乳腺非霍奇金淋巴瘤的影像表现

目的 复习10例乳腺非霍奇金淋巴瘤（NHL）的影像学表现，以期提高诊断准确率。材料与方法 回顾性分析10例经组织学及临床随诊证实的乳腺NHL影像表现。原发3例，继发7例，其中双侧受累3例。乳腺X线摄片10例，B超检查8例，CT检查2例。结果 乳腺X线摄片表现为孤立结节2例，乳腺大片密度增高及弥漫性皮肤增厚5例，双侧乳腺多发结节1例，双侧乳腺多发模糊小片影2例。无1例有成簇微小钙化、毛刺或肿物局部皮肤增厚、回缩。B超表现为轮廓规则或不规则的不均质低回声结节或肿块，后方透声增强2例，部分增强1例，无增强5例，皮肤增厚2例。CT扫描见多发结节及腋窝淋巴结肿大1例，乳腺弥漫性密度增高、皮肤增厚、乳头轻度回缩及纵隔、腋窝淋巴结肿大、胸大肌浸润、胸腔积液1例。结论 乳腺NHL无特异性的影像学表现，最常见的影像表现为乳腺弥漫性密度增高、皮肤增厚，其次为孤立或多发结节，少数亦可表现为乳腺内不规则的模糊小片状阴影。原发和继发病变的影像表现无明显区别。X线摄片结合B超及临床所见有助于提示NHL的诊断。

Imaging Manifestations of Non Hodgkin Lymphoma of the Breast

Objective To review the imaging manifestations of breast non Hodgkin lymphoma (NHL) in 10 patients, and to improve the diagnostic accuracy. Materials and Methods The imaging findings in 10 patients with histologically or clinically proved breast NHL, including primary NHL (n=3) and secondary involvement (n=7), were retrospectively analyzed. Mammography was performed in all ten cases, while ultrasonography in 8 and CT in 2.Results On mammograms the lesions were manifested as solitary nodule in parenchyma (n=2), diffuse increased opacity with skin thickening (n=5), bilateral multiple nodules (n=1), and bilateral multiple patchy lesions with ill defined margin (n=2). Neither clustered calcifications nor spicules or adjacent skin retraction were seen. On ultrasonograms the lesions were present as well defined circumscribed or irregular hypoechoic mass or nodule with posterior echo enhancement (n=2), partial enhancement (n=1) or non enhancement (n=5), and skin thickening (n=2). CT demonstrated multiple nodules with axillary lymphadenopathy in one case, and diffuse increased opacity with skin thickening, nipple retraction, mediastinal and axillary lymphadenopathy as well as pectoralis major invasion, pleural effusion in one case.Conclusion The imaging manifestations of breast NHL are nonspecific. Diffuse increased opacity with skin thickening, solitary or multiple nodules or mass are most common findings on mammograms. Irregular patchy lesion with ill defined margin is a rare finding, but it should be considered as breast involvement in an NHL patient. No difference in imaging manifestations can be found between primary and secondary lesions. Mammography, when combined with ultrasonography and clinical data, is helpful for the diagnosis of breast NHL.