原发性乳腺恶性淋巴瘤X线MR表现分析

目的探讨原发性乳腺恶性淋巴瘤(PBL)的影像学表现,以提高对该少见疾病的认识.方法回顾性分析20例经病理证实的PBL患者资料,20例均行乳腺MR平扫及动态增强扫描检查,其中15例行乳腺X线检查.20例患者均为女性,年龄34~73岁,中位年龄45岁.对肿瘤的部位、大小、形态、边缘、密度、信号及强化形式进行分析.结果20例患者中,单侧17例,双侧3例;单发15例,双发3例,多发2例,共27个病灶;肿瘤最大径1.5~9.2cm,平均(5.8±0.6)cm;21个病灶呈边缘光整、类圆形或椭圆形肿块;6个呈不规则分叶状肿块,未见毛刺、皮肤增厚及乳头凹陷.与正常乳腺腺体相比,X线检查病灶呈稍高密度12个,等密度5个,所有病灶均未见明显钙化;MR平扫病灶T1WI呈等信号10个,低信号17个;脂肪抑制T2WI呈高信号;DWI均呈高信号,ADC值平均(0.90±0.07)×10^-3mm^2/s,TIC呈Ⅱ型16例,Ⅲ?型4例.增强后病灶轻度强化11个,中度强化14个,明显强化2个;均匀强化10个,稍不均匀强化17个,延迟扫描内部脑回样强化8个,边缘蛋壳样强化6个病灶,8例伴腋窝淋巴结肿大.结论PBL的影像学表现具有一定的特征性,X线、MR检查可以准确显示肿瘤累及的范围,为临床治疗提供有价值的信息.

Objective To explore the mammography and MR imaging findings of primary breast lymphoma and enhance the diagnostic level of this rare disease.Methods A retrospective analysis of the mammography(n=15)and MR(n=20)findings was performed in 20 patients(20 females,median age 45 years old)with pathologically proved PBL.Mammography and MR images were evaluated in relation to the following:location,size,morphology,margin,density,MR signal intensity and enhancement pattern.Results There were total 27 lesions in 20 patients.The maximum diameter of the lesions ranged from 1.5 to 9.2cm.Twenty-one lesions demonstrated round or oval round masses with well-defined margin,6 lesions demonstrated irregular and lobular masses without spiculation,skin thickening and nipple inversion.Compared to normal mammary gland,12 lesions manifested as slight high-density and 5 lesions manifested as isodensity.All lesions had no calcification.Lesions were isointense in 10 lesions and hypointense in 17 lesions on T1WI,hyperintense in all lesions on T2WI fat suppression sequences and DWI.The apparent diffusion coefficient(ADC)values was 0.90±0.07×10^-3 mm^2/s on average.The curve of time-signal intensity were type Ⅱ and type Ⅲ in 16 cases and 4 cases respectively.On post contrast images,lesions demonstrated mild enhancement in 11 lesions,moderate enhancement in 14 lesions and obvious enhancement in 2 lesions.10 lesions demonstrated homogeneous enhancement and 17 lesions demonstrated heterogeneous enhancement.Among them,8 lesions revealed cerebroid enhancement and 6 lesions revealed eggshell-like enhancement on delayed contrast enhancement.Enlarged axillary fossa lymphonodes were found in 8 cases.Conclusions Primary breast lymphoma has some imaging characteristics.Mammography and MR examinations can accurately demonstrate the extent of tumor involvement and are helpful to provide more comprehensive information for clinical management.