继发性肾上腺淋巴瘤的影像学表现

摘要

目的 分析继发性肾上腺淋巴瘤的CT和MRI表现,以提高对该病变的认识.方法 回顾性分析经病理或临床随访证实的继发性肾上腺淋巴瘤21例,男性17 例,女性4例;年龄15～78岁,中位年龄53岁.其中6例既有MRI也有CT检查,15 例仅有CT检查.观察其CT和MRI表现并与临床和病理结果进行对照.结果 21例均为继发性非霍奇金淋巴瘤(non-Hodgkin lymphoma, NHL),其中B细胞来源19例,T细胞来源2例;12例单侧、9例双侧.肿瘤最大径2cm～13cm,中位数6.5cm.肿瘤最大径≤5cm者12个中8个呈肾上腺肿大并保持其轮廓的表现;肿瘤最大径≥10cm者5个,呈长椭圆形3个,不规则形2个; MRI冠状位检查8个中6个呈三角形.与正常肌肉相比,CT平扫呈稍低密度10个、等密度12个;MR平扫T1WI呈稍低信号;T2WI呈高信号.20例28个有增强扫描,轻度强化 24个,中度强化4个.肿瘤内部强化均匀者13个,稍不均匀者13个,不均匀者2个. 7例8个伴有同侧肾脏的直接侵犯,其中4侧肿瘤最大径≥10cm,表现为肿瘤包绕肾上极、肾门或相邻的血管.结论 继发性肾上腺淋巴瘤多为B细胞来源NHL,常表现为肾上腺区均质或稍不均质的软组织肿块,增强扫描轻度强化.肿瘤小者多保持肾上腺形态,肿瘤大者易包绕同侧肾脏和相邻血管.%Objective The purpose of this study was to analyze CT and MR imaging (MRI) manifestation of secondary adrenal lymphoma in order to deepen the recognition and understanding of this disease. Methods A group of 21 patients with pathologically or clinically proven secondary adrenal lymphoma were reviewed. 17 were men and 4 were women. Patients were 15~78 yeas old (median =53). Imaging findings (CT&MRI, n=6; only CT, n=15) were analyzed and correlated with clinical and pathologic findings. Results All 21 cases were secondary NHL (19 cases of B-cell type NHL and 2 cases of T-cell type NHL) with unilateral 12 cases, bilateral 9 cases. The maximum diameter of the lesions were 2~13 cm (median=6.5cm). Of the 12 lesions with the maximum diameter ≤ 5 cm, 8 manifested as diffuse enlargements of involved adrenal with presentation of overall configuration. Of the 5 lesions with the maximum diameter ≥10 cm, 3 were oblong oval and 2 were irregular. On coronary MRI, 6 of 8 lesions manifested as a triangular form. Compared with that of normal muscle, 10/22 lesions manifested as slightly low-density and 12/22 manifested as isodensity on unenhanced CT images; all of 13 lesions manifested as slightly low signal intensity on T1 weighted images and high signal intensity on T2 weighted images. After intravenous injection of contrast media, 24/28 lesions enhanced slightly and 4/28 lesions enhanced moderately in 20 cases on CT and MR images. 13/28 lesions were homogeneous, 13/28 lesions were a little heterogeneous and 2/28 were heterogeneous on enhanced CT and MR images. 7 lesions invaded the ipsilateral kidneys directly with the maximum diameter ≥10 cm in 4 lesions which manifested as the lesions embedded the upper kidney, renal hilar and adjacent blood vessels. Conclusion Most of the secondary adrenal lymphoma is the secondary B type NHL which usually manifest as homogeneous or a little heterogeneous masses with slightly enhancement. Most of small lesions manifest as diffuse enlargements of involved adrenal with presentation of overall configuration and most of the larger lesions are likely to embed the ipsilateral kidneys and adjacent blood vessels directly.