Imaging and pathology characteristics of non-Hodgkin lymphoma in different regions of the head and neck
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摘要:
目的探讨头颈不同部位结外非霍奇金淋巴瘤（NHL）的病理及影像学特征的差异。 方法回顾性分析49例经病理证实的头颈部结外NHL患者的病理及影像学资料，包括21例咽淋巴环NHL和28例咽淋巴环外NHL。5例患者仅行CT检查，16例仅行MRI检查，28例同时行CT及MRI检查，其中20例行CT或MRI增强检查。分析咽淋巴环NHL和咽淋巴环外NHL的病理学类型和病变形态、邻近组织侵犯及颈部淋巴结肿大情况等影像学表现，并采用Pearson卡方检验对两组间的影像学差异进行比较。 结果咽淋巴环NHL以弥漫性大B细胞淋巴瘤多见（n=16，76.2%）；咽淋巴环外NHL以发生于鼻腔多见（n=17，34.7%），NK/T细胞淋巴瘤居多（n=12，70.6%）。咽淋巴环NHL以肿块型多见，而咽淋巴环外NHL多为弥漫浸润生长（χ2=9.926，P=0.002）；咽淋巴环外NHL较咽淋巴环NHL容易向邻近组织浸润（χ2=25.126，P=0.000）；咽淋巴环NHL更容易伴发颈部淋巴结肿大（χ2=21.778，P=0.000）。 结论头颈部结外NHL在不同部位有相应好发的组织病理类型；咽淋巴环NHL与咽淋巴环外NHL在病变形态、对邻近组织的浸润及颈部淋巴结累及情况均有明显不同。 -
关键词:
- 头颈部淋巴结外淋巴瘤 /
- 非霍奇金淋巴瘤 /
- CT /
- MRI
Abstract:ObjectiveTo evaluate the difference of the pathology and imaging features of non-Hodgkin lymphoma (NHL) in different regions of the head and neck. MethodsThe pathology and imaging(CT and MRI)features of 49 patients with primary extranodal NHL confirmed by pathology were analyzed retrospectively. Twenty-one cases were located in Waldeyer's Ring (WR) and 28 cases were located in extra-WR. Five patients underwent CT scan, 16 patients underwent MRI scan, 28 patients underwent both CT and MR scans, and contrast CT or MRI scans were performed in 20 patients. The characteristics of pathology subtypes and imaging features of mass morphology, local structure invasion and the rate of nodes involvement were evaluated. The imaging features of NHL in WR and extra-WR were compared by using Chi-square test. ResultsWR was the most common region of diffuse large B-cell lymphoma (DLBCL) (n=16, 76.2%), nasal cavity was the most common extraWR site (n=17, 34.7%) and NK/T cell lymphoma was the most histological subtype (n=12, 70.6%). WR NHL was commonly in masses, and extra-WR NHL commonly in diffuse infiltration growth (χ2=9.926, P=0.002). WR NHL was less locally aggressive than extra-WR NHL(χ2=25.126, P=0.000). WR NHL was more commonly combined with cervical nodes involvement (χ2=21.778, P=0.000). ConclusionCorresponding NHL subtypes have predilections for different regions in the head and neck. The mass morphology, local structure invasion and the rate of nodes involvement between WR and extra-WR NHL are different. -
Key words:
- head and neck extranodal lymphoma /
- non-Hodgkin's lymphoma /
- CT /
- MRI
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图 1 右侧腭扁桃体弥漫性大B细胞淋巴瘤
MRI平扫轴位图像（A, B）示肿块局限性突向咽腔, 呈等T1长T2信号; MRI增强（C）示肿块轻度强化; 另（D）右侧颌下可见多个增大淋巴结; E:病理学图片（HE, ×40）
Figure 1. DLBCL of the right palatine tonsil
图 2 左侧腮腺弥漫性大B细胞淋巴瘤
CT轴位（A）平扫图像示肿块呈等密度, 边界不清; MRI平扫轴位（B, C）肿块呈等T1长T2信号, 信号欠均匀, 边界不清, 邻近皮肤受累; MRI冠状增强图像（D）示肿块明显强化、信号欠均匀, 邻近颈部间隙可见增大淋巴结; E:病理学图片（HE, ×40）
Figure 2. DLBCL of the left parotid gland
图 3 右侧鼻腔NK/T细胞淋巴瘤
MRI平扫轴位（A, B）与冠状位（C）图像示病变呈等T1稍长T2信号, 浸润性生长, 与邻近右侧中下鼻甲分界不清，累及右侧颌面部皮下组织; D:病理学图片（HE, ×100）
Figure 3. NK T-cell lymphoma of the right nasal cavity
图 4 鼻窦弥漫性大B细胞淋巴瘤
MRI平扫轴位（B）及冠状位（C）图像示双侧上颌窦及筛窦内可见等T1稍长T2肿块，弥漫性生长，突破上颌窦壁向颞下窝及颌面部皮下累及；CT平扫轴位（A）图像示上颌窦壁骨质破坏；E:病理学图片(HE, ×100)
Figure 4. DLBCL of paranasal sinus
图 5 左侧眼眶B细胞性淋巴瘤
MRI平扫轴位（A, B）及矢状位（C）图像示左侧眼眶病变呈等T1稍长T2信号, 铸型生长, 包绕视神经及眼外肌, 左侧眼眶周围局部皮肤增厚; D:病理学图片(HE, ×100)
Figure 5. B-cell lymphoma of the left orbit
表 1 头颈部结外NHL的病理类型与原发部位(n=49)
Table 1. Subtypes and localisations of identified extranodal NHL in the head and neck
病理类型 原发部位 合计 咽淋巴环 鼻腔 鼻窦 眼眶 腮腺 B细胞型 31 DLBCL 16 1 5 1 1 24 套细胞淋巴瘤 2 1 3 Burkitt淋巴瘤 1 1 结外黏膜相关组织边缘区淋巴瘤 1 1 具体类型不明确 1 1 2 T细胞型 18 NK/T细胞型淋巴瘤 1 12 1 14 间变性大细胞淋巴瘤 1 1 具体类型不明确 1 2 3 合计 21 17 5 5 1 49 NHL: non-Hodgkin's lymphoma; DLBCL: diffuse large B-cell lymphoma. 
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表 2 咽淋巴环和咽淋巴环外NHL的影像特点比较（n=49）
Table 2. Comparison of imaging features between WR NHL and extra-WR NHL
部位 病变形态 邻近组织侵犯 颈部淋巴结肿大 肿块型 弥漫浸润型 有 无 有 无 咽淋巴环NHL 17 4 6 15 17 4 咽淋巴环外NHL 10 18 27 1 4 24 χ2 9.926 25.126 21.778 P 0.002 0.000 0.000 NHL: non-Hodgkin's lymphoma.
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