眼眶黏膜相关性淋巴样组织淋巴瘤的MRI成像特征及临床分析

MRI imaging features and clinical analysis of orbital MALT lymphomaa

目的探讨眼眶黏膜相关性淋巴样组织(MALT)淋巴瘤MRI成像特征及临床诊断与治疗。方法回顾性分析11例经病理诊断明确的眼眶MALT淋巴瘤病灶在MRI中的形态、大小、部位及与临近组织的关系,以及在临床诊断中的注意要点。结果 11例眼附属器MALT淋巴瘤患者中男性10例,女性1例,年龄35~76岁,平均63.8岁;临床表现中眼球突出4例,眼部包块7例;MRI示肌锥外间隙8例,肌锥内外间隙3例;9例结节状生长,2例呈弥漫性生长。所有例病T_1WI、T_2WI均呈等信号,信号均中等强化;病理组织特点,11例患者CD20、CD45部分CD79a表达均(+)、bcl-2(+):9例(81.8%)、MUM-1(+):6例(54.5%);Ki-67(+):8例(72.7%)。所有患者均经手术切除或部分活检,局部放疗治疗5例,随访1~4年,均无复发或再生长。结论眼眶MALT淋巴瘤好发于老年男性,多位于肌锥外间隙,MRI成像T1WI、T2WI均呈等信号,均匀强化。结节性病灶者可手术治疗,弥漫性病灶可在手术治疗后需辅以局部放疗治疗,复发率较低。

Objective To describe the MRI imaging characteristics and clinical diagnosis and treatment of orbital mucosa-associated lymphoid tissue （MALT） lymphoma. Methods A retrospective analysis of 11 cases of pathologically confirmed orbital MALT lymphoma. The characteristics of tumor shape, size, location and its relationship to adjacent tis- sues in the MRI were reviewed. Key points in clinical diagnosis were also discussed. Results 11 cases of orbital MALT lymphoma included 10 males and 1 female, aged between 35-76 years with mean age of 63.8 years. Clinical presentation included protopsis （4 cases） and ocular mass （7 cases）. MRI showed locations were outside （8 cases） or both inside and outside （3 eases ） the orbital muscle cone. Shape was nodular （9 cases） or diffuse （2 cases）. All MRI images showed e- venly distributed T1WI and T2WI with moderate enhancement. Immunohistochemistry showed negative CD3, CDS, and CD10 in all patients. CD20, CD45, partial CD79a were all positive. Bcl-2 was positive in 9 cases （ 81.8% }. MUM-1 was found in 6 patients （ 54.5% ）. Ki-67 was positive in 8 cases （ 72.7% ）. All patients underwent surgical resection or partial biopsy, and 5 cases were treated with local radiotherapy. All patients were followed for 1 -4 years. There was no recur- rence or regrowth. Conclusions Orbital MALT lymphoma occurs in older male, mostly outside the orbital muscle cone. MRI imaging T1WI, T2WI showed equal signal and uniform enhancement. Nodular lesions can be surgically treated while diffuse lesions can be treated with surgery and radiotherapy. The recurrence rate is generally low.