脾脏原发性非霍奇金淋巴瘤的病理学及CT特征

Pathological and CT features of primary splenic non-Hodgkin's lymphoma

目的探讨脾原发性非霍奇金淋巴瘤的病理、临床和CT影像学特征,旨在加深对该病的认识,提高术前诊断水平。方法回顾性分析经临床病理证实的13例脾原发性非霍奇金淋巴瘤的CT图像、临床及病理资料。结果临床最多见为上腹部隐痛不适(8例),依次为左上腹部肿块和发热(6例),体重下降(5例)等。脾边缘型淋巴瘤6例,表现为脾弥漫性肿大,CT平扫见弥漫性密度减低,增强扫描晚期3例显示弥漫性粟粒结节低密度灶。弥漫大B细胞瘤7例,3例为巨块型,4例为多发肿块型;CT表现为脾内单发或多发混杂密度肿块,增强呈轻中度不均性强化。13例PSL的临床分期,Ⅰ期3例;Ⅱ期2例;Ⅲ期8例。10例存在脾外侵犯,侵犯脾门淋巴结5例,侵犯肝组织5例,另有5例分别表现为腹膜后,肝门及系膜淋巴结、结肠及胰腺侵犯。结论脾原发性非霍奇金淋巴瘤临床、病理及CT表现有一定的特征性,结合脾外病变对临床诊断和分期具有一定的价值。

Objective To study the pathological, clinical and CT features of primary non-Hodgkin＇s plenic lymphoma, in order to enhance the understanding of the disease and to improve the level of preoperative diagnosis. Methods 13 cases with primary non-Hodgkin＇s plenic lymphoma proved by pathohistological evidence underwent CT scans. The pathological and clinical data and CT images were retrospectively collected and analyzed. Results Patients with pain and discomfort in left upper abdomen were the most common （8 cases）, followed by mass in left upper abdomen （6 cases） and low fever （6 cases）, and decreased body weight （5 cases）. In the total of 13 cases, 6 PSL cases presented with splenic marginal zone lymphoma showed splenomegaly. Plain CT demonstrated the splenic density was diffuse decreases, and 3 cases showed the spleen with lower density multiple nodular on delayed enhancement phases. There were 7 patients with diffuse large B-cell lymphoma. Of these 7 patients, 3 cases were classified into focal massive pattern, and 4 cases into mutipie massive pat- tern. On plain CT, a solitary or mutiple lesions were seen in the spleen with heterogeneous density, and presented slight- mild heterogeneous enhancement. Using Ahmann＇s classification in 13 cases, 3 cases were stage Ⅰ , 2 cases were stage Ⅱ , 8 cases were stageⅢ There were 10 cases with invasive focal outside the spleen, including 5 cases with splenic hilar lymph node invasion, 5 cases with liver invasion, and 5 cases with retroperitoneal lymph node, portal lymph node and me- sangial lymph node, pancreas and colon invasion, respectively. Conclusion The pathology, clinic and CT imaging of pri- mary non-Hodgkin＇s plenic lymphoma have some certain typical features. Comparing with the invasive lesions outside the spleen is helpful to the clinical diagnosis and staging.