首页|小儿异基因造血干细胞移植术后淋巴组织增殖性疾病临床特征及CT表现

小儿异基因造血干细胞移植术后淋巴组织增殖性疾病临床特征及CT表现

The CT Manifestations and Clinical Characteristics of Post-Transplant Lymphoproliferative Diseases after Allogeneic Hematopoietic Stem Cell Transplantation in Children

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目的 观察小儿异基因造血干细胞移植(HSCT)移植后淋巴组织增殖性疾病(PTLD)的临床特征及CT表现.方法 回顾性分析2016年10月至2022年3月本院收治的21例PTLD患儿病例资料.确诊前所有病例均行CT平扫检查,10例平扫后行增强扫描.结果 21例患儿均见结内组织受累,其中20例累及颈部/颌下淋巴结(其中9例同时累及腭扁桃体、2例累及腺样体),另外1例累及腹部多处淋巴结;结外组织受累5例(23.8％),其中肺部受累3例、胃壁受累1例、膀胱壁受累1例.按部位观察,颈部20例、肺部3例、腹部3例.移植与PTLD确诊间隔时间1～24个月,平均(4.67±5.61)个月.临床首次就诊原因主要为颈部包块、气道阻塞、腹痛、发热等,多伴有EB病毒(EBV)、巨细胞病毒(CMV)及乳酸脱氢酶(LDH)升高.1例确诊PTLD后5个月死亡;另有1例肺部PTLD病灶,短期内较前逐渐、快速增大;15例好转;由于病程较短,其余4例暂未随访.结论 小儿PTLD具有较高的侵袭性,且小儿发病率明显高于成人,但预后优于成人;及时和准确的诊断对预后至关重要.临床与影像学检查相结合,有利于早期诊断.
Objective To observe The CT manifestations and clinical characteristics of post-transplant lymphoprolifera-tive diseases after allogeneic hematopoietic stem cell transplantation in children.Methods We conducted a retrospective analysis the case of 21 children with PTLD admitted to our hospital from October 2016 to March 2022.Before diagnosis,all cases received plain CT scan,and 10 cases received enhanced CT scan after plain scan.Results All the 21 cases were found to be involved in nodal tissue,including 20 cases involving cervical/submaxillary lymph nodes(9 cases involving pal-atine tonsils,2 cases involving adenoids among them at the same time),and 1 case involving multiple abdominal lymph nodes.Extranodal tissue was involved in 5 cases(23.8％),including pulmonary mass in 3 cases,gastric wall in 1 case and bladder wall in 1 case.By site observation,20 cases of neck,3 cases of lung and 3 cases of abdomen were involved.The av-erage interval between transplantation and PTLD diagnosis was(4.67±5.61)months from 1 to 24 months.The main rea-sons for the first visit were neck mass,airway obstruction,abdominal pain,fever,etc.,often accompanied by elevated EBV,CMV and LDH.1 patient died 5 months after diagnosis of PTLD;In addition,there was 1 case of pulmonary PTLD lesion,which increased gradually and rapidly in the short term;15 cases improved;and due to the short course of the disease,the other 4 cases were not followed up.Conclusion PTLDs in children are highly invasive,and the incidence of PTLD in children is significantly higher than that in adults,but the prognosis is better than that in adults.Timely and accurate diagno-sis is very important for prognosis.The combination of clinical and imaging examination is conducive to early diagnosis.

ChildrenAllogeneic hematopoietic stem cell transplantationLymphoproliferative diseaseTomography,X-ray computed

徐守军、杨春兰、曹娟、谢丽春、林飞飞、王春静、罗娜

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518026 深圳市儿童医院放射科

518026 深圳市儿童医院血液肿瘤科

518026 深圳市儿童医院病理科

510530 广州医科大学附属第三医院儿科

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儿童 异基因造血干细胞移植 淋巴组织增殖性疾病 体层摄影术,X线计算机

广东省高水平临床重点专科项目广东省基础与应用基础研究基金深圳市医学重点学科建设经费项目深圳市医疗卫生三名工程项目深圳市基础研究专项(自然科学基金)基础研究面上项目

SZGSP0122022A1515111121SZXK034SZSM202011005JCYJ20220530155616038

2024

临床放射学杂志
黄石市医学科技情报所

临床放射学杂志

CSTPCD北大核心
影响因子：0.872
ISSN：1001-9324
年,卷(期)：2024.43(2)
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