lymphoma （2/1 5 ）.There were 9 females （9/1 5 ）and 6 males （6/1 5 ）.1 3 of 1 5 were younger than 40 years old （13/15）,for comparison,the invasive thymoma was 5/15 and thymic carcinoma was 3/15,where P〈0.05.The plain CT scans of PTL show that：11 cases were bilateral （11/15）,8 cases were lobulated （8/15）,6 cases showed homogeneous density （6/15）.Compared with the invasive thymoma and thymic carcinoma,there was no statistical difference.On enhanced CT imaging,vessel encasement was observed in 11 cases of PTL （11/15）,in 2 cases of invasive thymoma （2/15）,and in 4 cases of thymic carcinoma （4/15,P〈0.05）.These were small cysts within the mass in 7 cases of PTL （7/15）,in one case of invasive thymoma （1/15）and in no case of the thymic carcinoma （0/15,P〈0.05）.10 cases of PTL had CT enhancement less than 20HU （10/15）,compared with thymic carcinoma （1/15,P〈0.05）.Conclusion：Primary thymic lymphoma occurs more frequently in young woman,which can be characterized by enhanced CT scan.Based on the enhanced CT scan,PTL can be distinguished from the invasive thymoma and thymic carcinoma.