头颈部结外淋巴瘤及其鉴别病变的影像表现
本文综述头颈部结外淋巴瘤在不同解剖部位的影像表现及其鉴别诊断,涵盖韦氏环、鼻腔鼻窦、眼眶、唾液腺和甲状腺。重点讨论非肿瘤性病变如眼眶特发性假瘤、肉芽肿性多血管炎、IgG4相关病、Rosai-Dorfman病及肿瘤性病变如鳞癌、NUT癌和淋巴上皮癌。目的是帮助放射科医生识别提示不典型淋巴瘤或拟似病变的影像红旗征象,减少不必要活检并指导患者管理。
要点
- 头颈部结外淋巴瘤影像表现多样,需结合解剖部位和临床背景综合判断。
- 发现与典型淋巴瘤不符的红旗征象时,应主动考虑非淋巴瘤性病变可能。
- 熟悉鉴别诊断有助于减少不必要的头颈部活检并优化患者处理流程。
核心结论
- 放射科医生应能够区分头颈部淋巴瘤与其影像拟似病变,从而提高影像判读水平、减少不必要活检并提供最佳患者管理。
研究设计与样本
- 本文为综述,回顾不同头颈部解剖部位中淋巴瘤拟似病变的影像表现,并参考临床表现、易感因素和实验室标志物。
关键影像表现/征象
- 综述涵盖韦氏环、鼻腔鼻窦、眼眶、唾液腺和甲状腺的结外淋巴瘤及拟似病变影像表现。
- 拟似病变包括非肿瘤性的眼眶特发性假瘤、肉芽肿性多血管炎、IgG4相关病和Rosai-Dorfman病。
- 肿瘤性拟似病变包括鳞状细胞癌、NUT癌和淋巴上皮癌。
- 文中讨论影像上提示不典型淋巴瘤或可能为拟似病变而非典型淋巴瘤的红旗征象。
临床应用与阅片要点
- 阅片时若见头颈部肿块影像特征与典型淋巴瘤不符,应结合实验室标志物与易感因素扩大鉴别诊断范围。
- 识别影像红旗征象有助于提示不典型淋巴瘤或潜在拟似病变,避免直接诊断为典型淋巴瘤。
以上解读依据论文摘要(全文未开放获取或许可不允许翻译转载)。
英文原文(摘要)· 点击展开
Extra-nodal head and neck lymphoma encompasses diverse histological subtypes and imaging appearances. Thus, it can be challenging to discriminate lymphoma from other lesions that may have similar radiological features. Herein, various lymphoma mimics will be reviewed in different anatomical locations in the head and neck including Waldeyer's ring, sinonasal tract, orbits, and salivary and thyroid glands, with reference to their clinical presentation, predisposing factors, and laboratory markers. These mimics encompass non-neoplastic (idiopathic orbital pseudotumor, granulomatosis with polyangiitis, IgG4-related disease and Rosai-Dorfman disease) and neoplastic (squamous cell carcinoma, NUT carcinoma, lymphoepithelial carcinoma) conditions. Red flags on imaging that should raise the suspicion for atypical lymphoma or potential mimics over typical lymphoma will be discussed. By the end of this review, radiologists should be able to differentiate lymphoma from its mimics in the head and neck, with the goal of improving imaging interpretation, reducing unnecessary biopsies, and providing the best patient management. Educational objectives.
引用
- Gad, Deng. Imaging of Extra-nodal Head and Neck Lymphoma and its Mimics. Eur J Radiol. 2026. PMID: 42235460. doi:10.1016/j.ejrad.2026.112965
供执业医师工作参考,不替代临床判断;数值与分级以指南原文为准。