艾滋病非霍奇金淋巴瘤CT表现及误诊原因分析

Analysis of CT Manifestations and Misdiagnosis Causes of AIDS Non-Hodgkins Lymphoma

目的:探讨伴淋巴结肿大的艾滋病非霍奇金淋巴瘤(non-Hodgkin lymphoma,NHL)CT表现及误诊原因,提高对NHL的CT诊断及鉴别诊断水平。方法:回顾性分析2017年5月至2020年10月南宁市第四人民医院首诊为NHL并淋巴结肿大、且经病理学确诊患者的CT表现,对照病理学检查及CT随访分析NHL的CT表现特点及误诊原因。结果:首诊NHL伴淋巴结肿大并病理学检查患者共98例,其中NHL 70例,首诊误诊病例淋巴结转移瘤(lymph node metastasis,LNM)9例,马尔尼菲蓝状菌病淋巴结炎(Talaromyces marneffei lymphadenitis,TML)13例,淋巴结结核(Tuberculous lymphadenitis,TL)6例。NHL患者发热较TML、TL少见,差异具有统计学意义(χ^(2)=28.671,P<0.001、Fisher精确检验,P=0.020);NHL患者乏力较TML少见,差异具有统计学意义(χ^(2)=15.744,P<0.001)。NHL患者CD4+T淋巴细胞计数通常较TML患者高,差异具有统计学意义(H=43.654,P<0.001)。NHL易累及浅表淋巴结(颈部、锁骨上窝、腋窝、腹股沟),结外组织易累及肝脏、回/结肠、脾脏、肾上腺等部位。NHL平扫以均匀软组织密度多见(40/70,54.14%),与TML、TL平扫密度存在差异(χ^(2)=10.227,P=0.006;χ^(2)=12.502,P=0.002);NHL最大淋巴结长径通常较TML、TL大,差异具有统计学意义(H=36.726,P<0.001;H=32.290,P=0.008);NHL最大淋巴结短径通常较TML、TL大,差异具有统计学意义(H=37.329,P<0.001;H=24.829,P=0.040)。此外增强扫描病例中NHL患者出现血管漂浮征或者三明治征9例(9/38,23.68%),较TML患者常见(2/7,28.57%),差异具有统计学意义(χ^(2)=34.605,P<0.001)。结论:艾滋病NHL具有一定特征CT表现,结合临床表现及实验室检查、完善影像学检查有助于NHL与LNM、TML、TL的鉴别诊断。

Objective:To explore the CT manifestations and misdiagnosis causes of AIDS non-Hodgkin lymphoma(NHL)with enlarged lymph nodes,and to improve the CT diagnosis and differential diagnosis level of NHL.Methods:The CT mainifestations of patients first diagnosed with NHL and lymph node enlargement in the Fourth Peoples Hospital of Nanning eity from May 2017 to October 2020 were retrospectively analyzed,The CT manifestations of NHL and the causes of diagnose and misdiagnosis were analyzed according to pathological examination and CT follow-up.Results:A total of 98 patients with NHL were first diagnosed with lymph node enlargement and pathological examinaion,including 70 cases with NHL and 9 cases with misdiagnosed Lymphnode metastasis(LNM),Talaromyces Marneffei Lymphadenitis(TML)was 13 cases,Tuberculous Lymphadenitis(TL)was 6 cases.Fever was less common in NHL patients than in TML and TL patients,and the diference was saistically significant(χ^(2)=28.671,P<0.001,Fishers exact test,P=0.020).Fatigue was less common in NHL patients than in TML,and the difference was stitically significant(χ^(2)=15.744,P<0.001).CD4^(+)T lymphocyte counts in NHL patients were generally higher than those in TML patients,and the difference was statistically significant(H=43.654,P<0.001).NHL is prone to involve superficial lymph nodes(neck,supraclavicular fossa,axilla and groin),and extranodal tssues are prone to involve liver,ileum colon,spleen,adrenal gland and other parts.NHL plain scan showed more uniform soft tissue density(40/70,54.14%)than TML and TL plain scan(χ^(2)=10.227,P=0.006,χ^(2)=12.502,P=0.002).The maximum lymph node lengh of NHL was usually larger than that of TML and TL,and the difference was satistitally significant(H=36.726,P<0.001,H=32.290,P=0.008).The minimum width of maximum lymph node of NHL was usually larger than that of TML and TL,and the difference was statistically significant(H=37.329,P<0.001,H=24.829,P=0.040).In addition,9 cases(9/38,23.68%)of NHL patients presented vascular floating sign or sandwich sign,which was more common than that of TML patients(2/7,28.57%),and the difference was statistically significant(χ^(2)=34.605,P<0.001).Conclusion:AIDS complicated with NHL had some characteristic CT manifestations,combining clinical manifestations,laboratory examination and Improved imaging examination were helpful for differential diagnosis of NHL with LNM,TML and TL.