原发性乳腺淋巴瘤的临床病理学及影像学特征

Clinicopathological and imaging characteristics of primary breast lymphoma

目的 :分析原发性乳腺淋巴瘤患者的临床病理学及影像学特征。方法 :回顾性分析2011年1月—2017年10月四川大学华西医院收治的原发性乳腺淋巴瘤患者的临床及影像学资料,对其乳腺病灶的临床病理特征及钼靶、B型超声和PET-CT检查的影像学特征进行总结及分析。结果 :本研究共纳入53例患者,70处病灶。其中女性52例(98.11%),中位年龄为48岁。霍奇金淋巴瘤和非霍奇金淋巴瘤分别为2例(3.77%)和51例(96.23%)。非霍奇金淋巴瘤中,弥漫性大B细胞淋巴瘤33例(62.26%),B细胞淋巴瘤5例(9.43%),结外鼻型自然杀伤(naturalkiller,NK)/T细胞淋巴瘤5例(9.43%),套细胞淋巴瘤2例(3.77%),滤泡细胞淋巴瘤2例(3.77%),T淋巴母细胞淋巴瘤2例(3.77%),间变性大细胞淋巴瘤1例(1.89%),浆细胞淋巴瘤1例(1.89%)。各病理亚型病灶最大横径及病灶数目差异均无统计学意义(P值均> 0.05)。钼靶检查发现病灶多表现为高密度、边界模糊的不规则肿块;B型超声检查发现病灶常表现为低回声、边界清晰、形状不规则的肿块;PET-CT检查发现病灶常表现为单发或多发的边界清晰的不规则状乳腺内肿块。钼靶、PET-CT和B型超声检查将乳腺病灶分为乳腺影像报告和数据系统(breast imaging-reporting and data systems,BI-RADS)4级或5级的百分比分别为100%、94.50%和86.10%。结论 :原发性乳腺淋巴瘤具有独特的临床病理学特征,其影像学表现复杂多样。PET-CT检查对原发性乳腺淋巴瘤的BI-RADS分级有较高的诊断价值。

Objective: To assess the clinicopathological and radiological imaging characteristics of patients with primary breast lymphoma.Methods: The clinical and imaging data of patients diagnosed with primary breast lymphoma in West China Hospital of Sichuan University from January 2011 to October 2017 were retrospectively analyzed. The imaging modalities were assessed by mammography, B-ultrasound and PET-CT. The clinicopathological features and radiological imaging characteristics of breast lesions were summarized and analyzed.Results: The fifty-three patients with 70 intramammary lesions were contained in this research. Most patients were females(n=52, 98.11%), and the median age was 48 years old. Primary breast lymphoma were divided into non-Hodgkin lymphoma(NHL)(n=51, 96.23%) and Hodgkin lymphoma(HL)(n=2, 3.77%). Among the patients with NHL, there were 33 cases(62.26%) of diffuse large B-cell lymphoma, 5 cases(9.43%) of B-cell lymphoma, 5 cases(9.43%) of extranodal natural killer(NK)/T-cell lymphoma(nasal type), 2 cases(3.77%) of mantle cell lymphoma, 2 cases(3.77%) of follicular cell lymphoma, 2 cases(3.77%) of T-lymphoblastic lymphoma, 1 case(1.89%) of anaplastic large cell lymphoma, and 1 case(1.89%) of plasmacytic lymphoma. There was no statistical difference(all P>0.05) in the maximum transverse diameter and the number of lesions among the pathological subtypes. The mammography showed that the most common manifestations were high density irregular lumps with indistinct edges. B-ultrasound showed that the lessions were presented as the irregular masses with hypoechoic pattern and circumscribed margins. PET-CT showed the majority of lesions were solitary or multiple intramammary masses with irregular shape and circumscribed margins. The percentages of lesions classified by mammography, PET-CT and B-ultrasound as breast imaging-reporting and data systems(BI-RADS) 4-5 were 100%, 94.50% and 86.10%, respectively.Conclusion: The imaging manifestations of primary breast lymphoma are varied and unique. PET-CT has good diagnostic value for the BI-RADS classification of primary breast lymphoma.