Dodd G D, Greenler D P, Confer S R
Department of Radiology, University of Pittsburgh Medical Center, Pennsylvania.
Radiol Clin North Am. 1992 May;30(3):597-610.
Organ transplant and AIDS patients are at a much higher risk for developing non-Hodgkin's lymphoma than is the general population. This increased risk is directly related to chronic immunosuppression and often is associated with viral infections. In contrast to lymphomas occurring in nonimmunocompromised patients, these tumors typically are of higher grade, are more aggressive, have a worse prognosis, and exhibit a higher frequency of extranodal disease. The most frequent organs involved are the head and neck, bowel, liver, and lungs. Thoracic manifestations of ARL and PTLD are similar, consisting of nodular, diffuse alveolar, and interstitial pulmonary disease, mild to moderate mediastinal adenopathy, and pleural effusions. Of these findings, pulmonary nodules are the most specific, although they can be difficult to differentiate from Kaposi's sarcoma and opportunistic infections. Abdominal findings are also similar for the two diseases, with the most common lesions appearing as low attenuation, hypoechoic masses in the solid abdominal organs; ulcerating nodular or diffusely infiltrating bowel lesions; and bulky retroperitoneal, mesenteric, or omental adenopathy. The identification of solid masses in the abdominal organs in AIDS and transplant patients is highly suspicious for ARL and PTLD. Due to the overlap of imaging characteristics of different pathologies, however, biopsy usually is necessary to confirm the diagnosis. Both ARL and PTLD respond to therapy; however, the prognosis for patients with ARL is uniformly poor, whereas the prognosis for treated PTLD is remarkably good. An awareness of the imaging characteristics of ARL and particularly PTLD can have significant impact on prognosis by allowing for timely diagnosis and therapy.
与普通人群相比，器官移植患者和艾滋病患者患非霍奇金淋巴瘤的风险要高得多。这种风险增加与慢性免疫抑制直接相关，并且通常与病毒感染有关。与非免疫功能低下患者发生的淋巴瘤不同，这些肿瘤通常分级更高、更具侵袭性、预后更差，并且结外疾病的发生率更高。最常受累的器官是头颈部、肠道、肝脏和肺部。艾滋病相关淋巴瘤（ARL）和移植后淋巴组织增生性疾病（PTLD）的胸部表现相似，包括结节状、弥漫性肺泡和间质性肺病、轻至中度纵隔淋巴结肿大以及胸腔积液。在这些表现中，肺结节最具特异性，尽管它们可能难以与卡波西肉瘤和机会性感染相鉴别。这两种疾病的腹部表现也相似，最常见的病变表现为实性腹部器官内的低密度、低回声肿块；溃疡性结节状或弥漫性浸润性肠道病变；以及巨大的腹膜后、肠系膜或网膜淋巴结肿大。在艾滋病患者和移植患者的腹部器官中发现实性肿块高度怀疑为ARL和PTLD。然而，由于不同病理的影像学特征存在重叠，通常需要活检来确诊。ARL和PTLD对治疗均有反应；然而，ARL患者的预后普遍较差，而接受治疗的PTLD患者的预后非常好。了解ARL尤其是PTLD的影像学特征，通过实现及时诊断和治疗，可对预后产生重大影响。
