脾淋巴瘤与脾转移癌的临床及超声特征分析

目的分析脾淋巴瘤和脾转移癌的临床表现及超声图像特征，以提高超声鉴别诊断的能力。 方法回顾性分析2004年1月至2021年4月在四川大学华西医院就诊并经病理确诊的50例脾淋巴瘤及15例脾转移癌患者的临床及超声检查资料，采用t检验、χ²检验或者Fisher精确检验比较2组患者临床表现及常规超声声像图特征的差异。 结果脾转移癌患者相较于脾淋巴瘤患者通常伴有其他部位原发恶性肿瘤病史（40.0% vs 0），差异具有统计学意义（P＜0.001）。两者在年龄、性别、发热、盗汗、体质量下降、腹痛等方面比较，差异均无统计学意义（P均＞0.05）。在形态学分型、病灶回声、脾增大、病灶数目方面：脾淋巴瘤形态学分型为弥漫型、病灶回声实性、脾增大的比例高于脾转移癌（44.0% vs 0；89.3% vs 60.0%；76.0% vs 20.0%），脾转移癌病灶多为单发（86.7% vs 50.0%），差异均具有统计学意义（χ²=17.409，P＜0.001；χ²=5.047，P=0.046；χ²=15.537，P＜0.001；P=0.023）。脾淋巴瘤和脾转移癌在边界、形态、血流信号、腹腔及腹膜后淋巴结长大方面比较，差异均无统计学意义（P均＞0.05）。两者在病灶最大径方面比较［（5.31±2.56）cm vs（6.23±3.55）cm］，差异也无统计学意义（P＞0.05）。 结论脾淋巴瘤和脾转移癌临床表现和超声图像特征虽然有相似之处，但不同的是，部分脾转移癌患者有原发肿瘤病史，形态上表现为直径较大的单发病变，脾增大不常见；而脾淋巴瘤可有多种表现，以弥漫型和混合型病变更为多见，病灶回声以实性回声多见，多数合并脾增大。

Analysis of clinical and ultrasonographic features between splenic lymphoma and splenic metastases

ObjectiveTo improve the ability of ultrasonic differential diagnosis by analyzing the clinical manifestations and ultrasonographic characteristics of splenic lymphoma and splenic metastases. MethodsThe clinical and ultrasonographic data of 50 patients with splenic lymphoma and 15 patients with splenic metastases diagnosed by pathology at West China Hospital of Sichuan University from January 2004 to April 2021 were analyzed retrospectively. The t-test and χ² test or Fisher's exact test were used to compare the differences of clinical manifestations and conventional ultrasonographic characteristics between the two groups. ResultsPatients with splenic metastases usually had a history of primary malignant tumors in other parts compared to those with splenic lymphoma (40.0% vs 0), which was significantly different (P＜0.001). No significant difference was observed in age, sex, fever, night sweats, weight loss, or abdominal pain between the two groups (P＞0.05). In terms of morphological classification, lesion echo, splenomegaly, and number of lesions: the proportions of diffuse lesions, lesions with solid echo, and patients with splenomegaly were higher in splenic lymphoma than in splenic metastases (44.0% vs 0; 89.3% vs 60.0%; 76.0% vs 20.0%), and the lesions of splenic metastases were mostly single (86.7% vs 50.0%); the differences were statistically significant (χ²=17.409, P＜0.001; χ²=5.047, P=0.046; χ²=15.537, P＜0.001; P=0.023). There were no significant differences between splenic lymphoma and splenic metastases in terms of boundaries, morphology, blood flow signal, and abdominal cavity and retroperitoneal lymph node growth (P＞0.05). The comparison of the maximum diameter of the lesions [(5.31±2.56) cm vs (6.23±3.55) cm] was also not statistically significant (P＞0.05). ConclusionAlthough there are similarities between the clinical and ultrasonographic characteristics of splenic lymphoma and splenic metastases, patients with splenic metastases often have a history of primary tumors, which morphologically manifest as single lesions with larger diameters, and splenomegaly is uncommon. In contrast, splenic lymphoma can have a variety of morphological types, diffuse and mixed lesions are more common, and unlike splenic metastases, lesion echoes of splenic lymphoma are more likely to manifest as solid echoes with splenomegaly.