Comparison of clinical and imaging findings in sinonasal NK/T cell lymphoma and diffuse large B cell lymphoma
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摘要:
目的比较NK/T细胞淋巴瘤（NKTCL）与弥漫大B细胞淋巴瘤（DLBCL）的临床及影像学特征，以提高其诊断的准确性。 方法回顾性收集我院病理证实的鼻腔鼻窦非霍奇金淋巴瘤（NHL）患者的临床及影像学资料，包括15例NKTCL及9例DLBCL，比较两组患者年龄、性别比例、临床症状、病变位置、病灶大小及形态、信号强度、强化程度及均匀性、邻近结构的变化。 结果DLBCL患者发病年龄较NKTCL大（P=0.001），性别差异无统计学意义（P=0.351）；NKTCL患者临床症状以鼻塞多见（93.3%），DLBCL患者以眼部症状多见（55.5%）。NKTCL多见于鼻腔、DLBCL多见于鼻窦（P < 0.001）；NKTCL病变以弥漫浸润型较多见、DLBCL以肿块型较多见，但两组差异无统计学意义（P=0.099）；DLBCL病灶比NKTCL大（P=0.019）；两组病灶T1WI、T2WI信号及强化程度差异无统计学意义（P > 0.05）；NKTCL病灶多强化不均匀，DLBCL多强化均匀（P=0.009）；NKTCL以鼻背部软组织受累多见（70.0%），DLBCL以累及眼眶多见（62.5%）；DLBCL较NKTCL对邻近骨质的破坏明显。 结论鼻腔鼻窦NKTCL与DLBCL的临床及影像学特征对病理分型有一定的提示作用。NKTCL患者症状主要为鼻塞，影像学上病灶多位于鼻腔、体积较小、强化不均匀、周围骨质毛糙呈轻微骨质破坏；DLBCL患者多表现为突眼、溢泪，影像学上病灶多位于鼻窦、体积大、强化均匀、周围骨质虫蚀样或溶骨样破坏。 Abstract:ObjectiveTo evaluate the difference of clinical and imaging findings in sinonasal NK/T cell lymphoma (NKTCL) and diffuse large B cell lymphoma (DLBCL) and to improve the diagnostic accuracy. MethodsPathology-proven fifteen patients with NKTCL and nine patients with DLBCL were collected in this study. Patient's age, gender distribution, clinical symptoms, mass location, volume, morphology, T1WI and T2WI signal intensity, enhancement degree and homogeneity, surrounding tissue invasion of the two groups were retrospectively analyzed. ResultsThe mean age at diagnosis for DLBCL was significantly higher than NKTCL(P < 0.001). Gender distribution did not have significant difference between the two groups(P= 0.351). The most common symptom for patients with NKTCL was nasal congestion (93.3%) whereas ocular signs more often occur in patients with DLBCL (55.5%). The most common region of NKTCL was nasal cavity whereas DLBCL more often located in paranasal sinus(P=0.000). NKTCL was commonly diffuse infiltration growth and DLBCL commonly in mass, but there was no significant difference between the two groups in this study(P=0.099). The lesion of DLBCL was larger than NKTCL (P=0.019). There was no difference in T1WI, T2WI signal intensity and enhancement degree (P values were 0.669, 0.118 and 0.617, respectively). NKTCL was characterized by heterogeneous enhancement and DLBCL was homogeneous enhancement (P=0.009). NKTCL often involved nasal dorsum(70.0%), and the region invasion of orbital cavity was more often in DLBCL (62.5%). The bone destruction degree was more serious in DLBCL than NKTCL. ConclusionThere are valuable differentiating clinical and imaging features between sinonasal NKTCL and DLBCL. Nasal obstruction is the most common presenting symptom in NKTCL patients, NKTCL is predominant in nasal cavity, with small volume, MR heterogeneous enhancement, and bone destruction mildly. The most common presenting symptoms in DLBCL patients are proptosis and epiphora, DLBCL often located in paranasal sinus, with large volume, MR homogeneous enhancement, and osteolytic bone destruction. -
Key words:
- sinonasal lymphoma /
- NK/T cell lymphoma /
- diffuse large B-cell lymphoma /
- imaging /
- clinical features
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图 1 右侧鼻腔NK/T细胞淋巴瘤
A: T1WI肿瘤呈稍高信号；B~C: T2WI肿瘤呈混杂稍高信号，沿右侧鼻甲弥漫浸润型生长，边界不清；D: 增强呈中度不均匀强化；E: 病理：异型淋巴细胞弥漫浸润，瘤细胞较小，有多灶坏死（HE，×40）.
Figure 1. NKTCL of the right nasal cavity.
图 2 左侧鼻腔NK/T细胞淋巴瘤
A: T1WI肿瘤呈等信号；B: T2WI肿瘤呈稍高信号，肿块型生长，边界清；C: 增强呈中度强化；D: 病理：异型淋巴细胞弥漫分布，瘤细胞较小（HE，×40）.
Figure 2. NKTCL of the left nasal cavity.
图 3 右侧鼻腔及右侧上颌窦弥漫大B细胞淋巴瘤
A: T1WI肿瘤呈等信号；B: T2WI肿瘤呈稍高信号，沿右侧鼻腔及右侧上颌窦弥漫浸润型生长，边界不清；C: 增强呈中度强化；D: 病理：淋巴细胞弥漫分布，体积较大，异型明显（HE，×40）.
Figure 3. DLBCL of the right nasal cavity and the right maxillary sinus.
图 4 右侧上颌窦弥漫大B细胞淋巴瘤
A: T1WI肿瘤呈等信号；B: 肿瘤呈稍高信号，肿块型生长，边界欠清；C: 增强呈中度强化；D: 病理：淋巴细胞弥漫分布，体积较大，异型明显（HE，×40）
Figure 4. DLBCL of the right maxillary sinus.
表 1 NKTCL与DLBCL两组患者的临床资料统计结果
Table 1. The demographic features of NKTCL and DLBCL groups
病理分型 性别（男/女） 年龄（岁, Mean±SD） NKTCL (n=15) 10/5 42.3±13.1 DLBCL (n=15) 8/1 65.1±16.3 检验值 - t=-3.760 P 0.351 0.001 NKTCL：NK/T细胞淋巴瘤；DLBCL：弥漫大B细胞淋巴瘤. 
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表 2 NKTCL与DLBCL两组患者的影像学特征比较
Table 2. Comparison of imaging features of NKTCL and DLBCL groups
影像特征 NKTCL（n=15） DLBCL（n=9） 检验值 P 病灶部位(n) Z=-2.355 0.000 鼻腔 14 0 鼻窦 1 6 鼻腔及鼻窦 0 3 病灶形态(n) 0.099 弥漫浸润型 12 4 肿块型 3 5 病灶体积（×104 mm3） 1.2（1.04~1.99） 2.3（1.6~8.4） 0.019 T1WI信号(n) 0.669 等信号 10 7 稍高信号 5 2 T2WI信号(n) 0.118 等信号 5 0 稍高信号 10 9 强化程度(n) 0.617 轻度 2 3 中度 10 4 明显 3 2 0.009 强化均匀性(n) 均匀 4 8 不均匀 11 1
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