胃原发性淋巴瘤的影像学诊断(1)
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【摘要】目的:探讨胃原发性淋巴瘤的影像学诊断及鉴别诊断。资料与方法:分析我院经病理证实的胃恶性淋巴瘤20例患者进行回顾性分析。结果：胃肠道气钡双重造影检查，20例胃原发性淋巴瘤中单个较大的不规则充盈缺损9例，其中7例形成“牛眼”征；6例表现为多个大小不等卵石样充盈缺损；3例形成单个巨大溃疡，1例表现为典型的“半月综合征”；多个大小不等浅淡龛影2例；7例胃腔变形，胃壁柔软，蠕动减弱。4例胃原发性淋巴瘤进行CT扫描，3例弥漫性胃壁增厚，1例腔内不规则形肿块，3例胃周脂肪间隙欠清晰。病理组织学结果：19例非何杰金淋巴瘤：其中16例B细胞性，3例T细胞性；1例何杰金淋巴瘤。结论：胃肠道气钡双重造影是胃原发性淋巴瘤定性诊断主要的检查方法，CT扫描是有效的补充。
【关键词】胃肠道；原发性淋巴瘤；气钡双重造影；CT
Radiologic diagnosis of primary gastric lymphoma
【Abstract】Objective To discuss the radiologic diagnosis and the differential diagnosis of primary gastric lymphoma. Materials and methods 20 cases with pathologic-proved primary gastric lymphoma were retrospectively analyzed. Results Double-contrast barium meal examinations of 20 cases: single magnus irregular filling defect (n=9), in which 7 cases demonstrated buphthalmos sign; multiple inequality of size, pebble-shaped filling defect (n=6); single great ulcer (n=3), in which 1 case presented typical crescent-shaped sign; multiple inequality of size, shallow niche (n=2); 7 cases revealed deformity of gastric lumen, soft of gastric wall, weakening of peristalsis. CT scans were performed in 4 cases,3 cases revealed diffuse thickening, 1 case revealed irregular mass in gastric lumen. Perigastric fat space of 3 cases was not clear. Pathologic findings: non-Hodgkin's lymphoma (n=19), including B-cell lymphoma (n=16) and T-cell lymphoma (n=3); Hodgkin's disease (n=1). Conlusion Double-contrast barium meal examination was the chief and first selected examination on diagnosis of primary gastric lymphoma, and CT scan was the effective supplement.
【Key words】 Gastric;Primary lymphoma;Double-contrast barium meal，CT.
【中图分类号】R352 【文献标识码】B【文章编号】1005-0515(2011)08-0323-03
胃原发性淋巴瘤(Primary gastrointestinal lymphoma) 是胃非癌恶性肿瘤中最常见的类型，约占胃肠道恶性肿瘤的1-4%，其中胃约占50-70%[1]。胃恶性淋巴瘤根据细胞形态特点和组织结构特点分为霍奇金病(Hodgkins Disease)和非霍奇金淋巴瘤(Non-Hodgkins Lymphoma)两类。胃原发性淋巴瘤绝大多数为霍奇金氏淋巴瘤(non-Hodgkin'S lymphoma，NHL),霍奇金氏淋巴瘤(Hodgkin'S disease，HD)罕见[2]。本文收集我院2005年9月～2011年2月间经病理证实的胃恶性淋巴瘤20例进行回顾性分析。
1 资料和方法
本组20例，均符合原发性胃淋巴瘤的Dawson(1961年)标准[3]。其中男7例，女13例，平均44岁。临床症状表现为腹痛15例，腹胀不适4例，贫血1例，伴黑便4例，恶心呕吐8例，呕血、消瘦各1例。
20例均做了上消化道气钡双重造影(UGI)检查。检查前患者均服产气粉使胃充分扩张，然后口服115ml浓度为220% w/v钡剂混悬液，多方位点片。
有4例行腹部CT平扫及增强扫描 ......
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