《肾淋巴瘤》课件.pptVIP

肾淋巴瘤张瑾淋巴瘤尸检病例中肾脏受侵的比例达30%to60%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01非霍奇金淋巴瘤淋巴瘤多见03恶性程度中等或较高02B细胞源常见04更多见于淋巴结弥漫增大的病例组织病理学特征典型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在所有肾脏受侵病例中发生率占10%–20%03密度均匀，与常见的透明细胞肾癌不同02淋巴瘤的病灶通常为低血供，增强扫描强化不明显01Renallymphomaina69-year-oldman.Contrast-enhancedhelicalCTscanshowsadominant5-cmmassintherightkidney(arrow).Thereisnoevidenceofretroperitonealadenopathy.Follicular,mixedsmallcleavedandlargecelllymphomaina74-year-oldman.Contrast-enhancedhelicalCTscanshowsalargemasslocatedintheleftkidneyandextendingintotheperirenalspace.Smallnodesareseenintheretroperitoneum(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?Largecelllymphomainan11-year-oldboy.Thepatientpresentedwithalargeanteriormediastinalmassandrenallesions.Contrast-enhancedhelicalCTscandemonstratessmall,hypoattenuatingmassesbilaterally(arrows),atypicalfindinginrenallymphoma.Thepatientrespondedwelltotreatment,andtherenallesionseventuallyresolved.Largecelllymphomaina73-year-oldwoman.Contrast-enhancedCTscanshowsbilateralrenalmasseswithcharacteristichomogeneousattenuation,smoothborders,andlowcontrastenhancement.Retroperitonealadenopathyisalsopresent(A).腹膜后病变直接侵犯01另一较常见类型，占25%–30%02表现为较大且边界不清的肿物包裹肾门及肾脏血管结构03密度均匀04肾脏动静脉血管保持通畅，但集合系统常可见梗阻?Diffuselymphocyticlymphomaina65-year-oldwoman.Contrast-enhancedhelicalCTscanshowsalarge,homogeneousmassenvelopingtheretroperitoneumandinvadingtherightkidney.Notehowflowismaintainedintherenalarteries(straightarrows)andleftrenalvein(curvedarrow)despitethemassivetumorburden.ThesefindingsarecharacteristicofretroperitoneallymphomaLargecelllymphomaina51-year-oldwoman.Contrast-enhancedhelicalCTscanshowsalargetumormassinvadinganddisplacingtheleftkidney.Thetumoralsoinvolvest