原发性女性生殖系统淋巴瘤的超声表现

Ultrasonic manifestations of primary female genital system lymphoma

目的探讨原发性女性生殖系统淋巴瘤(PFGSL)的超声表现,为该病的超声诊断提供参考。方法采用回顾性分析方法,选择2008年9月1日至2016年7月31日,于四川大学华西第二医院接受手术治疗,并经术后活组织病理学检查确诊为PFGSL的15例患者为研究对象。对其临床表现、术前超声检查结果、术后活组织病理学检查结果进行分析。对于不同类型病灶所占比例等计数资料,采用率(%)表示。本研究遵循的程序符合2013年修订的《世界医学会赫尔辛基宣言》要求。结果对本组15例PFGSL患者的研究结果显示,(1)临床表现:10例原发性卵巢淋巴瘤患者表现为盆腔肿块或腹水,3例原发性宫颈淋巴瘤及1例原发性子宫内膜淋巴瘤患者表现为阴道不规则流血,1例原发性阴道淋巴瘤患者表现为会阴不适及阴道不规则流血。(2)术前超声检查结果:1例原发性阴道淋巴瘤患者未能发现占位性病变,其余14例患者均发现病灶,共计检出20个病灶,其中原发性卵巢、宫颈、子宫内膜淋巴瘤患者的病灶分别为16、3及1个。原发性卵巢淋巴瘤患者可见腹膜增厚并出现转移结节,并且转移结节与原发性肿瘤超声声像图特征相似,均为血流信号丰富的实性弱回声团;62.5%(10/16)病灶出现囊性化改变,血流信号相对于实性病灶较稀疏。原发性宫颈及子宫内膜淋巴瘤患者表现为子宫内稍弱回声团,病灶血流信号较丰富。(3)术后活组织病理学检查结果:均确诊为PFGSL,均为非霍奇金淋巴瘤(NHL)。其中13例为B细胞型NHL,2例为T细胞型NHL(均为原发性卵巢淋巴瘤)。(4)手术结果:共计切除病灶21个,其中实性病灶占57.1%(12/21),其切面呈灰白色、鱼肉状,42.9%(9/21)病灶伴有囊性化改变。结论 PFGSL患者的临床及超声表现与发病部位相关,B细胞来源的PFGSL占绝大多数。PFGSL超声声像图具有一定特异性,可为临床诊治该病提供信息。

Objective To explore the ultrasonic manifestations of primary female genital system lymphoma （PFGSL）, and to provide guidance for the ultrasonic diagnosis of this disease. Methods A total of 15 patients with PFGSL who underwent surgical treatment in West China Second University Hospital, Sichuan University from September 1, 2008 to July 31, 2016 and were finally diagnosed as PFGSL by postoperative histopathological examination were selected as the study subjects by retrospective analysis method. All the 15 patients received preoperative ultrasound examinations. The clinical manifestations, preoperative ultrasonography results and postoperative histopathological examination results of those 15 patients were analyzed. The count data, such as proportions of different types of lesions were expressed by rate （%）. This study was in line with the requirements of the World Medical Association Declaration of Helsinki revised in 2013. Results The analysis results of those 15 patients were as follows. ①Clinical manifestations： the main clinical manifestations of 10 cases of patients with primary ovarian lymphoma were pelvic mass or ascites. Three cases of patients with primary cervical lymphoma and one case of primary endometrial lymphoma were mainly characterized by irregular vaginal bleeding. One case of patient with primary vaginal lymphoma was mainly characterized by perineal discomfort and irregular vaginal bleeding. ②Preoperative ultrasonography results： one patient with primary vaginal lymphoma failed to find space-occupying lesions, and the other 14 patients all found lesions. A total of 20 lesions were detected, including 16 lesions, 3 lesions and 1 lesion in patients with primary ovarian, cervical and endometrial lymphoma, respectively. Ultrasound examinations of patients with primary ovarian lymphoma showed peritoneal thickening and metastatic nodules. And the features of ultrasound sonogram of metastatic nodules and primary tumors were close, all of which were solid weak echoes with abundant blood flow signals. And 62.5% （10/16） lesions in patients with primary ovarian lymphoma had cystic changes, and their blood flow signals were sparser compared to solid lesions. Ultrasound examination of patients with primary cervical and endometrial lymphoma showed slightly weak echoes in the uterus with relatively abundant blood flow signals. ③Postoperative histopathological examination results： all those 15 subjects were finally diagnosed as PFGSL, belonging to non-Hodgkin lymphoma （NHL）, including 13 cases of B-cell NHL and 2 cases of T-cell NHL （all of them were primary ovarian lymphoma）. ④Surgical results： 21 lesions were removed, of which 57.1% （12/21） were gray white and fishy solid masses, and 42.9% （9/21） lesions were associated with cystic changes. Conclusions The clinical and ultrasonic manifestations of PFGSL are related to the invasion site of PFGSL, and B-cell-derived tumors account for the majority of PFGSL. The ultrasound images of PFGSL have certain characteristics and may provide a reference for the diagnosis and treatment of the disease.