5例原发性乳腺淋巴瘤的影像学表现、临床及病理学特征

Imaging Manifestations, Clinical and Pathological Features of 5 Cases of Primary Breast Lymphoma

摘要: 目的：探讨原发性乳腺淋巴瘤(PBL)的影像学表现、临床及病理学特征。方法：回顾分析5例患者经病理证实并具有完整CT及X线影像资料，其中1例有MRI资料。结果：5例均为女性，47~69岁，平均年龄58岁。病灶分布4例位于右乳外上象限(4/5)，1例位于左乳外上象限(1/5)，大小局限在2~5 cm较多(4/5)，1例大于5 cm (1/5)，淋巴瘤多数来源于B细胞(4/5)，少数来源于T细胞占(1/5)。X线上表现均为等密度肿块(5/5)，部分边缘模糊(4/5)，未见明显分叶及毛刺(5/5)，未见钙化及腋窝肿大淋巴结(5/5)，BIRADS分类3类2例(2/5)，4B类2例(2/5)，4C类1例(1/5)。CT表现为类圆形(1/5)、椭圆形(2/5)或不规则形(2/5)等密度影，部分边缘模糊(4/5)，部分脂肪间隙紊乱(3/5)。1例患者行MRI检查，T1WI低信号，T2WI抑脂序列高信号，信号较均匀，DWI (b = 800 s/mm²)呈明显高信号，ADC值(0.73 × 10⁻³ mm²/s)明显减低，动态增强早期均匀强化，可见血管穿行征，延迟期持续强化，延迟晚期稍降低，可见“勾边强化征”，动态增强曲线(TIC)大致呈速升缓降型或平台型。结论：原发性乳腺淋巴瘤影像学、病理、临床均具有一定的特征，全面了解PBL的这些特征将有助于PBL的诊断，治疗及预后。

Abstract: Objective: To explore the imaging, clinical, and pathological features of primary breast lymphoma. Method: A retrospective analysis was conducted on 5 patients with complete CT and X-ray imaging data confirmed by pathology, including 1 patient with MRI data. Results: All 5 cases were female, aged 47 to 69 years, with an average age of 58 years. The lesions are all distributed in the unilateral outer upper quadrant, with 4 cases located in the right outer upper quadrant and 1 case located in the left outer upper quadrant. The size is mostly limited to 2~5 cm (4/5), and 1 case is larger than 5 cm (1/5). The majority of lymphoma comes from B cells (4/5), and a few from T cells (1/5). The X-ray findings were all isodense masses (5/5), with some edges blurry (4/5), no obvious lobulation or spicules (5/5), no calcification or axillary lymph nodes (5/5), BIRADS classification 3 categories in 2 cases (2/5), 4B categories in 2 cases (2/5), and 4C categories in 1 case (1/5). CT manifestations include circular (1/5), elliptical (2/5), or irregularly shaped (2/5) isodensity shadows, some edges are blurry (4/5), and some fat spaces are disordered (3/5). One patient underwent MRI examina-tion, with low signal on T1WI and high signal on T2WI lipo suppression sequence. The signal was relatively uniform, and DWI (b = 800 s/mm²) showed significantly high signal, with an ADC value of 0.73 × 10⁻³ mm²/s significantly decreased, with early and uniform enhancement of dynamic en-hancement, visible vascular transit sign, continuous enhancement in the delayed phase, and slight decrease in the late delayed phase. The “hook edge enhancement sign” can be seen, and the dy-namic enhancement curve (TIC) roughly shows a rapid increase and slow decrease type or plateau type. Conclusion: Primary breast lymphoma has certain imaging, pathological, and clinical features. A comprehensive understanding of these features of PBL will help in the diagnosis, treatment, and prognosis of PBL.