鼻部和咽部NK/T细胞及B细胞型NHL淋巴瘤的影像学征象对照分析

Distinct imaging features of different pathological subtypes of B cell non-Hodgkin′s lymphomas of the nose and pharynx ministry type NK/T cell

目的 探讨不同病理类型的鼻部和咽部淋巴瘤的影像学征象,以提高其诊断准确率.方法 回顾性分析经病理证实的32例鼻部和咽部非霍奇金淋巴瘤（NHL）的影像学资料（CT或MR）,按病理类型分为NK/T细胞型及B细胞型两组. 分析两组病例的发病部位、范围、形态、生长方式、邻近组织情况等,并对两组统计结果进行 χ2检验. 结果 NK/T 细胞型 NHL 共12例（37.5%）,10例（83.3%）以鼻腔为主,2例（16.7%）以咽淋巴环为主,鼻腔型表现为鼻腔内软组织呈铸型生长. 其中7例（58.3%）出现表面小溃疡,6例（50.0%）出现邻近软组织侵犯及骨质破坏, 2例（16.7%）见颈部淋巴结转移. B 细胞型 NHL 共20例（62.5%）,发生于咽淋巴环者19例（95.0%）,发生于鼻腔者1例（5.0%）,表现为咽淋巴环软组织增厚,匍匐状生长. 咽旁间隙受累及骨质破坏2例（16.7%）;颈部淋巴结转移20例（100%）. 经χ2检验,鼻部和咽部NK/T细胞较B细胞NHL更好发于鼻腔（χ2=20.401,P=0.000）,铸型生长,更易破坏邻近软组织及骨质（χ2=6.400, P=0.011）及出现小溃疡（χ2=11.378,P=0.001）;而弥漫大B细胞淋巴瘤更易发生于在咽淋巴环,匍匐状生长（χ2=20.519,P=0.000）,更多存在淋巴结累及（χ2=23.058,P=0.000）. 结论 不同病理类型的鼻及咽部原发性NHL影像学上具有特征性的表现,具有辅助诊断价值.

Objective To investigate the distinct imaging features of different pathological subtypes of non-Hodgkin＇s lymphomas（NHL）of the nose and pharynx and to improve its diagnostic accuracy.Methods A retrospective study was performed on the imaging materials（including CT or MRI）of 32 patients who were con-firmed as NHL of the nose and pharynx by pathology.The materials were divided into two groups：NK/T cell lym-phoma（NKTCL）and B cell lymphoma（BCL）.The characteristics of the site,size,morphology,growth pattern,re-gional structure invasion of these lymphomas were evaluated and compared.The results were analyzed by Chi-quare test.Results A total of 12 cases（37.5%）were NK/T cell type,10 cases（83.3%）mainly had nasal cavity involvement,2 cases（16.7%）showed Waldeyer＇s ring involvement,which were characterized by nasal soft tissue with mold growth.Among these,7 cases（58.3%）had superficial ulcerations,6 cases（50.0%）with regional struc-ture invasion,2 cases（16.7%）lymph node involvements.Besides,20 cases（62.5%）were B cell type NHL.A-mong these,19 cases（95.0%）had Waldeyer＇s ring involvement and 1 case（5.0%）occurred in nasal cavity with pharyngeal lymphatic loop soft tissue incrassation,and 2 cases（16.7%）had regional structure involvement of pharyngeal space and bone.All cases showed cervical lymphadenopathy.Results of the Chi-square test showed that NKTCL had a higher incidence of nasal cavity involvement than B cell type NHL（χ2=20.401,P=0.000） and regional structure invasion（χ2=6.400,P=0.011）,as well as superficial ulcerations （χ2=11.378,P=0.001）.BCL had a higher incidence of Waldeyer＇s ring involvement and creeping growth pattern（χ2=20.519, P=0.000）,as well as lymphadenopathy（χ2=23.058,P=0.000）compared to NKTCL.Conclusion Primary NHLs of the nose and pharynx of different pathological subtypes has some characteristics on imaging,which may have supplementary value in the lymphoma diagnosis.