【双语病例】丙肝相关性非霍奇金淋巴瘤

History

A 56-year-old man with history of chronic hepatitis C and low-risk prostate cancer presents with periumbilical pain for the last week.

56岁男性,既往有慢性丙肝、低风险前列腺癌。现脐周痛一周。

【双语病例】

【双语病例】

【双语病例】

【双语病例】

【双语病例】

1.There is conglomerate retroperitoneal lymphadenopathy.

腹膜后淋巴结肿大并相互融合。

True

False

2.The spleen is nodular in contour.

脾脏边缘呈结节状。

True

False

3.There is an occlusive inferior vena caval thrombus.

下腔静脉血栓闭塞。

True

False

4.There is a rind of hypodense tissue around the visualized upper renal poles.

肾上极可见低密度组织包绕。

True

False

5.There are hypodense hepatic lesions.

肝内可见低密度病灶。

True

False

6.The attenuation pattern of the spleen is most likely related to which of the following?

脾脏的异常密度是由下列哪项所致?

Physiologic enhancement 正常生理性强化

Chronic post-traumatic changes 外伤后慢性改变

Multifocal hemangiomas 多发血管瘤

Neoplastic involvement 肿瘤侵犯

7.Which of the following is the most likely diagnosis?

最有可能的诊断是下列哪项?

Metastatic hepatocellular carcinoma 转移性肝细胞型肝癌

Metastatic prostate cancer 转移性前列腺癌

Lymphoma 淋巴瘤

Abdominal tuberculosis 腹部结核

Reactive lymphadenopathy from inflammatory bowel disease 肠道炎性病变反应性淋巴结肿大

【双语病例】

Additional Questions

8.The majority of lymphomas originate from which the following lymphocyte types?

大部分淋巴瘤起源于哪种淋巴细胞?

B cells

T cells

9.Mesenteric lymphadenopathy is more common in which of the following?

腹膜后淋巴结肿大最常见于下列哪种淋巴瘤?

Hodgkin\’s lymphoma

Non-Hodgkin\’s lymphoma

10.Infection with the hepatitis C virus (HCV) has been associated with increased risk for non-Hodgkin\’s lymphoma.

丙肝病毒感染可能会增加非霍奇金淋巴瘤的患病几率。

True

False

11.Patients with chronic hepatitis C have a higher risk of developing lymphoma than hepatocellular carcinoma.

慢性丙肝的患者发生淋巴瘤的几率高于肝细胞型肝癌。

True

False

【双语病例】

【双语病例】

选择题答案:

  1. True

  2. True

  3. False

  4. False

  5. True

  6. Neoplastic involvement

  7. Lymphoma

  8. B cells

  9. Non-Hodgkin\’s lymphoma

  10. True

  11. False

【双语病例】

Findings and Diagnosis

Findings

Contrast-enhanced CT demonstrates markedly enlarged, hypoattenuating conglomerate upper abdominal retroperitoneal and mesenteric lymphadenopathy (best demonstrated on coronal images). There are multifocal hypodense lesions throughout the spleen, which is enlarged and nodular in contour, reflecting lymphomatous involvement. There are a few small hypodense lesions in the liver, the most prominent in segment VI, which were incompletely characterized, but favored to represent hepatic lymphomatous involvement given the lymphadenopathy and splenic involvement. The patient was subsequently confirmed to have diffuse large B-cell lymphoma.

增强CT示上腹部腹膜后及肠系膜淋巴结明显增大、并相互融合(冠状位显示佳)。脾脏内见多发低密度灶,考虑为淋巴瘤侵犯所致。肝内可见数个低密度灶,最大的位于VI段,影像学表现不典型,但结合腹膜后淋巴结肿大和脾脏病灶,考虑肝脏淋巴瘤。该患者病理证实为弥漫性大B细胞淋巴瘤。

Differential Diagnosis

  • Lymphoma 淋巴瘤

  • Retroperitoneal metastases 腹膜后转移瘤

  • Retroperitoneal fibrosis 腹膜后纤维化

  • Abdominal manifestation of tuberculosis 结核病腹部表现

  • Abdominal manifestation of sarcoidosis 肉状瘤病腹部表现

Diagnosis

Non-Hodgkin\’s lymphoma (HCV-associated)

丙肝相关性非霍奇金淋巴瘤

【双语病例】

Pathophysiology

Non-Hodgkin\’s lymphoma (NHL)

  • Abnormal proliferation of mature lymphocyte population.

    成熟淋巴细胞数量的异常增多

  • Spectrum of disease or multiple subtypes: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype and can occur as primary disease or transformation from indolent lymphoma.

    弥漫性大B细胞淋巴瘤(DLBCL)是最常见的亚型,可以是首发,也可以由惰性淋巴瘤转化而来。

HCV-associated lymphoma

  • Clinical association with various viral infections is well-described, including Epstein-Barr virus (EBV), human T-lymphotropic virus 1 (HTVL-1), human immunodeficiency virus (HIV), hepatitis C virus (HCV), and herpes simplex virus (HSV)

    很多种病毒感染与淋巴瘤有一定的联系,包括EB病毒、人类嗜T细胞病毒I(HTVL-1)、人免疫缺陷病毒(HIV)、丙肝病毒(HCV)、单纯疱疹病毒(HSV)。

  • HCV associated with moderately increased risk of NHL (less than risk of hepatocellular carcinoma).

    HCV感染可以增加NHL的发病几率,但几率低于肝细胞肝癌。

CT Feature

Enlarged/conglomerate lymph nodes:

淋巴结肿大/融合:

  • Nodes larger than 1 cm in short axis

    淋巴结肿大,短径超过1cm

  • Confluent soft tissue from conglomerate nodes

    淋巴结相互融合,呈软组织密度肿块

  • Cystic occur in minority of cases

    少数病例淋巴结内可发生囊变

Extranodal solid organ involvement can be variable in appearance.Spectrum from diffuse infiltration to focal lesions:

结外实质器官受累表现多种多样,可以表现为弥漫性浸润,也可以表现为局限性病变:

Spleen:

  • Involved in 20% to 40% of cases.

    约20%-40%的患者可见脾脏受累

  • Lymphoma is most common malignancy of the spleen (more common than metastases).

    淋巴瘤是脾脏最初见的恶性肿瘤(发病率高于转移瘤)

Liver:

  • Involved in 15% of cases.

    约15%的患者可见肝脏受累

  • Single or multifocal hypodense lesions.

    单发或多发低密度灶

  • Diffuse infiltrative disease can be difficult to differentiate from steatosis by appearance alone.

    单从影像学角度,弥漫性浸润性病变很难与肝脂肪变性鉴别。

Other abdominal solid organs and bowel also can be involved and can also demonstrate a spectrum of appearances.

肿瘤还可以侵犯腹部其他实质器官及肠道,表现也各有不同。

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