原发性结外弥漫性大B细胞淋巴瘤的CT表现及误诊分析

Analysis of CT Findings and Misdiagnosis of Primary Extra-nodal Diffuse Large B-cell Lymphoma

目的 探讨原发性结外弥漫性大B细胞淋巴瘤的CT影像表现,总结CT误诊原因及其防范措施。方法 回顾性分析2019年1月—2021年12月收治的经手术或穿刺活检确诊为结外弥漫性大B细胞淋巴瘤8例的临床及CT影像资料。结果 8例中咽痛伴异物感和上腹部隐痛各2例,腰部隐痛、颈部肿胀并疼痛、右鼻闭塞伴右耳听力下降、低热并双下肢水肿各1例。首诊CT误诊6例,误诊为鼻咽癌、扁桃体区神经源性肿瘤、桥本甲状腺炎、脾脏转移瘤、结肠癌及胰腺癌各1例;另有2例首诊CT确诊。误诊时间1~7 d。所有患者术后病理证实均为弥漫性大B细胞淋巴瘤,给予相应治疗后均预后良好。结论 原发性结外弥漫性大B细胞淋巴瘤临床表现缺乏特异性,CT影像表现具有的共性特征对本病有重要的诊断和鉴别诊断价值,确诊需病理学检查。

Objective To explore CT findings in detecting primary extra-nodal diffuse large B-cell lymphoma(DLBCL),and to summarize causes of CT misdiagnosis and provide preventive measures.Methods The clinical and CT imaging data of 8 patients with extranodal DLBCL diagnosed by operation or biopsy from January 2019 to December 2021 were retrospectively analyzed.Results Of 8 patients,there were 2 cases of sore throat with foreign body sensation and dull pain in upper abdomen respectively,and 1 case of lower back pain,neck swelling and pain,right nose occlusion with hearing loss in right ear,and low fever and edema in both lower limbs,respectively.Six patients were initially misdiagnosed by CT as nasopharyngeal carcinoma(n=1),tonsil neurogenic tumor(n=1),Hashimoto thyroiditis(n=1),splenic metastasis(n=1),colon cancer(n=1)and pancreatic cancer(n=1).Another 2 patients were confirmed by CT at initial diagnosis.Misdiagnosis lasted from 1 to 7 d.All patients were pathologically confirmed to have DLBCL,and were given corresponding treatment,with good prognosis.Conclusion Primary extra-nodal DLBCL lacks specificity in clinical manifestations,and CT imaging manifestations have certain common features that have important diagnostic and differential diagnostic values for this disease,and confirmation of the diagnosis relies on pathological examination.