皮下脂膜炎样T细胞淋巴瘤的临床及影像征象分析

Clinical manifestations and imaging features of subcutaneous panniculitis-like T-cell lymphoma

目的探讨皮下脂膜炎样T细胞淋巴瘤(SPTCL)的临床及影像学特征。方法回顾性分析2007年1月至2012年12月经病理确诊的SPTCL共7例,重点分析总结其临床表现、影像学特征。结果 (1)临床特点:SPTCL多以皮肤结节就诊(最好发于肢体),常伴发热等全身症状;多累及浅表淋巴结肿大;实验室检查无特殊;最终确诊靠病理。(2)影像特征:X线片多为阴性,超声检查可作为一般筛查手段,CT、MRI与核医学除可判断病变位置、范围外,还可观察病变的强化程度,髓腔有无受累,并能指导临床穿刺部位。因病变多位于皮下,MRI对肿瘤本身观察最佳,可进一步提供肿瘤细节征象。结论 SPTCL临床无特征性,多种影像学检查可以进一步提供病变部位、范围、发现远处转移、确定穿刺部位及进行疗效评价,最终确诊仍然依靠病理。

[Abstract] Objective To investigate the clinical manifestations and imaging features of subcutaneous panniculitis-like T-cell lymphoma （SPTCL）. Methods The clinical manifestations and imaging features of 7 SPTCL patients were retrospectively analyzed from January 2007 to December 2011. Results There were 3 males and 4 females with average age of 37.9 years old （range： 24-72）. 4 patients presented with multiple subcutaneous nodules or deeply seated plaques, most commonly on the extremities.~ 3 patients had protracted course of single subcutaneous nodules, with the location of lower limb, chest and shoulder respectively. The common associated symptom was fever （n=4） and lymphadenectasis （n=2）. Enlargement of superficial lymph nodes （n=4） were found. Laboratory tests showed a normal liver and renal function test （n=5） and 4 patients had ESR raised. The final diagnosis was based on pathology： high-power view of subcutaneous infiltrate demonstrated small to medium lymphocytes and some large lymphoid cells with irregular nuclei, showing characteristic rimming along adipocytes. results showed that heterotypic lymph-like cells in adipose tissue were positive for CD3 （n=6）, CD5 （n--4）, TIA-1 （n=6）, Granzyme B （n=4） while being negative for CD56 （n=7）. Imaging features： the plain film （n=7） was negative mostly. Ultrasound （n=4） could be used for screening tool. MRI （n=2）, and PET/CT （n=3） could be useful in delineating the extent, finding distant metastasis, confirming the site of puncture, predicting therapeutic effect. Because the lesion was subcutaneous, MR/could supply more details about tumors. Conclusions The clinical manifestations of SPTCL are non-specific. The imaging features are useful in delineating the extent, finding distant metastasis, confirming the site of puncture, predicting therapeutic effect. And the biopsy is necessary for an final diagnosis.