鼻中隔非霍奇金淋巴瘤一例

梁丰丽，高艳艳

患者女，26岁，因“间断鼻塞头痛10年余，加重10 d”就诊于甘肃省人民医院。患者自述10年前感冒后出现双侧鼻塞，伴有头痛、头晕，就诊于秦安县人民医院予以药物口服后症状减轻，之后上述症状间断发作，患者未予重视，10 d前上述症状加重，伴有发热，最高达39℃。体重近期无变化。行前鼻镜检查示：双侧鼻腔脓性分泌物。CT平扫：鼻中隔见类圆形软组织密度影，大小约2.4 cm×2.1 cm，呈膨胀性生长，邻近骨质吸收变薄，内密度均匀，边界清晰，CT值约50 HU(图1A、B)，增强扫描病灶呈轻度强化(图1C)，影像诊断为良性囊肿。MRI平扫：病灶呈短T1、等T2信号影，短TI反转恢复(short TI inversion recovrey，STIR)序列压脂呈明显低信号(图1D～F)，影像诊断为脂肪瘤。MRI平扫：病灶呈短T1、等T2信号影，Dixon压脂呈稍高信号(图1G)，DWI呈低信号(图1H)，影像诊断为黏液囊肿合并感染。行鼻内镜下鼻腔肿物切除术，术中见肿物呈囊性改变，质地软，切开囊壁吸出囊液后，见硬腭呈大小约2 cm×2 cm的凹陷。病理检查可见大量组织细胞、淋巴细胞和浆细胞(图 1I)。免疫组化结果：CD45(+)、CD3(+)、CD20(灶+)、CD4(散在+)、CD8(+)、CD38(灶+)、CD138(灶+)、EMA(上皮细胞+)、Ki67(75%)。病理诊断：非霍奇金淋巴瘤(non-Hodgkin's lymphoma，NHL；T细胞)。术后随访6个月患者病情控制良好，无明显不适。

图1 患者女，26岁，确诊非霍奇金淋巴瘤。A、B：CT平扫示鼻中隔类圆形软组织密度影，内密度均匀，呈膨胀性生长，邻近骨质吸收变薄(白箭)；C：CT增强示病灶呈轻度强化；D、E：MR平扫示病灶信号均匀，呈短T1、等T2信号；F：STIR压脂呈明显低信号；G：Dixon压脂呈稍高信号；H：DWI呈低信号；I：病理图示可见大量组织细胞、淋巴细胞和浆细胞，部分细胞核形欠规则，深染(HE×400)Fig.1 A 26-year-old female patient was diagnosed with non-Hodgkin's lymphoma.A,B:CT plain scan showed round soft tissue density shadow in nasal septum,with uniform internal density and expansive growth,and bone absorption and thinning near the nasal septum(white arrow).C:Enhanced CT showed mild enhancement.D,E:MR plain scan showed that the signal intensity of the lesion was uniform,showing short T1 and equal T2 signals.F:STIR fat pressure was obviously low signal.G:Dixon fat pressure was slightly high signal.H:DWI showed low signal.I:Pathological examination showed a large number of histiocytes,lymphocytes and plasma cells,and some of the nuclei were irregular and hyperchromatic(HE×400).

讨论NHL是起源于淋巴结和淋巴组织的免疫系统恶性肿瘤。……