原发性肺黏膜相关淋巴组织淋巴瘤的临床和影像学表现

Clinical and Radiological Features of Pulmonary Mucosa-associated Lymphoid Tissue Lymphoma

目的探讨原发性肺黏膜相关淋巴组织淋巴瘤(primary pulmonary mucosa-associated lymphoid tissue lymphoma,PPMALT)的临床和影像学表现,提高对该疾病的认识及诊断水平。方法回顾性收集2011年4月至2023年3月通过组织活检和病理确诊的PPMALT患者。观察临床指标包括年龄、性别、吸烟史、实验室检查等。接受胸部CT检查的患者,记录病灶的数量、部位、形态、边缘、密度、强化程度等。根据影像学表现分为五种亚型:结节肿块型;肺炎实变型;支气管血管淋巴管型;粟粒型;混合型。接受全身18F-FDG PET/CT检查的患者,记录病灶的代谢情况。结果共纳入15例PPMALT患者,男7例,女8例;年龄37~70岁,平均年龄(56.3±9.6)岁。影像学表现为结节肿块型8例,肺炎实变型4例,支气管血管淋巴管型1例,混合型2例。10例出现空气支气管征,7例伴有支气管扩张。7例病灶边缘呈磨玻璃样改变。4例伴有胸腔积液。13例患者有CT增强检查,其中12例均匀强化,1例不均匀强化;9例轻中度强化;9例出现血管造影征。9例行全身PET/CT检查,病灶均表现为糖代谢不同程度增高,SUVmax范围为1.8~6.7,平均值为(3.8±1.9)。结论PPMALT发病率低,临床表现缺乏特异性。胸部CT影像学表现如空气支气管征、支气管扩张征、边缘磨玻璃密度影、增强扫描血管造影征和轻中度均匀强化等有助于鉴别诊断。

Objective To investigate the clinical and imaging features of primary pulmonary mucosa-associated lymphoid tissue lymphoma(PPMALT)to improve the level of awareness and diagnosis.Methods Patients with PPMALT confirmed by tissue biopsy and pathology result from April 2011 to March 2023 were collected retrospectively.Clinical indicators as age,gender,smoking history and laboratory examination were observed.Chest CT manifestations as lesion number,location,shape,margin,density,and degree of enhancement were recorded,respectively.Five subtypes were classified as nodular/mass,consolidation pneumonia,bronchial vascular lymphatic,miliary and mixed type according to CT findings.The SUVmax of the lesion was measured in patients who underwent 18F-FDG PET/CT examination.Results A total of 15 patients with PPMALT were included finally(7 males and 8 females;average age,56.3±9.6 years;age range:37~70 years).There were 8 cases in nodular/mass type,4 cases in consolidation pneumonia type,1 case in vascular broncholymphatic type,and 2 cases in mixed type.Air bronchial sign were identified in 10 cases and bronchiectasis were showed in 7 cases.Ground glass opacity on the edge of the lesion was presented in 7 cases.4 cases were accompanied by pleural effusion.CT enhancement was performed in 13 patients,12 cases with homogeneous enhancement and 1 case with heterogeneous enhancement.9 cases showed mild to moderate enhancement.Angiographic signs were found in 9 cases.9 patients underwent PET/CT examination and all lesions showed various increased metabolism(SUVmax average:(3.8±1.9);range:1.8~6.7).Conclusion The incidence of PPMALT is low and the clinical manifestations lack specificity.Chest CT imaging findings such as air bronchial sign,bronchiectasis sign,edge ground glass density shadow,angiography and mild to moderate homogeneous enhancement are helpful for differential diagnosis.