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结外鼻型NK/T细胞淋巴瘤的MSCT表现

作者:廖俊杰1 毕纯龙2 朱文丰1 陈镜聪1 黄丽莹1 周翠屏1

所属单位:1.广东省惠州市中心人民医院放射 科 (广东 惠州 516001) 2 大庆油田总医院CT室 (黑龙江 大庆 163001)

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摘要

目的 探讨结外鼻型NK/T细胞淋 巴瘤(NKTCL)的MSCT表现,提高诊断与鉴 别诊断的水平。方法 回顾性分析31例经 临床和病理证实的NKTCL的MSCT表现。结 果 22例病灶原发于鼻腔,局限型9例, 7例病变位于鼻腔前部或鼻前庭,2 例位 于鼻腔后段,骨质无明显破坏;弥漫型13 例,侵犯整个鼻腔,包绕中下鼻甲呈铸型 生长,部分侵犯鼻前庭、鼻翼、鼻窦及眼 眶,中线结构有破坏;2例原发于鼻窦, MSCT平扫为密度欠均匀的软组织肿块,增 强后呈轻-中度强化。7例原发于咽淋巴 环,其中5例位于腭扁桃体,2例侵犯多 个部位,MSCT 平扫为软组织密度肿块, 密度均匀或不均匀,增强后呈轻-中度强 化。结论 结外鼻型NK/T细胞淋巴瘤的部 位、形态、密度及强化特点等MSCT 表现 具有一定特征性,对临床早期诊断及治疗 有指导价值。

Objective To study the MSCT findings of Extranodal Nasal-Type NK/T-cell Lymphoma(NKTCL), in order to improve level of diagnosis and differential diagnosis. Methods The MSCT data of 31 cases of NKTCL, proven clinically and pathologically were studied retrospectively. Results Of the 31 patients, 22 patients primary lesions were in nasal cavity, 9 patients showed localized type, the localized lesions were found in the anterior nasal cavity or nasal vestibule in 7 cases, and in posterior part in 2 cases, no obvious bone destruction. 13 patients showed localized diffuse type, the lesions to diffuse growth and widely existed nasal cavity, in volving middle and inferior turbinate, part patients invaded nasal vestibule, naslala, paranasal sinus and orbit, accompanying with variable bony destruction in the midline of nasal cavity. 2 patients primary lesions were in paranasal sinus, MSCT manifestation of heterogeneous soft tissue density mass and mildmoderate enhancement. 7 patients primary lesions were in Waldeyer's ring, 5 patients in palatal tonsil and 2 patients invaded multiple sites were homogeneous or heterogeneous soft tissue density mass and mild-moderate enhancement on MSCT. Conclusion The extranodal nasal-type NK/T-cell lymphoma has some characteristics imaging features of the position, shape, density and enhancement on MSCT, these information are helpful for the clinical early diagnosis and treatment.

【关键词】结外鼻型NK/T细胞淋巴瘤;多 层螺旋CT

【中图分类号】R733.4;R445.3

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2017.07.007

前言

结外鼻型NK/T细胞淋巴瘤(Extranodal Nasal-Type NK/T-cell Lymphoma,NKTCL)是来源于成熟NK细胞或NK样T细胞的与EB病毒感染相 关的一种特殊类型非何杰金淋巴瘤,占恶性淋巴瘤的2%~10%[1],多发 生于鼻腔、鼻窦及咽淋巴环等位置,早期临床症状及影像学检查均缺 乏特异性,极易误诊为鼻息肉、慢性鼻窦炎、鼻中隔黏膜糜烂、咽炎 及鼻-鼻窦-咽部肿瘤等疾病[2]。随着影像检查的广泛应用及对NKTCL的 逐渐认识,NKTCL的发病率呈逐年上升趋势。笔者回顾性分析31例经临 床和病理证实的NKTCL的MSCT资料,探讨NKTCL的MSCT表现,旨在不断 提高对NKTCL的早期影像诊断水平,减少误诊、漏诊。