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原发性肺淋巴瘤(primary pulmonary lymphoma,PPL)是一种累及单侧或双侧肺(实质或支气管)的淋巴细胞恶性克隆增生性疾病,肺是结外淋巴瘤好发部位之一,仅次于胃肠道。PPL最常见的病理类型为黏膜相关淋巴组织边缘区B细胞淋巴瘤,而原发性肺弥漫大B细胞淋巴瘤临床相对少见。目前,有关原发性肺弥漫大B细胞淋巴瘤的CT报道多见[1-2],但由于缺乏特异性,诊断较困难,而有关18F-FDG PET/CT显像报道少见[3],本病例分析1例确诊为原发性肺弥漫大B细胞淋巴瘤的18F-FDG PET/CT影像学表现及鉴别诊断,以提高诊断水平。
原发性肺弥漫大B细胞淋巴瘤18F-FDG PET/CT显像一例
18F-FDG PET/CT imaging of primary pulmonary diffuse large B-cell lymphoma:a case report
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摘要: 笔者报道了一例原发性肺弥漫大B细胞淋巴瘤的18F-FDG PET/CT显像病例,从临床症状、实验室检查、18F-FDG PET/CT影像学等方面分析该病特点,并通过文献回顾了原发性肺弥漫大B细胞淋巴瘤鉴别诊断要点。研究结果显示,本例原发性肺弥漫大B细胞淋巴瘤18F-FDG PET/CT影像学表现为巨大软组织团块影、边缘光滑、内见多发点状钙化灶,18F-FDG代谢团块状增高,SUVmax为26.2。18F-FDG PET/CT显像能够为原发性肺弥漫大B细胞淋巴瘤的诊断提供参考依据。Abstract: The author report one case of primary pulmonary diffuse large B-cell lymphoma of 18F-FDG PET/CT imaging. The characteristics of the disease were analysed according to clinical symptoms, laboratory examinations and 18F-FDG PET/CT imaging, meanwhile, the main points of differential diagnosis of primary pulmonary diffuse large B-cell lymphoma were reviewed in the literature. The results of imaging findings of 18F-FDG PET/CT in this case showed a large soft tissue mass with smooth edge and multiple spotty calcifications inside, 18F-FDG PET/CT imaging showed obvious 18F-FDG hypermetabolism in the mass with a SUVmax of 26.2. 18F-FDG PET/CT imaging could provide reference for diagnosis of primary pulmonary diffuse large B-cell lymphoma.
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图 1 患者男性,74 岁,原发性肺淋巴瘤患者 18F-FDG PET/CT 图像和病理图(苏木精-伊红染色,×100) 图中,A~D 分别为 PET、CT、PET/CT 肺窗图像和 MIP 图像。PET/CT 结果示,右肺上叶支气管开口处有一巨大软组织肿块影,边缘光滑,放射性摄取异常增高,SUVmax 为 26.2;E~H 分别为 PET、CT、PET/CT 纵隔窗图像和 MIP 图像。PET/CT 结果示,右肺上叶肿块(短粗箭头),密度不均匀,肿块内见多发点状钙化灶(短粗箭头),纵隔内 3A 区(细短箭头)、4R 区(细长箭头)、5 区(粗长箭头)多发钙化淋巴结影,放射性摄取 轻度增高,SUVmax 为 3.0;I:病理图。光镜下示弥漫性淋巴细胞样细胞浸润伴大片坏死。MIP:最大密度投影。
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