肾淋巴瘤

肾淋巴瘤,张瑾,淋巴瘤尸检病例中肾脏受侵的比例达 30% to 60%CT 仅发现3%8%受侵 原因：多数侵犯较为隐匿，病灶较小，CT不能显示,血源性播散 腹膜后病灶的直接侵犯病变发展的晚期 临床上无症状体征,组织病理学特征,非霍奇金淋巴瘤淋巴瘤多见 B细胞源常见恶性程度中等或较高更多见于淋巴结弥漫增大的病例,典型CT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,单发结节,淋巴瘤的病灶通常为低血供，增强扫描强化不明显密度均匀，与常见的透明细胞肾癌不同在所有肾脏受侵病例中发生率占10%20%,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.,Follicular, mixed small cleaved and large cell lymphoma in a 74-year-old man. 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).,多发结节,最常见 在所有肾脏受侵病例中发生率占60%常为双侧发生，但偶可仅见于单侧,Large cell lymphoma in an 11-year-old boy. The patient presented 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.,Large cell 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).,腹膜后病变直接侵犯,另一较常见类型，占 25%30% 表现为较大且边界不清的肿物包裹肾门及肾脏血管结构密度均匀肾脏动静脉血管保持通畅， 但集合系统常可见梗阻,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 renal vein (curved arrow) despite the massive tumor burden. These findings are characteristic of retroperitoneal lymphoma,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 right side of the retroperitoneum,肾周病变,腹膜后病变的直接侵犯或肾被膜的侵犯表现为肾窦受侵，肾周筋膜增厚， 肾周肿物 偶尔，肾周病变完全未侵犯肾实质相对少见，有一定的特异性,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 compression and deformity of the right kidney are somewhat unusual for perirenal involvement,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 kidney. The symmetric renal function seen in b reflects the characteristic soft nature of lymphomatous tumor,弥漫浸润,多为双侧性， 约占20%的病例 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 受侵的肾脏功能下降，但肾功能常能保持不出现临床症状多数病例通过化疗后能恢复正常。,High-grade large cell lymphoma in a 35-year-old man. (a) Contrast-enhanced CT scan 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 diagnosis,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,Infiltrative renal lymphoma in a 44-year-old woman. Contrast-enhanced CT scan shows the kidneys as diffusely enlarged and replaced by