影像学表现为双肺弥漫磨玻璃影的肺非霍奇金淋巴瘤的临床特点

目的 分析影像学表现为双肺弥漫磨玻璃影(GGO)的肺非霍奇金淋巴瘤的临床特点,以提高其诊断率.方法 回顾性分析北京协和医院2008年1月至2010年3月,胸部CT表现为双肺GGO的肺非霍奇金淋巴瘤的6例患者的资料.结果 6例患者中男5例,女1例,年龄30～59岁(平均52岁),病程2～36个月(平均14个月).临床表现为胸闷憋气5例,体重下降5例,浅表淋巴结肿大2例,肝脾肿大2例.血红蛋白平均下降25 g/L,血清乳酸脱氢酶平均755 U/L,3例患者肺功能为弥散功能障碍(一氧化碳弥散量平均为70%).影像学表现为单纯双肺GGO 2例、双肺GGO伴双肺实变影3例、伴小叶间隔增宽3例、伴小结节影2例、伴纵膈淋巴结肿大2例.6例患者均经肺组织活检病理确诊,其中4例为B细胞淋巴瘤(血管内淋巴瘤及弥漫大B细胞淋巴瘤各2例),2例为T细胞淋巴瘤.随访2～6个月(平均4个月),4例B细胞淋巴瘤患者化疗后病情平稳;2例T细胞淋巴瘤患者中1例未化疗失访,1例因合并重症肺部感染未能化疗,4个月后死亡.结论 以双肺GGO为首发影像学表现的肺非霍奇金淋巴瘤起病隐匿,少见,临床症状及影像学检查无特异性,肺活检是最终确诊的手段.

Non-Hodgkin's lymphoma with diffuse ground-glass opacity on chest CT: a report of 6 cases

Objective To investigate the clinical, pathological and imaging characteristics,misdiagnosis and treatment of pulmonary non-Hodgkin's lymphoma with diffuse ground-glass opacities (GGO). Methods Six cases of pulmonary non-Hodgkin's lymphoma with diffuse GGO on chest CT diagnosed from January 2008 to March 2010 were retrospectively analyzed. Results There were 5 males and 1 female with average age of 52 years old ( range: 30-59). The course had a range of 2-36 months. Most patients presented with dyspnea ( n = 5) and loss of weight (n = 5). Enlargement of superficial lymph nodes ( n = 2) and hepatosplenomegaly (n = 2) were also found. Laboratory tests showed that average hemoglobin decreased to 25 g/L and average serum LDH was 755 U/L. Chest CT showed diffuse GGO (n =2) ,diffuse GGO with consolidations ( n = 3 ), with wide lung septum ( n = 3 ), with multiple nodules ( n = 2 ), with enlargement of mediastinal lymph nodes ( n = 2 ). Diagnosis of the 6 cases were made by lung biopsy.Histological findings including intravascular lymphoma ( n =2), diffuse large B cell lymphoma ( n =2) and T cell lymphoma (n = 2). The average follow-up period was 4 months( range: 2-6). Chemotherapy was administered in 4 patients with B cell lymphoma and all of them improved or remained stable. One patient with T cells lymphoma was lost to follow-up and another patient with T cell lymphoma died due to lung infection. Conclusions Non-Hodgkin's lymphoma with diffuse GGO on chest CT scan is rare. And its misdiagnosis is common due to a lack of specific clinical manifestations. And lung biopsy is necessary for an early diagnosis.