Lu Qing, Zhang Hui, Wang Wen-Ping, Jin Yun-Jie, Ji Zheng-Biao
Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China.
Hepatobiliary Pancreat Dis Int. 2015 Feb;14(1):75-81. doi: 10.1016/s1499-3872(14)60285-x.
A preoperative diagnosis of primary hepatic lymphoma (PHL) can have profound therapeutic and prognostic implications. Because of the rarity of PHL, however, there are few reports on diagnostic imaging. We reviewed the clinical and radiologic findings of 29 patients with PHL, the largest series to date, to evaluate the diagnostic features of this disease.
Clinical data and radiologic findings at presentation were retrospectively reviewed for 29 patients with pathologically confirmed PHL from January 2005 to June 2013. Imaging studies, including ultrasound (US) (n=29) and contrast-enhanced computed tomography (CECT) (n=24), were performed within 2 weeks before biopsy or surgery.
Among the 29 patients, 23 (79%) were positive for hepatitis B virus (HBV) and 26 (90%) had a significantly elevated level of serum lactate dehydrogenase (LDH). There were two distinct types of PHL on imaging: diffuse (n=5) and nodular (n=24). Homogeneous or heterogeneous hepatomegaly was the only sign for diffuse PHL on both US and CECT, without any definite hepatic mass. For the nodular type, 63% (15/24) of patients had solitary lesions and 38% (9/24) had multiple lesions. On US, seven patients displayed patchy distribution with an indistinct tumor margin and a rich color flow signal. CECT showed rim-like enhancement (n=3) and slightly homogeneous or heterogeneous enhancement (n=14) in the arterial phase and isoenhancement (n=5) and hypoenhancement (n=12) in the portal venous and late phases. Furthermore, in five patients, CT revealed that hepatic vessels passed through the lesions and were not displaced from the abnormal area or appreciably compressed.
The infiltration type of PHL was associated with the histologic subtype. Considered together with HBV positivity and elevated LDH, homogeneous or heterogeneous hepatomegaly may indicate diffuse PHL, whereas patchy distribution with a rich color flow signal on US or normal vessels extending through the lesion on CECT may be the diagnostic indicators of nodular PHL.
原发性肝淋巴瘤（PHL）的术前诊断对治疗和预后具有深远影响。然而，由于PHL罕见，关于其诊断性影像学的报道较少。我们回顾了29例PHL患者的临床和影像学表现，这是迄今为止最大的病例系列，以评估该疾病的诊断特征。
回顾性分析2005年1月至2013年6月间29例经病理证实的PHL患者的临床资料和就诊时的影像学表现。活检或手术前2周内进行了影像学检查，包括超声（US）（n = 29）和增强计算机断层扫描（CECT）（n = 24）。
29例患者中，23例（79%）乙型肝炎病毒（HBV）阳性，26例（90%）血清乳酸脱氢酶（LDH）水平显著升高。影像学上有两种不同类型的PHL：弥漫型（n = 5）和结节型（n = 24）。在US和CECT上，均匀或不均匀肝肿大是弥漫型PHL的唯一征象，无明确肝肿块。对于结节型，63%（15/24）的患者有单个病灶，38%（9/24）有多个病灶。在US上，7例患者表现为斑片状分布，肿瘤边界不清，血流信号丰富。CECT显示动脉期环形强化（n = 3）、轻度均匀或不均匀强化（n = 14），门静脉期和延迟期等密度强化（n = 5）和低密度强化（n = 12）。此外，5例患者的CT显示肝血管穿过病灶，未从异常区域移位或明显受压。
PHL的浸润类型与组织学亚型相关。结合HBV阳性和LDH升高，均匀或不均匀肝肿大可能提示弥漫型PHL，而US上斑片状分布伴丰富血流信号或CECT上正常血管穿过病灶可能是结节型PHL的诊断指标。
