O'Neill J K, Devaraj V, Silver D A T, Sarsfield P, Stone C A
Department of Plastic and Reconstructive Surgery, Royal Devon and Exeter Hospital, Barrack Road, Exeter, UK.
J Plast Reconstr Aesthet Surg. 2007;60(6):646-54. doi: 10.1016/j.bjps.2006.03.040. Epub 2006 Jun 6.
Non-Hodgkin's lymphoma usually presents with lymphadenopathy at multiple sites but can also involve any part of the musculoskeletal system. Occasionally the presentation is with a soft tissue mass. The presentation of large, superficial lymphomatous masses is similar both clinically and radiologically to that of soft tissue sarcomas. The six cases of lymphoma presenting to the Exeter Sarcoma Service as suspected soft tissue sarcomas, over a two-year period (2002-2004), are presented. We describe the clinical and imaging characteristics of these tumours and their subsequent management. Our cases showed variability in presentation. Only one of the six cases presented with pain and one with tenderness. Four of the cases had no lymphadenopathy and the other two had lymphadenopathy restricted to one nodal basin. Overlying soft tissue swelling occurred in four cases and in distal limb swelling beyond the mass in one case. Radiologically, lymphomas are known to be likely to exhibit confluent lymphadenopathy that is rare in patients with soft tissue sarcoma. Confluent lymphadenopathy was demonstrated in only one case of this series of patients. It is thought that lymphomas infiltrate across anatomical fascial planes more readily than sarcomas and in four of our six cases this feature was present. Clinical history, examination and MRI are insufficient to differentiate between soft tissue sarcoma and lymphoma and the importance of obtaining a pathological diagnosis prior to surgery is clear. It is crucial to differentiate lymphoma from sarcoma in order to avoid unnecessary excisional procedures in lymphoma patients.
非霍奇金淋巴瘤通常表现为多部位淋巴结病，但也可累及肌肉骨骼系统的任何部位。偶尔表现为软组织肿块。大的浅表淋巴瘤肿块在临床和影像学上与软组织肉瘤相似。本文介绍了在两年期间（2002 - 2004年），以疑似软组织肉瘤就诊于埃克塞特肉瘤服务中心的6例淋巴瘤病例。我们描述了这些肿瘤的临床和影像学特征以及后续治疗情况。我们的病例表现各异。6例中只有1例有疼痛，1例有压痛。4例无淋巴结病，另外2例的淋巴结病局限于一个淋巴结区域。4例出现覆盖软组织肿胀，1例出现肿块远端肢体肿胀。在影像学上，已知淋巴瘤可能表现为融合性淋巴结病，这在软组织肉瘤患者中很少见。本系列患者中仅有1例显示融合性淋巴结病。据认为，淋巴瘤比肉瘤更容易穿过解剖筋膜平面浸润，我们的6例中有4例具有这一特征。临床病史、检查和磁共振成像不足以区分软组织肉瘤和淋巴瘤，术前获得病理诊断的重要性显而易见。为避免对淋巴瘤患者进行不必要的切除手术，区分淋巴瘤和肉瘤至关重要。
