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眼眶弥漫性大B细胞淋巴瘤的病理学与磁共振成像特征研究

Pathological and magnetic resonance imaging characteristics of orbital diffuse large B-cell lymphoma

    摘要
  • 摘要:
    目的 探讨眼眶弥漫性大B细胞淋巴瘤(DLBCL)的病理学特征与磁共振成像(MRI)特征。
    方法 采用回顾性病例对照研究方法，选取48例眼眶DLBCL患者纳入眼眶DLBCL组，另选取同期51例原发性中枢神经系统DLBCL患者纳入原发性DLBCL组。分析眼眶DLBCL组患者的临床特征和MRI影像学特征，并比较2组患者的病理学特征和外周血中血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)和淋巴细胞与单核细胞比值(LMR)。
    结果 眼眶DLBCL患者的主要临床表现包括眼局部肿块48例(100.00%)、眼球活动受限38例(79.17%)、眼球突出33例(68.75%)、视力下降25例(52.08%)、复视17例(35.42%)和鼻出血9例(18.75%); 眼眶DLBCL好发于肌锥外间隙(54.17%), 病变多位于眼眶上方(52.08%), T1加权像主要表现为中等信号(60.42%), T2加权像主要表现为中等信号(56.25%)和高信号(29.17%), 扩散加权成像主要表现为高信号(58.33%), 表观扩散系数图主要表现为低信号(60.42%)。2组患者在病理组织学分型、CD20阳性表达、CD79a阳性表达、CD45RO阳性表达、国际预后指数评分、病理学分期方面比较，差异均无统计学意义(P>0.05); 眼眶DLBCL组患者外周血PLR高于原发性DLBCL组, NLR、LMR低于原发性DLBCL组，差异均有统计学意义(P < 0.05)。
    结论 眼眶DLBCL具有特异性的临床表现和MRI特征, MRI可作为其主要诊断手段，结合病理学免疫组化分析及外周血PLR、NLR、LMR检测结果，有助于提高诊断的准确性和及时性。

     

    Abstract:
    Objective To investigate the pathological and magnetic resonance imaging (MRI) characteristics of orbital diffuse large B-cell lymphoma (DLBCL).
    Methods A total of 48 patients with orbital DLBCL were selected via a retrospective case-control study in the orbital DLBCL group, and 51 patients with DLBCL of primary central nervous system during the same period were included in primary DLBCL group. The clinical characteristics and MRI features of the orbital DLBCL group were analyzed, and the pathological characteristics and peripheral blood platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR) were compared between the two groups.
    Results The main clinical manifestations of orbital DLBCL patients included local orbital mass in 48 cases (100.00%), limited ocular motility in 38 cases (79.17%), exophthalmos in 33 cases (68.75%), decreased visual acuity in 25 cases (52.08%), diplopia in 17 cases (35.42%), and epistaxis in 9 cases (18.75%). Orbital DLBCL predominantly occurred in the extraconal space (54.17%), with lesions mostly located above the orbit (52.08%). T1-weighted images mainly showed intermediate signal intensity (60.42%), T2-weighted images mainly showed intermediate (56.25%) and high signal intensity (29.17%), diffusion-weighted images mainly showed high signal intensity (58.33%), and apparent diffusion coefficient maps mainly showed low signal intensity (60.42%). There were no statistically significant differences in histopathological subtype, CD20 positive expression, CD79a positive expression, CD45RO positive expression, International Prognostic Index score, and pathological stage between the two groups (P>0.05). The PLR in the orbital DLBCL group was higher, while NLR and LMR were lower than that in the primary DLBCL group (P < 0.05).
    Conclusion Orbital DLBCL exhibits specific clinical manifestations and MRI characteristics. MRI can serve as the primary diagnostic tool, and its combination with pathological immunohistochemical analysis and peripheral blood PLR, NLR, and LMR test results can improve the accuracy and timeliness of diagnosis.

     

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