肾淋巴瘤课件

1、肾淋巴瘤1 肾淋巴瘤 张瑾 肾淋巴瘤2 n淋巴瘤尸检病例中肾脏受侵的比 例达 30% to 60% nCT 仅发现3%8%受侵 n 原因：多数侵犯较为隐匿，病灶 较小，CT不能显示 肾淋巴瘤3 n血源性播散 腹膜后病灶的直接侵犯 n病变发展的晚期 n临床上无症状体征 肾淋巴瘤4 组织病理学特征组织病理学特征 n非霍奇金淋巴瘤淋巴瘤多见 nB细胞源常见 n恶性程度中等或较高 n更多见于淋巴结弥漫增大的病例 肾淋巴瘤5 典型典型CT征象征象 单发结节多发结节腹膜后病变 直接侵犯 弥漫浸润 肾周病变 肾淋巴瘤6 单发结节单发结节 n淋巴瘤的病灶通常为低血供，增强 扫描强化不明显 n密度均匀，与常见的

2、透明细胞肾癌 不同 n在所有肾脏受侵病例中发生率占 10%20% 肾淋巴瘤7 Renal lymphoma in a 69-year-old man. Contrast-enhanced helical CT scan shows a dominant 5-cm mass in the right kidney (arrow). There is no evidence of retroperitoneal adenopathy. 肾淋巴瘤8 Follicular, mixed small cleaved and large cell lymphoma in a 74-year- old ma

3、n. Contrast- enhanced helical CT scan shows a large mass located in the left kidney and extending into the perirenal space. Small nodes are seen in the retroperitoneum (arrow). 肾淋巴瘤9 多发结节多发结节 n最常见 n在所有肾脏受侵病例中发生率占 60% n常为双侧发生，但偶可仅见于单 侧 肾淋巴瘤10 Large cell lymphoma in an 11-year-old boy. The patient pre

4、sented with a large anterior mediastinal mass and renal lesions. Contrast- enhanced helical CT scan demonstrates small, hypoattenuating masses bilaterally (arrows), a typical finding in renal lymphoma. The patient responded well to treatment, and the renal lesions eventually resolved. 肾淋巴瘤11 Large c

5、ell lymphoma in a 73-year-old woman. Contrast-enhanced CT scan shows bilateral renal masses with characteristic homogeneous attenuation, smooth borders, and low contrast enhancement. Retroperitoneal adenopathy is also present (A). 肾淋巴瘤12 腹膜后病变直接侵犯腹膜后病变直接侵犯 n另一较常见类型，占 25%30% n表现为较大且边界不清的肿物包裹 肾门及肾脏血管结

6、构 n密度均匀 n肾脏动静脉血管保持通畅， 但集 合系统常可见梗阻 肾淋巴瘤13 Diffuse lymphocytic lymphoma in a 65-year-old woman. Contrast-enhanced helical CT scan shows a large, homogeneous mass enveloping the retroperitoneum and invading the right kidney. Note how flow is maintained in the renal arteries (straight arrows) and left r

7、enal vein (curved arrow) despite the massive tumor burden. These findings are characteristic of retroperitoneal lymphoma 肾淋巴瘤14 Large cell lymphoma in a 51-year-old woman. Contrast-enhanced helical CT scan shows a large tumor mass invading and displacing the left kidney. The tumor also involves the

8、right side of the retroperitoneum 肾淋巴瘤15 肾周病变肾周病变 n腹膜后病变的直接侵犯或肾被膜的 侵犯 n表现为肾窦受侵，肾周筋膜增厚， 肾周肿物 n偶尔，肾周病变完全未侵犯肾实质 n相对少见，有一定的特异性 肾淋巴瘤16 Large cell lymphoma in a 34-year-old man. Contrast- enhanced helical CT scan demonstrates perirenal masses bilaterally, especially on the right side. The resulting marked

9、 compression and deformity of the right kidney are somewhat unusual for perirenal involvement 肾淋巴瘤17 Perirenal lymphoma in a 64-year-old man. Helical CT scans obtained before (a) and after (b) intravenous administration of contrast material show a perirenal soft-tissue mass enveloping the left kidne

10、y. The symmetric renal function seen in b reflects the characteristic soft nature of lymphomatous tumor 肾淋巴瘤18 弥漫浸润弥漫浸润 n多为双侧性， 约占20%的病例 n表现为受侵肾脏弥漫增大，密度 减低，病变与肾实质界限不清 n受侵的肾脏功能下降，但肾功能 常能保持不出现临床症状 n多数病例通过化疗后能恢复正常。 肾淋巴瘤19 High-grade large cell lymphoma in a 35-year-old man. (a) Contrast- enhanced CT sc

11、an demonstrates patchy tumor infiltration within the kidneys. The kidneys have retained their normal contour, a finding that is characteristic of infiltrative lymphoma. (b) On an unenhanced CT scan, the infiltration is undetectable, which underscores the importance of contrast- enhanced CT for diagn

12、osis 肾淋巴瘤20 Infiltrative renal lymphoma in an 80- year-old man. Contrast-enhanced CT scan shows minimal renal enlargement bilaterally, a finding that suggests subtle involvement by lymphoma 肾淋巴瘤21 Infiltrative renal lymphoma in a 44-year-old woman. Contrast-enhanced CT scan shows the kidneys as diffusely enlarged and replace