原发性肾上腺淋巴瘤的CT征象及误诊分析

CT findings and Misdiagnosis Analysis of Primary Adrenal Lymphoma

目的探讨原发性肾上腺淋巴瘤(PAL)的CT表现特征,提高诊断准确率。方法回顾性分析经病理证实的10例PAL患者的影像资料,并结合相关文献复习。结果 10例(3例单发,7例双发)共17个病灶,最大径均为上下径(3.6~14.7cm),其中3个病灶上下径≤4.5cm,均表现为肾上腺肿大且保持原有轮廓,密度均匀,增强扫描呈轻度均匀强化,均不伴有淋巴结肿大,1例误诊为肾上腺增生。14个病灶上下径>4.5cm,呈类圆形或不规则状肿块,8个密度均匀,10个边界清晰,8个病灶冠面呈"三角形",10个与脊柱缘平直且不引起骨质破坏,10个包绕血管,但未引起血管狭窄;10个不伴有附近淋巴结肿大,4个伴有同侧附近淋巴结肿大;增强扫描:轻度强化11个,中度强化3个,6个病灶内可见条索状强化;1例误诊为肾上腺皮质癌,1例误诊为转移瘤。结论 PAL影像学具有一定特征,当其表现不典型(体积较小、密度/强化不均、边界不清等)时,容易引起误诊,应引起临床重视。

Objective To investigate the CT features of primary adrenal lymphoma(PAL)and improve the diagnostic accuracy.Methods The imaging data of 10 patients with PAL confirmed by pathology were retrospectively analyzed,and the related literature was reviewed.Results A total of 17 lesions were found in 10 cases(3 cases were single and 7 cases were double),with the maximum diameter of upper and lower diameter(3.6 to 14.7 cm),and the upper and lower diameter of 3 lesions≤4.5 cm.All the lesions showed adrenal enla rgement with the original contour and uniform density.The enhanced scan showed mild uniform enhancement without lymph node enlargement.The upper and lower diameter of 14 lesions was>4.5 cm,presenting quasi-circular or irregular masses.8 lesions had uniform density,10 lesions had a clear bounda ries,8 lesions had"t riangle"coronal su rface,10 lesions we re straight with the spinal ma rgin and did not cause bone destruction,10 lesions surrounded blood vessels but did not cause vascular stenosis.10 lesions were not associated with peripheral lymph node enlargement and4 lesions were associated with ipsilateral lymph node enlargement.Contrast-enhanced scan showed11 lesions of mild enhancement,3 lesions of moderate enhancement,and cord-like enhancement in6 lesions.One case was misdiagnosed as adrenal cortical carcinoma,and one case was misdiagnosed as a metastatic tumor.Conclusion The imaging of PAL has specific cha racteristics,and when its atypical manifestations(small volume,uneven density/enhancement,unclear boundary,etc.),it is easy to ca use misdiagnosis,which should be paid more attention to in clinic.