获得性免疫缺陷综合征相关淋巴瘤的影像与病理对照研究

Comparative study of imaging and pathology of acquired immune deficiency syndrome-related lymphoma

目的比较不同病理类型的获得性免疫缺陷综合征(AIDS)相关淋巴瘤(ARL)的电子计算机断层扫描(CT)和磁共振(MR)影像特征。方法收集首都医科大学附属北京地坛医院2008年1月1日～2018年10月1日ARL确诊患者,对确诊时的临床资料和影像资料进行回顾性分析,为横断面调查研究。确诊经穿刺或手术病理证实。结果收集ARL患者共83例,其中弥漫大B细胞淋巴瘤(DLBCL)患者48例(57.8%)[包括未分型17例,生发中心(GC)18例,非生发中心(NGC)13例],Burkitt淋巴瘤(BL)患者23例(27.7%),其他少见类型淋巴瘤患者12例(14.5%)。根据以上病理类型分为3组:DLBCL组、BL组和其他类型组。BL组患者CD4+T细胞计数中位数为201个/μl,高于DLBCL组患者(78个/μl)和其他类型组(74个/μl),差异均有统计学意义(χ~2=6.603,P=0.037)。HIV载量(χ~2=0.396,P=0.820)、AIDS病程(F=1.342、P=0.267)及是否ART治疗(χ~2=3.084、P=0.544)在不同病理类型患者间差异均无统计学意义。结内和头部ARL最常见,其次为消化道(以胃和小肠多见)、肝脏,不同病理类型患者间差异无统计学意义(χ~2=0.083、P=0.959)。结内病变形态以结节、肿块为主,头部病变为环形强化,消化道可见"假性动脉瘤样"扩张且不伴肠梗阻征象,而实质脏器病变多数不伴血管受侵、瘤栓。Ann Arbor分期1期患者20例(31.7%),2期患者14例(22.2%),3期患者8例(12.7%),4期患者21例(33.3%),不同病理类型患者的Ann Arbor分期间差异无统计学意义(χ~2=4.948、P=0.547)。Ki67(+)≥90%患者在DLBCL组(8例、21.1%)和BL组(12例、31.6%)中例数均高于其他类型组(χ~2=6.016、P=0.049),但DLBCL组和BL组患者Ki67阳性率构成比差异无统计学意义(χ~2=2.440、P=0.118)。结内淋巴瘤患者Ki67阳性率与影像所见肿块坏死范围、肿块大小无相关性(Spearman相关系数R=0.224、0.059,P=0.199、0.857)。结论不同病理类型的AIDS相关淋巴瘤同一部位的影像表现类似,结内淋巴瘤Ki67阳性率不能预测影像所见肿块大小和坏死范围。

Objective To compare the imaging characteristics of computed tomography(CT)and magnetic resonance imaging(MR)of acquired immune deficiency syndrome(AIDS)associated lymphoma(ARL)with different pathological types.Methods Patients with ARL were collected from Beijing Ditan Hospital,Capital Medical University from January 1st,2008 to October 1st,2018.The clinical data and imaging data were analyzed by cross-sectional investigation,retrospectively.Diagnosis is confirmed by puncture or surgery.Results A total of 83 cases with ARL were collected,including 48 cases(57.8%)with diffused large B cell lymphoma(DLBCL)[(17 cases unclassified,18 cases with germinal center(GC),13 cases with nongerminal center(NGC)].There were 23 cases(27.7%)with Burkitt lymphoma(BL)and 12 cases(14.5%)with other rare types of lymphoma.Patients were divided into three groups according to pathological types:DLBCL group,BL group and other types group.The median CD4^+T cell count of patients in BL group was 201 cells/μl,which was significantly higher than that of DLBCL group(78 cells/μl)and other types(74 cells/μl)(χ^2=6.603,P=0.037).There was no significant difference among the patients with different pathological types in viral load of HIV(χ^2=0.396,P=0.820),AIDS course(F=1.342,P=0.267)and whether or not taking ART therapy(χ^2=3.084,P=0.544).Lymph node and cerebral forms of ARL was the most common,followed by digestive tracts(stomach and small intestine)and liver,but there was no significant difference among patients with different pathological types(χ^2=0.083,P=0.959).Nodules or masses were the main forms in lymph node,and head lesions were ring enhancement.“Pseudoaneurysm like”dilatation was seen in digestive tract without intestinal obstruction,while parenchymal visceral lesions were not accompanied by vascular invasion and tumor embolus.According to Ann Arbor 4-stage classification:there were 20 cases(31.7%)of Ann Arbor stage 1,14 cases(22.2%)of stage 2,8 cases(12.7%)of stage 3,21 cases(33.3%)of stage 4.There was no significant difference in Ann Arbor scores between patients with different pathological types(χ^2=4.948,P=0.547).The number of patients with Ki67(+)≥90%in DLBCL group(8 cases,21.1%)and BL group(12 cases,31.6%)were significantly higher than that of other groups(χ^2=6.016,P=0.049).There was no significant difference in Ki67 positive ratio between DLBCL group and BL group(χ^2=2.440,P=0.118).There was no correlation between the positive rate of Ki67 with tumor necrosis and tumor size(Spearman correlation coefficient R=0.224,0.059;P=0.199,0.857).Conclusions The imaging findings of different pathological types of ARL are similar and the positive rate of Ki67 could not predict the size and necrotic extent of the tumor.