原发性眼附属器淋巴瘤的诊断及鉴别诊断
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摘要
目的搜集原发性眼附属器淋巴瘤患者的影像资料,进行影像学分析,总结其影像特点,从而提高对该疾病的认识。方法回顾性分析经手术病理证实的19例原发性眼附属器淋巴瘤患者的CT及MRI特点,其中CT检查18例,MRI检查12例,同时进行CT及MRI检查者11例。结果 19例分别位于眼睑(n=10)、泪腺(n=5)、泪囊(n=3),眼外肌(n=1)。CT表现为眼附属器高密度软组织占位,CT值50~56HU,病灶无包膜,呈匍匐铸型生长,MRI呈等T1WI、等或稍长T2WI信号,增强扫描后明显强化。CT及MRI均可显示肿瘤与周围结构的关系,眼环受累(n=3),眼外肌受累(n=6)、泪腺受累(n=4),同时累及泪腺、眼环及眼外肌(n=2),以包绕为主,占位效应不明显。结论原发性眼附属器淋巴瘤较少见,临床工作中需不断总结经验,提高认识,以减少误诊。
Objective To collect the imaging data of the patients with primary ocular adnexal lymphoma,their imaging features were analyzed and summarized,so as to improve the understanding of this disease. Methods We condueted a retrospective analysis of the CT and MRI features of 19 patients with primary ocular adnexal lymphoma who were confirmed by pathologically,in which 18 cases were examined by CT,12 by MRI,and 11 by CT and MRI at the same time. Results 19 cases were located in the eyelid(n = 10),lacrimal gland(n = 5),lacrimal sac(n = 3),and extraocular muscles(n = 1). CT showed high density soft tissue of ocular adnexal lesions,CT values were 50 ~ 56 HU,there were no capsule,the masses of creeping growth were like mold,MRI showed T1 WI equal signal,T2 WI equal signal or slightly higher signal,after the enhanced scan,the tumors were markedly enhanced. CT and MRI can show the relationship between the tumors and the surrounding structures,the eye rings were invaded(n = 3),the extraocular muscles were invaded(n = 6),the lacrimal glands were invaded(n = 4),and the lacrimal glands,eye rings and extraocular muscles were simultaneously violated(n = 2),mainly around growth,occupying effect was not obvious. Conclusion Primary ocular adnexal lymphoma is rare. In clinical work,we should constantly sum up experience and raise awareness so as to reduce misdiagnosis.
Objective To collect the imaging data of the patients with primary ocular adnexal lymphoma,their imaging features were analyzed and summarized,so as to improve the understanding of this disease. Methods We condueted a retrospective analysis of the CT and MRI features of 19 patients with primary ocular adnexal lymphoma who were confirmed by pathologically,in which 18 cases were examined by CT,12 by MRI,and 11 by CT and MRI at the same time. Results 19 cases were located in the eyelid(n = 10),lacrimal gland(n = 5),lacrimal sac(n = 3),and extraocular muscles(n = 1). CT showed high density soft tissue of ocular adnexal lesions,CT values were 50 ~ 56 HU,there were no capsule,the masses of creeping growth were like mold,MRI showed T1 WI equal signal,T2 WI equal signal or slightly higher signal,after the enhanced scan,the tumors were markedly enhanced. CT and MRI can show the relationship between the tumors and the surrounding structures,the eye rings were invaded(n = 3),the extraocular muscles were invaded(n = 6),the lacrimal glands were invaded(n = 4),and the lacrimal glands,eye rings and extraocular muscles were simultaneously violated(n = 2),mainly around growth,occupying effect was not obvious. Conclusion Primary ocular adnexal lymphoma is rare. In clinical work,we should constantly sum up experience and raise awareness so as to reduce misdiagnosis.
引文
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[10]Priego G,Majos C,Climent F,et al.Orbital lymphoma:imaging features and differential diagnosis[J].Insights Imaging,2012,3(4):337-344.
[11]周全,刘斯润,黄力,等.眶部肌锥外间隙非霍奇金淋巴瘤的高分辨率MRI表现[J].中华放射学杂志,2005,39(3):248-251.
[12]阎锡蕴.肿瘤新生血管及分子靶向治疗新策略[J].生物物理学报,2010,26(3):180-193.
[13]尚柳彤,家斐,王鑫坤,等.眼眶淋巴瘤的MRI征象[J].中国医学影像学杂志,2016,24(4):256-260.
[14]Demirci H,Shields CL,Karatza EC,et al.Orbital lymphoproliferative tumors:analysis of clinical features and systemic involvement in 160 cases[J].Ophthalmology,2008,115(9):1626-1631.
[15]刘海燕,张立,李双生.眶前肿瘤性病变的CT表现[J].医学影像学杂志,2015,25(7):1293-1295.
[2]武犁,陈樱,周芸芸,等.Sono Liver时间强度曲线在眼附属器淋巴瘤和眼眶良性肿瘤诊断中的应用[J].山东大学耳鼻喉眼学报,2015,29(4):74-79.
[3]赵水喜,曹京旭,肖利华.ⅠE期非结膜眼附属器黏膜相关淋巴组织型淋巴瘤放射治疗的临床观察[J].临床肿瘤学杂志,2017,22(1):66-69.
[4]Frederik Holm Svendsen,Steffen Heegaard.Lymphoma of the eyelid,Survey of Ophthalmology[J].2017,62(3):312-331.
[5]Shinder R,AL-Zubidi N,Esmaeli B.Survey of orbital tumors at a comprehensive cancer in the United States[J].Head Neck,2011,33(5):610-614.
[6]王婕,刘霆.36例原发性眼附属器淋巴瘤的分类及临床病理分析[J].中国实验诊断学,2011,15(10):1723-1725.
[7]Akansel G,Hendrix L,Erickson BA,et al.MRI patterns in orbital malignant lymphoma and atypical lvmphocvtic infiltrates[J].Enr J Radiol,2005,53(2):175-181.
[8]Sassone Marianna,Ponzoni Maurilio,Ferreri Andres JM,et al.Ocular adnexal marginal zone lymphoma:clinical presentation,pathogenesis,diagnosis,prognosis,and treatment[J].Best Practice&Research Clinical Haematology,2017,30(1-2):118-130.
[9]王超,王晓明.眶内原发非霍奇金淋巴瘤的影像学特征及病理学分析[J].J Chin Clin Med Imaging,2015,26(8):542-547.
[10]Priego G,Majos C,Climent F,et al.Orbital lymphoma:imaging features and differential diagnosis[J].Insights Imaging,2012,3(4):337-344.
[11]周全,刘斯润,黄力,等.眶部肌锥外间隙非霍奇金淋巴瘤的高分辨率MRI表现[J].中华放射学杂志,2005,39(3):248-251.
[12]阎锡蕴.肿瘤新生血管及分子靶向治疗新策略[J].生物物理学报,2010,26(3):180-193.
[13]尚柳彤,家斐,王鑫坤,等.眼眶淋巴瘤的MRI征象[J].中国医学影像学杂志,2016,24(4):256-260.
[14]Demirci H,Shields CL,Karatza EC,et al.Orbital lymphoproliferative tumors:analysis of clinical features and systemic involvement in 160 cases[J].Ophthalmology,2008,115(9):1626-1631.
[15]刘海燕,张立,李双生.眶前肿瘤性病变的CT表现[J].医学影像学杂志,2015,25(7):1293-1295.