原发性肝脏淋巴瘤的CT表现

CT features of primary hepatic lymphoma

目的：结合文献对原发性肝脏淋巴瘤的CT表现、实验室检查及临床特点进行讨论、分析，以提高其术前诊断的准确率。方法：回顾性分析4例经病理证实的原发性肝脏淋巴瘤的CT表现、实验室检查及临床特点，总结其诊治要点。结果：4例病例中，女性2例，男性2例，发病年龄61~73岁（中位年龄65岁）。其中2例患者无明显症状而在体检时发现，其余2例患者以上腹部不适为首发症状。病灶体积较大，最大径从4.9~17.1cm不等。CT平扫肝脏病灶均呈均匀低密度，边界尚清，CT增强病灶未见明显强化，其内见小片状低密度未强化区，动脉期肿块内可见强化的血管走行影，但无明显受侵征象。4例均为B细胞型非霍奇金淋巴瘤（弥漫大B细胞淋巴瘤3例，肝脏黏膜相关性淋巴瘤1例），且均表现为单发肿块型。结论：肝脏淋巴瘤临床特点大多不具有典型性，但CT表现为较大的软组织低密度肿块，无明显强化，其内可见“血管漂浮征”是较为特征性的表现，诊断肝脏原发性淋巴瘤之前，需排除其他部位淋巴瘤肝脏浸润。

Objective: This study reviewed and analyzed the CT features, relative laboratory tests and clinical symptoms of primary hepatic lymphoma to improve the accuracy of preoperative diagnosis. Methods: Four primary hepatic lymphoma cases with pathological confirmation were retrospectively analyzed in terms of their CT features, laboratory tests and clinical symptoms y. Results: In the 4 cases(2 females and 2 males), aged from 61-73 (median age 65 years old), 2 patients had abdominal pain, and the other 2 had no obvious discomfort during physical exam. The size of the lesion was large with the maximum diameter ranged from 4.9—17.1 cm. The abdominal CT showed homogeneous low density and clear boundary, and poor enhancement after contrast. In the arterial phase, the uninvaded vascularity in the tumors were observed. All cases were B-cell non-Hodgkin's lymphoma type, including 3 diffuse large B cell lymphomas, and 1 hepatic mucosa-associated lymphoid tissue (MALT) lymphoma, in which all cases appeared as solitary mass type. Conclusions: The clinical features of hepatic lymphoma are not typically presented in these cases. The CT showed uniform density and poor enhancement. The uninvaded vascularity observed in the tumors is a typical feature of primary hepatic lymphoma.