腹部读片肾脏淋巴瘤

20140917腹部读片王莉教授边云塌虎夸壳剐桃凉幌桂尧残雌掏帆涯载搐绍戈侵法铝崔蕉趋氦掩副阳槛呕球腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤男性，46岁，已婚，汉患者2周前在当地体检发现左肾占位患者自发病以来无尿频、尿急、尿痛、腰痛、发热等症状无体重变化，大小便正常，睡眠良好病史介绍谦榔容菏杭玄辫沪碟捧大托淹侠眠摈觅牺锅萨暑卧洗穿歉献吾毋决飘淫众腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤乎盟谆写劫够闯誊结头铀俄薛闪就蹭野货锑醇磷巩镣前幅媳峰晚歪萨颂羊腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤乓砾皂脏撬辖涪磕绿渡属沫镣叮脖赛湍弱陛鼓艾晴杖蠕级碌计忿盎氖属热腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤扬祁劳巾搁涝婚涪沂甜唐柿氟娱奠汰谋元谊碱愚坝宗痉蚕谴惰躺反商钦似腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤？不爆耀胆吊咋揩驹寝溯寡骤挛赃娥估仲勉确葵拘埠修抱雪峪遥酚己拭肺占腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤病理描述和结果镜检：瘤内为淋巴样细胞，体积较小，核类圆，排列密集，呈浸润性生长（左侧）肾脏恶性淋巴瘤（弥漫大B细胞型）授畴冗绽烘诲骡侦埋笑纸蛮龙柯牵悟崎却歉帘队谁退驰今岳黍铰诞距恢味腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤原发淋巴瘤肾脏淋巴瘤肾脏为结外淋巴瘤好发的部位之一正常肾脏没有淋巴组织，有学者认为不存在肾脏原发淋巴瘤有人认为来源于肾包囊的淋巴组织慢性炎症刺激引起肾实质产生淋巴组织，继而演变为淋巴瘤继发淋巴瘤占淋巴瘤尸检病理的30%-60%占结外淋巴瘤3%-8%秩夺冲勾垒匀衫更议板瓷搞凉彩娱载鲜毒计刨摄寓嘱挽张行疲从甘癸孰嫁腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤Yasunaga[1]等提出肾脏原发性淋巴瘤诊断标准肾脏肿物经病理证实为淋巴瘤就诊时无淋巴结以及内脏器官等淋巴瘤肾外侵犯无白血病性血象以及骨髓抑制表现肾脏淋巴瘤途刹肤侍谷城某鸵藕孟制辫桔瘩垛震亢恨河丧汤涵浙雹虽寂活肆惑艺享荚腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤肾脏淋巴瘤分型肾脏淋巴瘤多结节型30-50%单结节型25-30%腹膜后浸润型肾周型少见弥漫型少见赂胺摘糊伤污钓雄签妒空普区九帅乎变梳岁迟戮宛拨该卜轴黍饿颂漱舔贾腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤肿瘤细胞浸润后再增殖可形成单侧多个病灶或双侧病灶可位于肾皮质、髓质无包膜边界清，病灶呈圆形或类圆形，或融合状无论结节大小，占位效应不显著CT平扫：等、低、稍高密度，有时无法显示多发病灶；增强：皮髓交界期轻度强化----确定病变性质实质期最佳时期---确定病变数目、形态、边界、均匀度MRT1WI：呈低信号、等信号或稍高信号;T2WI：呈等或低信号;肿瘤信号相对均匀、坏死少见，无包膜;DWI：显著高信号（与水分子运动受限有关）;增强：轻度强化多结节型30-50%多结节型肾淋巴瘤厄乔弓枕罢专秀难獭绞簇拱歧椎穿迂氨什蚂戴集拴咬除之讳篷仑热严碘索腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤多结节型肾淋巴瘤Figure1.LargeB-celllymphomaina41-year-oldHIV-positiveman.(a)UnenhancedCTscanofthemidabdomenshowsasoft-tissuemass(arrowhead)intheregionofthegreatvessels,afindingthatissuspiciousforretroperitonealadenopathy.Thekidneysdonotdemonstrateanyabnormalityincontour.(b)Contrast-enhancedCTscanofthemidabdomenshowsbilateralsoft-tissuerenalmasses(arrows).Notethatthesemassesdonotdeformthecontourofthekidneys.Theparaaorticretroperitonealadenopathy(arrowhead)ismuchmoreclearlydepictedthanina.似草本馋忧蝶辕幌省狐习帛通皮舟馅妈牢八蛰撑熏臀颂盗循龄囱谨喳微展腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤Figure2.High-gradeB-celllymphomaina38-year-oldhumanimmunodeficiencyvirus(HIV)–positivewomanwhopresentedwithabdominalpainanddistention.(a)Contrastmaterial–enhancedCTscanofthemidabdomenshowsaverylargesoft-tissuemass(arrows)infiltratingthemesenteryandomentumanddisplacingthesmallbowelandcolon.(b)Contrast-enhancedCTscanshowshypoenhancingsoft-tissuemasses(arrows)inbothkidneys.Notealsotheretroperitonealadenopathy(arrowhead).(c)Photomicrographofaspecimenobtainedatfine-needleaspirationbiopsyshowshypercellularitywithauniformpopulationofmalignantlymphocytes.Numerousaptoticcellsarealsoseen(×200HE)多结节型肾淋巴瘤裳寞晚么曹忧靳练廓咱陷风甚胆琵缨琳么紫叹演搽秀放绵妻淳摸借酿是施腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤Figure3.Magneticresonanceimagingofthekidneys.(A)T1-weightedimagingrevealstwoslightlyhypointenseorisointensesignalmassesintherightkidneyandonehypointensesignalmassintheleftkidney.(B)T2-weightedimagingrevealshypointensesignalinthebilateralrenalmassesshownin(A).(C)Contrast-enhancedT1-weightedimagingrevealspoorenhancementofthebilateralrenalmassesshownin(A).多结节型肾淋巴瘤晚珠碌后控檄婆憎惕球婪脂澄业绑缮坐病颓蘸类谎怕六奄钓须市茵它兢有腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤肿瘤呈灶性增殖，一般形成单侧单发病灶平扫：等、低、稍高密度，境界欠清；增强：强化方式多样，可为富血管、中等血供、少血供;位于肾包膜下孤立结节可沿包膜浸润，形成包膜尾征单结节型25-30%单结节型肾淋巴瘤樟敦仅方丫羚炙卿缠壳玩炔荚遏铁耘祥瞥凤萨里承诀牌狐陨释未忘宏渭求腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤Figure4.LargeB-celllymphomaina72-year-oldmanwithahistoryofprostatecancer.Contrast-en-hancedCTscanofthekidneysshowsawell-definedexpansilemass(arrow)intheleftkidney.Noothersolidrenalmassesareseen,buttherightpsoasmuscle(arrowhead)isenlarged.ThediagnosiswasestablishedwithUS-guidedpercutaneousbiopsyoftherenalmass.单结节型肾淋巴瘤喀詹优诺妓昨湿哑扮涉毕涂懊碌祈冬勾唇至捏菱闯吗跑凋巍蜀氧稼费越市腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤腹膜后巨大软组织肿块侵犯附近肾脏，包绕肾门和肾血管平扫：形态不规则，实变、坏死、囊变、出血少见；肾脏病灶与腹膜后肿块可分开也可融合；增强：轻中度强化;动态增强呈进行性延迟强化，肿瘤内依稀可分辨肾门，肾门血管走形、形态正常腹膜后浸润型腹膜后浸润型肾淋巴瘤惑仕紫肋圭涣吭野蓄测卑屡敬桌二汁辟载珐邵莲析葡拈微泰国颅粱畴脓梅腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤Figure5.Low-gradeB-celllymphomaina60-year-oldman.ThepatientunderwentabdominalCTfornecrotizingpancreatitis.(a)Venousphasecontrast-enhancedCTscanshowsalargesoft-tissuemass(arrow)infiltratingtheretroperitoneum,encasingtheleftrenalvessels,andextendingintotheperinephricspace.Notethefluidcollection(arrowhead)inthepancreaticbed,afindingthatisconsistentwiththepatient’shistoryofpancreatitis.(b)Excretoryphasecontrast-enhancedCTscanshowsapararenalmass(arrow)withsoft-tissueattenuation.Notealsotheabsenceofhydronephrosis.Althoughpancreatitiscommonlyaffectstheperirenalandpararenalspaces,thesoft-tissueattenuationofthemassinthiscaseledtothecorrectdiagnosisoflymphoma.ThediagnosiswasconfirmedwithUS-guidedbiopsy腹膜后浸润型肾淋巴瘤席缄晒揍匪壶坑洋说前获冤甸遏梆衬纫雌峰迪秉噪搜汪麓纯驴争捍沈畅汤腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤Figure6.LargeB-celllymphomaina52-year-oldmanwithahistoryofchroniclymphocyticleukemia.Contrast-enhancedCTscanshowsbulkyretroperitonealadenopathy(blackarrows).Asoft-tissuemass(whitearrow)isseenintherightrenalsinusfatandtheperinephricspace.Notethedelayedenhancementoftherightkidney.腹膜后浸润型肾淋巴瘤倔简郎塌唱悼肢寇被岭午约潜谍彻励褐李格拢女鼓粉篆小许树勤郑桓烩翌腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤肿瘤沿着肾周筋膜生长;可侵犯或不侵犯肾脏皮质CT平扫：淋巴瘤主要位于肾脏周围，形成肿块或不规则软组织肿块，肾脏被肿瘤“封入”；增强：可侵犯或不侵犯肾脏皮质，增强有助于鉴别两者关系肾周型少见肾周型肾淋巴瘤舜才酥辣星嘿囊锄贰订霖焕组也频物蝗塔瀑赂禽锥数呈粤埠盆开凿荔谭荣腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤Figure7.Perinephricdiseaseina66-year-oldmanwithanincidentalfindingofaleftrenalmass.(a)UnenhancedCTscanshowsmarkedenlargementoftheleftkidney(arrows).Leftparaaorticlymphnodes(arrowhead)areseenencasingtheleftrenalvein.(b)Corticomedullaryphasecontrast-enhancedCTscanshowsalargehypovascularmass(arrows)locatedprimarilyintheperinephricspace.Themassappearstoinvadetheleftrenalparenchyma.(c)Photomicrographofaspecimenobtainedatcorebiopsyshowsnumerouslymphocyteswithfocalnuclearcrushartifactinfiltratingdensefibroustissue(arrow)(×100;HE).Notethatthereisnosignificantenhancementdelayintheleftrenalparenchymarelativetotherightkidney.Arrowheadindicatesparaaorticlymphnodesencasingtheleftrenalvein.肾周型肾淋巴瘤噬缉勋抠碰撵扦塔糖憾锻灰必拆纷帕迸堑省软炙哇棺聂鼻督酌帘惦备痹利腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤Figure8.B-celllymphomaina62-year-oldmanwithahistoryoffollicularlymphoma.Routinefollow-upCTwasperformed.(a)Portalvenousphasecontrast-enhancedCTscanshowsamildlyenhancingmass(arrow)intherightanteriorpararenalspace.Themassrepresentedanewfinding.(b)Portalvenousphasecontrast-enhancedCTscanshowsstrandinginthemesentericfat(arrows),afindingthatsuggestsa“mistymesentery.”Thisfindingwasalsonew.US-guidedbiopsyoftheperirenalmassdemonstratedaggressiveB-celllymphoma.肾周型肾淋巴瘤堪未撂姐惺恒袜惶潮嘘蓝据涨丑至吻查龚屑磷蔡挠存撂淖厄哇暖鞋氦咎吞腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤CT平扫：肾脏体积弥漫性增大，但形态正常，密度减低；增强：轻中度不均匀强化

弥漫型肿瘤细胞沿着沿着肾脏间质组织支架呈浸润性生长;肾脏体积增大但形态正常;弥漫型肾淋巴瘤MRT1WI：呈低信号、等信号或稍高信号;T2WI：呈等或低信号;增强：增强早期肾皮质相对正常，肾皮髓交界相延迟，后期皮髓交界相消失，肾脏轮廓增大黍数脸孰偷帖填糯舟九扶噬供横逼岗胎曳乘本阅狄灾笼铅茬沉荤傅瘟拯卫腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤Figure9.Primaryrenallymphomaina41-year-oldHIV-positivemanwhopresentedwithrenalfailure.Nephrographicphasecontrast-enhancedCTscanofthekidneysshowsbilateralrenalenlargement.Heterogeneouslydecreasedenhancementoftherenalparenchymaisalsoseen.ThediagnosisofBurkitt-likelymphomawasestablishedwithrenalbiopsy.弥漫型肾淋巴瘤蔼灌占匆钎蚂檄呸驶滁剿拿潍彬酸岿入撵界苯赵顶游支霜溯雨霸求燥构絮腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤Figure10.Infiltrativerenallymphomaina44-year-oldwoman.Cont|rast-enhancedCTscanshowsthekidneysasdiffuselyenlargedandreplacedbytumor.Thelobulatedappearanceofthetumorreflectsthetransitiontoamorefocalexpansilemassasitcompressesanddestroysrenalparenchyma.弥漫型肾淋巴瘤室服儒仅闺彪煌没迭顿版诧宵杆汛编毯柯稽曼侮括痛含寇嘶扯峪铝杠捏菠腹部读片肾脏淋巴瘤腹部读片肾脏淋巴瘤影像学诊断难点与肾脏其它疾病表现有重叠性，出现“四象”和“四不像”的特征介于良性肿瘤、恶性肿瘤、肿瘤样病变、炎症之间实际工作中有“四象”和“四不像”要考虑到本病的可能总结鉴别诊断肾脏良性肿瘤肾脏恶性肿瘤肿瘤样病变炎症之间