腹部巨淋巴结增生症患者CT影像学特征及诊断价值

CT imaging characteristics and their diagnostic value in patients with abdominal Castleman's disease

目的探究腹部巨淋巴结增生症(CD)患者计算机断层扫描(CT)的影像学特征及诊断价值。方法回顾性分析延安市人民医院经手术或穿刺活检证实为腹部CD的80例患者的CT影像学表现,与病理结果进行对比,分析其表现特征。结果80例患者中男性12例,女性68例,年龄18~60岁,平均(37.15±3.01)岁;48例(60.00%)肿瘤位于腹膜后腔,16例(20.00%)位于上腹腔内,10例(12.50%)位于肝门与腔静脉之间;6例(7.50%)位于腹盆腔交界区域,平均肿瘤大小为47.5 mm×38.6 mm。本组病例有透明血管型60例,浆细胞型13例,混合型7例;所有患者肿块均边界清晰,形态相对较为规则,其中豌豆形40例,椭圆形32例,多发小结节型8例,3例显示均匀强化,14例伴有钙化。CT平扫结果显示72例患者表现为单发肿块,主要是局灶肿块型;8例患者表现为多发小结节,主要为多发结节型;57例密度均匀,23例密度不均匀,病灶内可见点状、弧形、分支状或放射状钙化影。结论腹部巨淋巴结增生症较为少见,以局灶型CD为主,常见为单发强化肿块,肿块边缘光滑,密度均匀,肿块内可见各类型钙化,有一定影像学特征;发现腹部单发强化肿块应考虑该疾病,避免误诊、漏诊。

Objective To explore the imaging characteristics of computed tomography(CT)and their diagnostic value in patients with abdominal Castleman's disease(CD).Methods CT imaging findings of 80 patients with abdominal CD confirmed by surgery or biopsy at Yan'an People's Hospital was retrospectively analyzed,and the findings were compared with pathological results to analyze their characteristics.Results Among the 80 patients,there were 12 males and 68 females,aged 18-60 years old,with an average age of(37.15±3.01)years.There were 48 cases(60.00%)of tumors located in the retroperitoneal cavity,16 cases(20.00%)located in the upper abdominal cavity,6 cases(7.50%)located in the abdominal pelvic junction area,with an average tumor size of 47.5 mm×38.6 mm.There were 60 cases with hyaline vascular type,13 cases with plasmocyte type,and 7 cases with mixed type.The boundary of all lumps was clear,and their shape was relatively regular.In the 80 patients,there were 40 cases with pea shape,32 cases with oval shape,and 8 cases with multiple small nodule shape.There were 3 cases with uniform enhancement and 14 cases with calcification.The results of CT plain scan showed that there were 72 cases with single lump(mainly on focal lump type)and 8 cases with multiple small nodules(mainly on multiple nodule type).There were 57 cases with uniform density and 23 cases with uneven density.There were punctate,arc-shaped,branched or radial calcification shadows in lesions.Conclusion Abdominal CD is rare,mainly on focal type.It is usually a single enhanced lump with smooth edge and uniform density.There is various types of calcification in lumps,with certain imaging characteristics.CD should be considered when there are abdominal single enhanced lumps,in order to avoid misdiagnosis or missed misdiagnosis.