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目的通过探讨原发性肺非霍奇金淋巴瘤(PPNHL)的影像学表现及病理学特征之间的关联性,以提高此病的诊断准确率。方法对照分析22例PPNHL患者的临床病理特征及其胸部CT表现。结果组织病理学示低级别分化淋巴瘤12例,均为黏膜相关淋巴组织型(MALT型)淋巴瘤,占54.5%,呈小淋巴样细胞的弥漫浸润。胸部CT检查除1例(8.3%)为多发病灶外,其余11例(91.7%)均呈外周单发病灶,主要沿支气管黏膜下蔓延,形成肺内结节或肿块影8例(66.7%),部分周边有“晕征”;斑片状肺炎影4例(33.3%);伴支气管充气征者7例(58.3%)。中高级别分化淋巴瘤10例,占45.5%。胸部CT呈单发病灶者4例,占40%;多发性病灶6例,占60%。其中肺内结节或肿块影4例(40%),浸润影1例(10%),混合型5例(50%),伴单侧胸腔积液5例(50%),伴肺门/纵隔淋巴结肿大2例(20%),伴肺不张3例(30%),伴小叶间隔增厚等间质性改变2例(20%)。结论 PPNHL的病理学基础决定其影像学表现具有一定特征,低级别分化PPNHL以外周局灶性实变区、支气管充气征为其特征性改变。高级别分化淋巴瘤更多表现为肺间质改变为主或与结节病灶共存的混合型病变。认真分析其影像表现,在多数情况下有助于临床正确诊断。
Objective To explore the correlation between the imaging features and pathological features of primary pulmonary non-Hodgkin’s lymphoma (PPNHL) in order to improve the diagnostic accuracy of this disease. Methods The clinical and pathological features of 22 patients with PPNHL and their chest CT findings were analyzed. Results Histopathology showed that there were 12 cases of low grade differentiation lymphoma, all of which were mucosa - associated lymphoid tissue (MALT) lymphoma, accounting for 54.5% with diffuse infiltration of small lymphoid cells. Thoracic CT examination showed peripheral single lesion in 11 patients (91.7%) except one case (8.3%) with multiple lesions. The lesions mainly spread along the bronchial submucosa, forming nodules or mass in the lung (8 cases, 66.7%). , Part of the periphery with “halo sign ”; patchy pneumonia in 4 cases (33.3%); with bronchial inflatable sign in 7 cases (58.3%). High-grade lymphoma in 10 cases, accounting for 45.5%. Chest CT showed single lesions in 4 cases, 40%; multiple lesions in 6 cases, accounting for 60%. Among them, 4 cases (40%) of pulmonary nodules or masses, 1 case of infiltration shadow (10%), 5 cases of mixed type (50%) and 5 cases of unilateral pleural effusion (50% Mediastinal lymph nodes in 2 cases (20%), with atelectasis in 3 cases (30%), with interlobular septal thickening and other interstitial changes in 2 cases (20%). Conclusions The pathological basis of PPNHL determines the imaging features of PPNHL to have certain characteristics. Peripheral focal areas of PPNHL differentiate into low grade and bronchial inflamation sign is the characteristic change. High-grade differentiated lymphoma is more manifested as interstitial lung lesions or nodular lesions coexist with mixed lesions. A careful analysis of its imaging performance will, in most cases, contribute to the correct clinical diagnosis.