目的：分析肺原发性淋巴瘤患者的影像学及临床表现特征,提高对于该疾病的诊断和鉴别诊断能力。方法：回顾性分析经病理明确诊断的肺原发淋巴瘤患者的CT影像学表现,结合相关文献,总结肺部原发淋巴瘤的影像学表现特点。结果：10例肺原发性淋巴瘤患者中,7例确诊为黏膜相关淋巴组织淋巴瘤（mucosa-associated lymphoid tissue, MALT）淋巴瘤,1例确诊为弥漫大B细胞淋巴瘤,2例确诊为外周T细胞淋巴瘤。8例患者的CT图像上病灶可见支气管充气征,9例增强CT均可见病灶轻度强化及血管漂浮征,8例可见晕征,而患者的临床表现均无特异性。结论：肺部原发性淋巴瘤患者的影像学表现复杂多样,且临床和影像学表现无特异性,空气支气管征、增强后病灶呈轻中度强化、血管漂浮征、晕征等为肺部淋巴瘤在CT图像上较为特征的征象。
Objectives: To analyze the imaging features of primary pulmonary lymphoma and to differentiate it from other pulmonary tumors. Methods: CT imaging of patients proved by pathology as primary pulmonary lymphoma were analyzed retrospectively, and relevant literatures were reviewed. Results: Ten patients were enrolled in this study,7 patients were confirmed as mucosa-associated lymphoid tissue lymphoma (MALT),1 patient was diffuse large B cell lymphoma (DLBCL), and 2 patients were peripheral T-cell lymphoma. Air bronchogram could be seen in 8 patients. Vessel floating sign and mild enhancement could be seen in 9 patients.Halo sign could be seen in the edge of lesion in 8 patients. There were no special features in clinical manifestation. Conclusions: The imaging of primary lymphoma of lung is complicated and varied. There is no specific feature in both CT and clinical features. Air bronchogram, mild enhancement, vessel floating sign and halo sign could be the relatively specific sign of primary lymphoma in lung. The diagnosis of primary lymphoma in lung depends on pathological examination. For differential diagnosis, immunohistochemical staining and molecular pathological examination may be helpful.
[1] 中华医学会核医学分会PET与分子影像学组. 淋巴瘤18F-FDG PET/CT显像临床应用指南(2016版)[J]. 中华核医学与分子影像杂志,2016,36(5):458-460.
[2] Kligerman SJ, Franks TJ, Galvin JR.Primary Extranodal Lymphoma of the Thorax[J]. Radiol Clin North Am,2016, 54(4):673-687.
[3] 郑玉萍, 王列样, 白敏, 等. 原发性肺淋巴瘤十例临床分析[J]. 白血病·淋巴瘤,2013,22(12):747-748.
[4] Cordier JF, Chailleux E, Lauque D, et al.Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients[J]. Chest,1993,103(1):201-208.
[5] Yoshino N, Hirata T, Takeuchi C, et al.Primary Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma with a Nodular Opacity: Report of a Case[J]. J Nippon Med Sch,2017,84(2):87-89.
[6] 李平, 胡粟, 刘永浩, 等. 原发性肺淋巴瘤的CT表现[J]. 实用放射学杂志,2015,31(2):334-335,338.
[7] 张锦, 黄幸, 陆珍凤, 等. 肺原发性非霍奇金淋巴瘤28例临床病理分析[J]. 临床与实验病理学杂志,2015, 31(7):784-788.
[8] Yang L, Feng W, Chen C, et al.Primary pulmonary T-cell lymphoma mimicking pneumonia: A case report and literature review[J]. Exp Ther Med,2016,12(1):365-368.
[9] 唐光才. 肺淋巴瘤的影像学表现[J]. 内科急危重症杂志,2015,21(2):92-95.
[10] Isaacson P, Wright DH.Malignant lymphoma of mucosa-associated lymphoid tissue. A distinctive type of B-cell lymphoma[J]. Cancer,1983,52(8):1410-1416.
[11] 温戈, 张玉晶, 张金山, 等. 早期肺原发黏膜相关淋巴组织淋巴瘤的预后分析及文献回顾[J]. 中华放射肿瘤学杂志, 2016,25(7):713-717.
[12] Maeshima AM, Taniguchi H, Toyoda K, et al.Clinicopathological features of histological transformation from extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue to diffuse large B-cell lymphoma: an analysis of 467 patients[J]. Br J Haematol,2016,174(6):923-931.
[13] Bligh MP, Borgaonkar JN, Burrell SC, et al.Spectrum of CT Findings in Thoracic Extranodal Non-Hodgkin Lymphoma[J]. Radiographics,2017,37(2):439-461.
[14] Yachoui R, Leon C, Sitwala K, et al.Pulmonary MALT Lymphoma in Patients with Sjögren's Syndrome[J]. Clin Med Res,2017,15(1-2):6-12.
[15] 曹达魁, 姚扬伟. 原发性肺淋巴瘤一例并文献复习[J]. 浙江临床医学,2017,19(2):383,385.
[16] 张艳, 余建群, 朱洪基, 等. 肺黏膜相关淋巴组织淋巴瘤的CT和临床表现及其病理学基础[J]. 放射学实践,2016,31(8):734-738.
[17] Troch M, Streubel B, Petkov V, et al.Does MALT lymphoma of the lung require immediate treatment? An analysis of 11 untreated cases with long-term follow-up[J]. Anticancer Res,2007,27(5B):3633-3637.
[18] Ding X, Makino T, Koezuka S, et al.Primary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue with multiple pure ground-glass opacities: a case report[J]. J Cardiothorac Surg,2017,12(1):2.
[19] Nahorecki A, Chabowski M, Straszak E, et al.Primary pulmonary MALT lymphoma - case report and literature overview[J]. Eur Rev Med Pharmacol Sci,2016,20(10):2065-2069.
[20] Wang T, Zhang M, Sun J, et al.A rare case of primary pulmonary diffuse large B cell lymphoma with CD5 positive expression[J]. Open Med (Wars),2016,11(1):49-51.
[21] Salhan D, Verma P, Naing TW, et al.Primary Pulmonary Lymphoma Presenting with Superior Vena Cava Syndrome in a Young Female[J]. Case Rep Pulmonol,2017, 2017:1937107.
[22] Xu H, Xu K, Wang R, et al.Primary Pulmonary Diffuse Large B-Cell Lymphoma on FDG PET/CT-MRI and DWI[J]. Medicine (Baltimore),2015,94(29):e1210.
[23] 孙璐, 石怀银, 陈薇, 等. 原发性肺外周T细胞淋巴瘤临床病理观察[J]. 诊断病理学杂志,2012,19(2):135-139.
[24] 张嵩, 梁斌, 姜淑娟. 肺原发性非特指型外周T细胞淋巴瘤一例[J]. 中华结核和呼吸杂志,2013,36(11):860-862.
