原发性肾淋巴瘤3例_临床医学论文.docVIP

原发性肾淋巴瘤3例_临床医学论文 原发性肾淋巴瘤3例_临床医学论文 作者：方福生， 朱宏丽， 宋志刚， 卢学春 【摘要】 原发性肾淋巴瘤（primary renal lymphoma， PRL）罕见。为了探讨PRL的临床特点、诊治和预后，对我院近10年收治的3例原发性肾淋巴瘤进行分析，总结其临床表现、实验室检查、病理特征和病程，以及相应的诊治措施。结果表明： 3例男性原发性肾淋巴瘤，发病年龄大于50岁，最常见的症状是腰痛，伴有腹部包块、血尿等，术前均高度怀疑肾癌而予以手术切除，术后病理提示肾淋巴瘤，且都是弥漫B细胞性，细胞表面抗原CD20阳性，应用人源化的抗CD20单克隆抗体联合方案化疗，同时局部进行放疗，治疗间歇辅予干扰素，并加强支持治疗，其中2例生存超过5年。结论：原发性肾淋巴瘤极少见，临床易误诊，早期确诊和个体化治疗可望改善预后。 【关键词】 原发性肾淋巴瘤 Three Cases of Primary Renal Lymphoma Abstract Primary renal lymphoma （PRL） is very rare. In order to investigate the clinical features, diagnosis, therapy and prognosis of PRL, three cases of primary renal lymphoma diagnosed definitely and treated in our hospital in the recent ten years were reported, and their clinical features, laboratory examination, pathological observation and their therapeutics were analyzed. The results indicated that the three cases of primary renal lymphoma were all male elders. Their most common symptoms were flank pain along with abdominal mass and hematuria, etc. Becanse of suspicion of cancer with renal involvement, the three patients all underwent laparotomy. Histological examination showed diffuse Bcell lymphoma in the three cases, and the immunophenotype was CD20 positive in all three cases. These cases were treated with combinated therapeutics, including rituximab, intermittent interferon and local radiotherapy. The 2 out of 3 cases lived for more than 5 years after therapy. In conclusion, as PRL is especially rare， and often diagnosed mistakenly, it is suggested that early and definite diagnosis and individualization of treatment for PRL patients may be possible to achieve a better therapeutic result. Key words Primary renal lymphoma; clinical presentation; renal pathology; prognosis J Exp Hematol 2007; 15(5):1107-1111 原发性肾淋巴瘤非常罕见，老年人多发，腰痛是常见的症状，临床上极易误诊为肾癌，确诊主要依赖于组织学，治疗上强调早期发现和个体化治疗。我们分析了近10年收治的3个病例，着重了解其临床特点、诊治及预后，以期为临床提供参考。 材料和方法 病例选择 1995年1月-2005年1月我院收治的原发性肾淋巴瘤3例，诊断依据包括：手术病理、骨髓穿刺活检和胸腹CT。上述诊断技术提供的材料，符合原发性淋巴瘤诊断标准［1］，诊断明确。 实验室与病理学检查 各项生化指标