原发性骨淋巴瘤影像学表现与病理特征
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摘要
目的:探讨总结原发性骨淋巴瘤的影像学表现及病理特征,以提高其诊断准确性。方法:回顾性分析2012年1月至2017年12月经病理证实的21例原发性骨淋巴瘤患者的X线片,CT,MRI及SPECT的影像学资料,仔细复习其影像学征象并与病理特征作参照。结果:21例患者,单发18例,多发3例。单发18例中,椎骨6例,股骨4例,肱骨及髂骨各2例,肋骨、腓骨、尺骨、肩胛骨各1例。多发3例中,多节段椎骨1例,累及椎骨、髂骨1例,累及下颌骨、股骨、胫骨、左腕骨及双足跗骨1例。X线和CT显示溶骨型19例,混合型2例,病理骨折11例,有明显的软组织肿块11例。MRI检查9例,信号均匀7例,信号不均匀2例;病灶T1WI呈等信号或稍低信号,T2WI呈稍高信号2例、高信号7例。MRI增强扫描7例,肿瘤不均匀强化3例,均匀强化4例。SPECT显像8例,病灶均表现为核素异常浓聚。病理类型均为弥漫性非霍奇金淋巴瘤,其中B细胞19例,T细胞2例。结论:原发性骨淋巴瘤可发生于全身骨骼各个部位,有一定影像学特征,综合应用多种影像学检查可增加病变显示的信息量,但最终确诊仍需要病理学检查。
Objective:To summarize the imaging and pathological features of primary bone lymphoma(PBL), in order to improve its diagnostic accuracy.Methods:The imaging data of 21 cases with PBL confirmed by pathology were retrospectively analyzed and compared with corresponding pathological results.Results:Of these 21 cases, single bone involved in 18 cases and multiple bones involved in 3 cases.Of these 18 cases, 6 cases involved in vertebrae, 4 cases of femurs, 2 cases of humerus and iliums respectively, 1 case of ulnar, rib, tibia and scapular respectively.Of these 3 cases, 1 cases involved in vertebrae, 1 case vertebrae and ilium,1 case mandible, femur, tibia, left carpal bone and bilateral tarsal.X-ray and CT showed osteolytic destruction type in 19 cases, mixed destruction type in 2 cases, pathological fracture in 11 cases, obvious soft tissue mass in 11 cases.MRI examination in 9 cases showed homogeneous signal in 7 cases, heterogeneous signal in 2 cases, isointense signal on T1 WI in 2 cases, high signal on T2 WI in 7 cases.Enhanced scanning in 7 cases, 3 cases of tumor showed nonuniform enhanced, 4 cases uniform enhanced.SPECT imaging in 8 cases, the cases showed abnormal concentration of nuclides.Pathological types were diffuse non-Hodgkin's lymphoma, including 19 cases of B cells, 2 cases of T cells.Conclusion:PBL can occur in all parts of the body skeleton, imaging features have some characteristics, comprehensive application of a variety of imaging can fully display the disease, but the final diagnosis still requires pathological examination.
Objective:To summarize the imaging and pathological features of primary bone lymphoma(PBL), in order to improve its diagnostic accuracy.Methods:The imaging data of 21 cases with PBL confirmed by pathology were retrospectively analyzed and compared with corresponding pathological results.Results:Of these 21 cases, single bone involved in 18 cases and multiple bones involved in 3 cases.Of these 18 cases, 6 cases involved in vertebrae, 4 cases of femurs, 2 cases of humerus and iliums respectively, 1 case of ulnar, rib, tibia and scapular respectively.Of these 3 cases, 1 cases involved in vertebrae, 1 case vertebrae and ilium,1 case mandible, femur, tibia, left carpal bone and bilateral tarsal.X-ray and CT showed osteolytic destruction type in 19 cases, mixed destruction type in 2 cases, pathological fracture in 11 cases, obvious soft tissue mass in 11 cases.MRI examination in 9 cases showed homogeneous signal in 7 cases, heterogeneous signal in 2 cases, isointense signal on T1 WI in 2 cases, high signal on T2 WI in 7 cases.Enhanced scanning in 7 cases, 3 cases of tumor showed nonuniform enhanced, 4 cases uniform enhanced.SPECT imaging in 8 cases, the cases showed abnormal concentration of nuclides.Pathological types were diffuse non-Hodgkin's lymphoma, including 19 cases of B cells, 2 cases of T cells.Conclusion:PBL can occur in all parts of the body skeleton, imaging features have some characteristics, comprehensive application of a variety of imaging can fully display the disease, but the final diagnosis still requires pathological examination.
引文
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[14] 刘嘉辰,林笑丰,李敬彦,等.(99m)Tc-MDP SPECT/CT融合骨显像在恶性肿瘤骨转移诊断和治疗决策中的作用[J].实用医学杂志,2017,33(8):1331-1334.
[2] 吴枕戈,郑汉朋,邱乾德.原发性骨淋巴瘤影像表现[J].中国临床医学影像杂志,2016,27(6):431-434.
[3] FLETCHER C D M,UNNI K K,MERTENS F.Pathology and genetics of tumours of soft tissue and bone[M]//World Health Organization Classification of Tumours.Lyon:IARC Press,2002:194-198.
[4] 范娇娇,催建玲.原发性骨淋巴瘤的临床、病理及影像研究进展[J].国际医学放射学杂志,2016,39(2):171-174.
[5] 曾静,曲芃芃,庞青松,等.40例原发性骨淋巴瘤的预后分析及分期探讨[J].中华放射肿瘤学杂志,2016,25(8):843-846.
[6] SUN Y,LIU X,PAN S,et al.Analysis of imaging characteristics of primary malignant bone tumors in children[J].Oncol Lett,2017,14(5):5801-5810.
[7] DUARTE N,GUILHERME S,MARUAN H,et al.The role of magnetic resonance imaging in the evaluation of bone tumours and tumour-like lesions[J].Insights Imaging,2014,5(4):419-440.
[8] GAUDIO F,PEDOTE P,NICCOLI A A,et al.Bone involvement in Hodgkin's lymphoma:clinical features and outcome[J].Acta Haematol,2018,140(3):178-182.
[9] ALVI H M,DAMRON T A.Prophylactic stabilization for bone metastases,myeloma,or lymphoma:do we need to protect the entire bone?[J].Clin Orthop Rela Res,2013,471(3):706-714.
[10] ZEKRY K M,YAMAMOTO K,HAYASHI A,et al.Primary lymphoma of the pelvis:a case report[J].J Orthop Case Rep,2017,7(6):6-9.
[11] 李慧燕,郑泽宇,许乙凯.前列腺疾病的多参数磁共振成像[J].实用医学杂志,2016,32(4):624-626.
[12] TROUT A T,SHARP S E,ANTON C G,et al.Spondylolysis and beyond:value of SPECT/CT in evaluation of low back pain in children and young adults[J].Radiographics,2015,35(3):819-834.
[13] KHULOOD S A R,SULIMAN M A,ZIAUDDIN Z S,et al.Evaluation and identification of lumbosacral transitional vertebra causing intractable low back pain utilizing bone single-photon emission tomography with computed tomography[J].World J Nucl Med,2017,16(4):328-330.
[14] 刘嘉辰,林笑丰,李敬彦,等.(99m)Tc-MDP SPECT/CT融合骨显像在恶性肿瘤骨转移诊断和治疗决策中的作用[J].实用医学杂志,2017,33(8):1331-1334.