《肾淋巴瘤》ppt课件.ppt

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 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 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 ma