泪腺良性淋巴上皮病彩色多普勒超声及临床特征分析

Color Doppler ultrasonography and clinical characteristics of benign lymphoepithelial disease of lacrimal gland

目的总结泪腺良性淋巴上皮病(benign lymphoepithelial disease,BLL)的彩色多普勒超声特征及临床表现,提高泪腺BLL的诊断准确性。方法回顾性分析2014年11月至2019年8月就诊于河北医科大学第二医院的16例泪腺BLL患者(共31个病灶)的临床表现及声像图特征。结果病程<3个月的患者病灶内散在不规则低回声,且血流信号较丰富(AdlerⅡ级),病理结果提示泪腺基质可见较多淋巴细胞及泪腺导管的肌上皮增长形成上皮-肌上皮岛。病程3~6个月的患者超声表现为病灶内多个弥漫等大类圆形低回声,呈"蜂窝状"改变,病变内大量血流信号(AdlerⅢ级),病理结果提示泪腺基质内大量淋巴细胞及上皮-肌上皮岛,与病程<3个月的患者比较淋巴细胞明显增多。病程>6个月的患者超声表现除病灶内多个等大类圆形低回声外,还有较大的低回声,长径超过3 mm,彩色多普勒同样显示病变内大量血流信号(AdlerⅢ级),病理结果与病程3~6个月患者一致。1例患者结核菌素试验阳性,11例患者血清IgG4值较正常升高。随着病程延长,病灶内淋巴细胞数量增多。结论掌握泪腺BLL的彩色多普勒超声特点,同时参考患者血清IgG4水平,可提高超声诊断的准确率。

Objective To summarize the clinical manifestations and color Doppler ultrasonography of benign lymphoepithelial disease(BLL)in lacrimal gland,so as to improve the diagnostic accuracy of lacrimal BLL.Methods Clinical manifestations and color Doppler flow imaging(CDFI)features of lacrimal BLL in 16 patients(2 males and 14 females,with 31 lesions)who visited the Second Hospital of Hebei Medical University from November 2014 to August 2019 were retrospectively analyzed.Results The performance for lesions in patients with duration less than 3 months was scattered in irregular low echo,lesion blood flow signals within the rich(AdlerⅡlevel),pathologic examination results showed more lymphocytes were seen in the lacrimal matrix,and the myoepithelium of the lacrimal duct grew to form the epithelium-myocutaneous island.The ultrasonic feasures in patients with course of 3-6 months were in multiple categories such as circular low echo,"honeycomb"change,CDFI showed lesions with a lot of blood flow signals(AdlerⅢlevel),the pathological examination results indicated that there were a large number of lymphocytes and epithelial-musculocutaneous islands in the lacrimal matrix,and the lymphocytes were significantly increased compared with patients with the course of disease less than 3 months.The ultrasound results in patients with a course of more than 6 months showed lesions in multiple categories such as circular low echo,and large low echo,greater than 3 mm in diameter,CDFI showed lesions within the same large amounts of blood flow signals(AdlerⅢlevel),the pathological examination results were consistent with the course of 3 to 6 months.One patient had positive tuberculin test and 11 had higher IgG4 than normal.The number of lymphocytes increased with the prolongation of disease course.Conclusions With the expert knowledge of color Doppler ultrasonographic characteristics of lacrimal gland BLL and with the serum IgG4 level helps to improve the accuracy of ultrasonic diagnosis.