原发性肝淋巴瘤的诊断(附7例报告)

目的 探讨原发性肝淋巴瘤(PHL)的诊断方法。方法 回顾性分析7例手术病理诊断为原发性肝淋巴瘤患者的临床特点和超声等影像学表现。结果 PHL的主要临床表现为肝区胀痛或上腹不适(4例)，肝肿大(3例)；血清乙肝二对半阳性者5例，曾患肝炎5例，其中慢性肝炎或肝硬化4例；均无发热及外周淋巴结肿大；超声声像图除1例外均表现为低回声病灶，CT表现为低密度占位，二维超声和彩色多普勒超声共误诊为良性病变1例次、血管瘤4例次，误诊率为62．5％(5／8)；CT误诊为血管瘤或炎症性病变3例次，误诊率50％(3/6)；MRI误诊为血管瘤1次，误诊率50％(1/2)。结论 原发性肝淋巴瘤临床及超声等影像学表现无特异性，确定诊断必须依靠组织学检查及免疫组织化学测定。在声像图上表现为非常见的原发性肝癌及肝血管瘤等典型声像图或图像类似肝转移性肿瘤但无原发肿瘤存在时，应注意与之鉴别。

Diagnosis of primary hepatic lymphoma:a report of 7 cases

Objective To discuss diagnostic methods of primary hepatic lymphoma (PHL). Methods We reviewed retrospectively the clinical presentation and imaging findings in seven patients in whom a diagnosis of PHL was finally made histologically. Results The main clinical manifestations of PHL were right upper quadrant pain(four patients) and hepatomegaly (three patients). Five Patients were hepatitis B surface antigen-seropositive. Five patients had preexisting liver diseases and four patients had chronic hepatitis or cirrhosis. None had fever or peripheral lymphadenopathy. All foci of PHL were hypoechoic relative to normal liver on ultrasound (US) except one patient. Computed tomography (CT) showed hypoattenuating lesions in all cases. Three patients were misdiagnosed as hemangioma or benign lesions 9 times in all by US, CT and magnetic resonance imaging (MRI). Conclusions The clinical presentation and imagings of PHL are non-specific, so that histology is required in all patients to establish the diagnosis. It should be considered in the differential diagnosis of liver metastases when no primary tumour is apparent or when sonographic findings show atypical features of primary liver carcinoma or hemangioma.