骨盆原发性非霍奇金淋巴瘤的临床及影像表现分析

Clinical and imaging manifestation of primary bone marrow non-Hodgkin lymphoma in pelvic bones

目的探讨骨盆原发性非霍奇金淋巴瘤的临床及影像表现。方法经手术病理证实的20例骨盆原发性非霍奇金淋巴瘤,19例行X线检查,8例行CT检查,14例行MRI平扫加增强扫描。结果 1)临床表现:男性14例,女性6例,发病年龄15-74岁,平均年龄39岁。15例位于髂骨(其中10例同时累及髋臼,另外5例同时累及髋臼及耻骨),4例累及髋臼及耻骨,1例为骨盆多部位受累。临床症状主要为髋部疼痛及髋关节活动受限;2)影像表现:X线及CT表现为溶骨性骨质破坏19例,其中13例表现为单纯溶骨性骨质破坏,6例表现为溶骨性骨质破坏合并骨质硬化。8例行CT检查病例均表现为骨皮质破坏合并软组织肿块。14例行MRI检查病例均表现为正常的骨髓信号被肿瘤信号取代并形成软组织肿块。T_1WI上病变表现为等信号10例,稍高信号4例,T_2WI上均表现为高信号,增强扫描病灶均明显强化;3)病理类型:弥漫大B细胞淋巴瘤17例,T细胞淋巴瘤、滤泡性淋巴瘤及间变性大细胞淋巴瘤各1例。结论当患者年龄>30岁,骨盆出现单纯溶骨性破坏或溶骨性骨质破坏合并骨质硬化,伴周围软组织肿块,且软组织MRI信号较均匀,无瘤骨及钙化,需考虑为非霍奇金淋巴瘤。

Objective The objective was to characterize clinical manifestation and imaging findings of primary non-Hodgkin lymphoma in pelvic bones. Methods Clinical and imaging data for primary non-Hodgkin lymphoma of pelvic bones in 20 patients were reviewed retrospectively. Conventional radiographs （ n = 19 ）, computed tomographic images （ n = 8 ）, and magnetic resonance images （n = 14） were reviewed. All the patients were stained with hematoxylin-eosin and microscopically examined. Results There were six female and 14 male patients, with an age range of 15 to 74 years （ average age, 39 years）. 15 of the cases were principally in the ilium, in which 10 also involved the acetabular area, while the other five also invaded the pubis. In four cases, the disease was found in the acetabulum and pubis. One patient had multiple lesions at different sites of pelvic bones. The most common symptom was hip pain or reduced range of movement. Conventional radiographs and CT showed ill defined lytic lesions in 19 eases, includinng solitary lyric lesions in 13 cases, mixed lytic and sclerotic lesions in six cases. Eight cases that had CT examination all showed the cortical disruption with soft tissue mass. CT also showed hyperdensity within the pelvic bones destruction. All the 14 cases that had MRI examination showed normal marrow being replaced by tumors and had extra-osseous soft tissue mass. The affected bone marrow and soft tissue mass showed isointensity relative to muscles in 10 cases, and slightly hyperintensity in four cases. T2-weighted MR images revealed intermediate to hyperintensity. Gadolinium-DTPA-enhanced T1 -weighted MR images showed significant enhancement in all cases. Of 20 cases of primary non-Hodgkin lymphoma, diffuse large B cell lymphoma 17 cases, T cell lymphoma,follicular lymphoma and anaplasia large cell lymphoma 1 case repectively. Conclusion Patient whose age is over 30 years, as well as inlaging features such as lytic or mix lytic-sclerotic （moth-eaten or permeative） with soft tissue mass, but without mineralization and osteoid matrix can help distinguish DLBCL of pelvic bones.