頭頸部淋巴瘤之電腦斷層表徵

CT Presentation of Head and Neck Lymphomas

凌憬峯(Jiing-Feng Lirng)；鄧木火(Michael Mu Huo Teng)；陳行素(Shing-Su Chen)；張遵(Tsuen Chang)

淋巴瘤 ； 頭頸部腫瘤 ； 頭頸部電腦斷層 ； lymphoma ； head and neck ； neoplasm ； head, CT ； neck, CT

中華放射線醫學雜誌

16卷4期（1991 / 12 / 01）

345 - 352

繁體中文

我們收集了本院從1983到1990年，8年間接受過電腦斷層檢查患有頭頸部淋巴瘤的病人，共有50例，針對電腦斷層表徵做有系統的分類整理。病人中，男性39例女性11例；Hodgkin's病5例，non-Hodgkin's淋巴瘤45例。年齡分佈從6歲到84歲，大部份病人分佈在50歲到80歲之間。所表現的症狀以頸部腫瘤最常見，佔56% (28/50)。若以病理組織型態來分，5例Hodgkin, 5病均為混合細胞型(mixed cellularity), non-Hodgkin's淋巴瘤則以擴散性大細胞型(diffuse large cell type)較常見。以病灶生長的位置來分類的話，淋巴結內(intranodal)病灶有11例(22%)，淋巴結外淋巴系統內(extranodal intralymphatic)病灶有21例(42%)，淋巴結外淋巴系統外(extranodal extralymphatic)病灶有15例(30%)，多發性結外病灶3例(6%)，扁桃腺則是最常見的結外病灶分佈組織。若依Lee YY等人對頭頸部淋巴瘤電腦斷層表徵所作之四種分類，我們的病人以第三類合併結內及結外病灶者最多見。有82% (41/50)的病灶於電腦斷層上呈現略低或等於軟組織密度之腫瘤，腫瘤邊綠對比劑增強的現象可有可無，結內病灶則可見多個淋巴結融合成大腫塊，分佈範圍較廣泛。腫瘤中呈低密度區病變者有九例(18%)。電腦斷層檢查對頭頸部淋巴瘤的診斷，治療計畫的擬定及病灶復發之評估均佔有重要地位。

We collected 50 cases of head and neck lymphomas who received CT examination in Veterans General Hospital-Taipei from January 1983 to December 1990, including 39 men and 11 women in the range between 6 and 84 years of age. The most common symptom is neck mass (es), found in 56% (28/50) of our cases. The histopathology of mixed cellularity type was noted in all of the 5 patients with Hodgkin's disease. In 45 patients with non-Hodgkin's lymphoma, diffuse large cell lymphoma was the most common histopathologic subgroup. Intranodal lesions were found in 22% (11/50) of cases; extranodal intralymphatic lesions in 42% (21/50); extranodal extralymphatic lesions in 30% (15/50) and multifocal extranodal lesions in 6% (3/50). According to the study of Lee Y Y et al, four types of abnormalities can be identified by CT: nodal involvement alone (type 1), extranodal involvement alone (type 2), a combination of extranodal and nodal disease (type 3), and multifocal extranodal disease with or without nodal involvement (type 4). Among them, type 3 is the prevailing CT presentation in our study, followed by type 2. The CT presentation of slightly hypoclense or isodense soft tissue mass lesions with or without rim enhancement was found in 82% (41/50) of our cases. The lymphomatous nodes were extensive and confluent. Focal low attenuation areas within the lesion were found in 9 cases (18%). CT examination plays an important role in suggesting diagnosis, treatment planning and evaluation for recurrence following treatment of head and neck lymphomas.