腹部读片肾脏淋巴瘤.pptxVIP

20140917腹 部 读 片王莉教授边 云病史介绍男性，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）肾脏淋巴瘤原发淋巴瘤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肾脏为结外淋巴瘤好发的部位之一占淋巴瘤尸检病理的30%-60%占结外淋巴瘤3%-8%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肾脏淋巴瘤分型多结节型30-50%单结节型25-30%腹膜后浸润型肾周型少见弥漫型少见多结节型肾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，占位效应不显著多结节型30-50%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：轻度强化多结节型肾淋巴瘤Figure 1. Large B-cell lymphoma in a 41-year-old HIV-positive man. (a) Unenhanced CT scan of the midabdomen shows a soft-tissue mass (arrowhead) in the region of the great vessels, a ?nding that is suspicious for retroperitoneal adenopathy. The kidneys do not demonstrate any abnormality in contour. (b) Contrast-enhanced CT scan of the midabdomen shows bilateral soft-tissue renal masses (arrows). Note that these masses do not deform the contour of the kidneys. The paraaortic retroperitoneal adenopathy (arrowhead) is much more clearly depicted than in a.多结节型肾淋巴瘤Figure 2. High-grade B-cell lymphoma in a 38-year-old human immunode?ciency virus (HIV)–positive woman who presented with abdominal pain and distention. (a) Contrast material–enhanced CT scan of the midabdomen shows a very large soft-tissue mass (arrows) in?ltrating the mesentery and omentum and displacing the small bowel and colon. (b) Contrast-enhanced CT scan shows hypoenhancing soft-tissue masses (arrows) in both kidneys. Note also the retroperitoneal adenopathy (arrowhead). (c) Photomicrograph of a specimen obtained at ?ne-needle aspiration biopsy shows hypercellularity with a uniform population of malignant lymphocytes. Numerous aptotic cells are also seen(×200 HE)多结节型肾淋巴瘤Figure 3. Magnetic resonance imaging of the kidneys. (A) T1-weighted imaging reveals two