骨原发性恶性淋巴瘤影像学诊断与组织病理对照研究

目的 探讨骨原发恶性淋巴瘤(PLB)的影像学表现特点.方法 回顾性分析经手术或穿刺活检病理学证实的PLB 9例,其中男6例,女3例,年龄9～60岁,中位年龄26.5岁.9例中X线平片检查8例、CT检查5例、MRI检查7例.其中2例行X线平片和MR检查,2例CT和MR检查,4例具有X线、CT和MR资料.2例为穿刺活检证实;7例行手术切除和病理学检查证实,全部病例均做了常规的组织切片HE染色和免疫组化检查.结果 病灶位于骨盆4例、额骨1例、枕骨斜坡1例、脊柱1例、股骨上端2例.影像学表现:X线表现,病变骨组织外形基本正常4例,内部可见斑点状、大小不等的虫蚀状骨质破坏;4例表现为病变骨质轻度～中度膨胀性改变,局部骨质呈明显溶骨性破坏:CT表现骨髓腔内和骨皮质上可见大小不等的溶骨性破坏,病变骨质周围围绕明显的软组织肿块;MR表现病变区骨髓腔内及周围软组织肿块在T2WI上呈不均匀中度～明显高信号,T1WI上呈均匀等信号.增强扫描后骨髓腔内病灶和周围软组织肿块在CT和MRI上均呈中度～明显强化.病理结果B细胞型5例、T细胞型4例.结论 影像学上PLB以斑点状或渗透性溶骨性破坏为主,病变骨质外形可正常或呈膨胀性改变,伴有明显的周围软组织肿块,中块以病骨为中心生长并有明显强化为其特征.

Imaging features of primary bone lymphoma and its histopathology

Objective To study the imaging features of primary bone of the lymphoma PLB) on X-ray, CT and magnetic resonance imaging (MRI). Methods The data of 8 patients (6 males and 3 females, aged 9-60 years with a median age of 26.5 years) with pathologically confirmed PLB were retrospectively reviewed. Plain radiographs were obtained in all the 8 cases, CT scans performed in 5 and MRI examinations in 7. Four patients underwent X-ray, CT and MRI, two underwent CT and MRI, and one underwent X-ray and MRI. Surgical resection was performed in 7 cases and biopsy done in 2, and routine histopathological examination and immunohistochemistry were performed for all patients. Results The site of PLB focus was found in the pelvic bone in 4 cases, right frontal bone in 1 case, proximal femoral bone in 1 case, occipital clivus in 2 cases, and vertebral column in 1 case. Plain X-ray revealed in 4 cases roughly normal shape of the involved bone with stippled interior bone structure destruction; the other 4 cases presented with slight or moderate bone expansion with obvious signs of osteolysis. CT scans displayed areas of different sizes of osteolytic cortical and marrow cavity destruction with large soft tissue masses around the lesion. MRI found heterogeneous iso- to hyperintense signals in the lesions in the bone and soft-tissue masses on T2-weighted images but homogeneous isointense signals on T2-weighted images. The tumors were obviously enhanced after contrast-enhanced scans on CT and MRI. Histological examination identified B-cell lymphoma in 5 cases and T-cell lymphoma in 4 cases. Conclusion PBL is characterized in imaging examinations by basically normal shape of the involved bones with possible bone expansion, obvious stippled osteolytic destruction, large soft-tissue mass around the lesion and obvious enhancement after contrast-enhanced scans.