孤立型脾脏单发淋巴管瘤CT影像特点与病理对照

CT Features of Solitary Splenic Single Lymphangioma:Comparison with Pathological Findings

目的探讨孤立型脾脏单发淋巴管瘤的CT影像特点与病理类型间的关系,加强对本病的认识,提高诊断水平。方法搜集本院经手术病理证实的孤立型脾脏单发淋巴管瘤10例,回顾性分析患者的临床、CT影像及病理资料,CT平扫10例,增强扫描9例。结果本组10例中,男4例,女6例,年龄32-79岁,平均53.4岁,其中8例无任何临床症状,由B超体检发现,仅2例有与脾脏增大相关的轻微临床症状。10例均为单发,共10个病灶,直径3.2-6.6 cm,CT平扫所有病灶均为囊性低密度灶,境界清楚8例,不清楚2例,其中形态不规则呈分叶状、密度不均、内见粗细不均分隔的病灶有6例,增强后病灶囊壁较薄,囊壁及分隔轻-中度强化,囊内容物除分隔外均无强化,病理均诊断为海绵状淋巴管瘤,另外4例形态规则呈类圆形、密度均匀、内无分隔的病灶,增强后病灶囊壁较薄,囊壁轻-中度强化,囊内容物密度均匀、均无强化,病理均诊断为囊状淋巴管瘤。10例中误诊为脾脏囊肿1例。结论孤立型脾脏单发淋巴管瘤少见,成年人发病率明显高于儿童,患者临床上无明显症状或症状轻微,病程较长,进展缓慢,其CT影像特点与病理类型有关,海绵状淋巴管瘤CT平扫病灶形态多不规则,呈分叶状,密度不均,内见粗细不均的分隔,增强后囊壁及分隔轻-中度强化,囊内容物除分隔外无强化;囊状淋巴管瘤CT平扫病灶形态较规则,呈类圆形,密度均匀,内无分隔,增强后病灶囊壁较薄,囊壁轻-中度强化,囊内容物无强化、密度均匀。

Objective To discuss the correlation between CT features and pathologic findings in solitary splenic single lymphangioma in order to make a further understanding of the disease and to improve the diagnostic accuracy. Methods A total of 10 patients with pathologically-proved solitary splenic single lymphangioma were collected. The clinical data, CT materials and pathological findings were retrospectively analyzed. Plain CT scan was performed in all the 10 patients, and additional enhanced CT scan was employed in 9 patients. Results In this series, the patient＇ s mean age was 53.4 years, ranging from 32 to 79 years. Eight patients had no clinical symptoms; the disease was detected by ultrasound examination in health screening. Only two patients had slight clinical symptoms due to splenomegaly. The lesion was solitary in all 10 patients （10 lesions in total） ; the lesion＇ s diameter was 3.2 -6.6 mm. On plain CT scan, the lesions were characterized by cystic low-density shadow with clear margin （ n = 8） or unclear margin （ n = 2）. Six lesions were irregular and lobulated in shape, the density was inhomogeneous, and uneven thickness septum could be observed within it. Enhanced scan revealed that the cystic wall was thin, the cystic wall and septum showed slight enhancement while the cystic contents showed no enhancement. Pathological diagnosis was cavernous lymphangioma for all these 6 patients. In the remaining 4 patients, the lesion was round, its density was homogeneous with no septum within it; enhanced scan revealed that the cystic wall was thin with slight to moderate enhancement, the density of cystic contents was homogeneous with no enhancement ; pathological diagnosis was cystic lymphangioma. One patient was misdiagnosed as splenic cyst. Conclusion Clinically, solitary splenic single lymphangioma is rare. The incidence in adults is obviously higher than that in children. Patients have no obvious symptoms or have only mild symptoms, the course of the disease is long and its progression is slow. CT features are well correlated with their pathological types. Cavernous lymphangioma usually presents as an irregular and lobulated mass with inhomogeneous density and uneven thickness septum inside on plain CT scan, and its cystic wall and septum shows slight to moderate enhancement on enhanced scan. The cystic lymphangioma is regular and round in shape with homogeneous density with no septum structure inside on plain CT scan, and on enhanced CT scan the thin cystic wall shows slight to moderate enhancement, and its cystic contents show even density and no enhancement.