《腎淋巴瘤》課件

1、腎淋巴瘤,1,腎淋巴瘤,張瑾,腎淋巴瘤,2,淋巴瘤尸檢病例中腎臟受侵的比例達 30% to 60% CT 僅發(fā)現(xiàn)3%8%受侵 原因：多數(shù)侵犯較為隱匿，病灶較小，CT不能顯示,腎淋巴瘤,3,血源性播散 腹膜后病灶的直接侵犯 病變發(fā)展的晚期 臨床上無癥狀體征,腎淋巴瘤,4,組織病理學特征,非霍奇金淋巴瘤淋巴瘤多見 B細胞源常見 惡性程度中等或較高 更多見于淋巴結彌漫增大的病例,腎淋巴瘤,5,典型CT征象,單發(fā)結節(jié),多發(fā)結節(jié),腹膜后病變直接侵犯,彌漫浸潤,腎周病變,腎淋巴瘤,6,單發(fā)結節(jié),淋巴瘤的病灶通常為低血供，增強掃描強化不明顯 密度均勻，與常見的透明細胞腎癌不同 在所有腎臟受侵病例中發(fā)生率占1

2、0%20,腎淋巴瘤,7,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,腎淋巴瘤,8,Follicular, mixed small cleaved and large cell lymphoma in a 74-year-old man. Contrast-enhanced helical

3、 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,腎淋巴瘤,9,多發(fā)結節(jié),最常見 在所有腎臟受侵病例中發(fā)生率占60% 常為雙側發(fā)生，但偶可僅見于單側,腎淋巴瘤,10,Large cell lymphoma in an 11-year-old boy. The patient presented with a large anterior mediastin

4、al mass and renal lesions. Contrast-enhanced helical CT scan demonstrates small, hypoattenuating masses bilaterally (arrows), a typical finding in renal lymphoma. The patient responded well to treatment, and the renal lesions eventually resolved,腎淋巴瘤,11,Large cell lymphoma in a 73-year-old woman. Co

5、ntrast-enhanced CT scan shows bilateral renal masses with characteristic homogeneous attenuation, smooth borders, and low contrast enhancement. Retroperitoneal adenopathy is also present (A,腎淋巴瘤,12,腹膜后病變直接侵犯,另一較常見類型，占 25%30% 表現(xiàn)為較大且邊界不清的腫物包裹腎門及腎臟血管結構 密度均勻 腎臟動靜脈血管保持通暢， 但集合系統(tǒng)?？梢姽Ｗ?腎淋巴瘤,13,Diffuse lymph

6、ocytic 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 bur

7、den. These findings are characteristic of retroperitoneal lymphoma,腎淋巴瘤,14,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,腎淋巴瘤,15,腎周病變,腹膜后病變的

8、直接侵犯或腎被膜的侵犯 表現(xiàn)為腎竇受侵，腎周筋膜增厚， 腎周腫物 偶爾，腎周病變完全未侵犯腎實質 相對少見，有一定的特異性,腎淋巴瘤,16,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 u

9、nusual for perirenal involvement,腎淋巴瘤,17,Perirenal lymphoma in a 64-year-old man. Helical CT scans obtained before (a) and after (b) intravenous administration of contrast material show a perirenal soft-tissue mass enveloping the left kidney. The symmetric renal function seen in b reflects the chara

10、cteristic soft nature of lymphomatous tumor,腎淋巴瘤,18,彌漫浸潤,多為雙側性， 約占20%的病例 表現(xiàn)為受侵腎臟彌漫增大，密度減低，病變與腎實質界限不清 受侵的腎臟功能下降，但腎功能常能保持不出現(xiàn)臨床癥狀 多數(shù)病例通過化療后能恢復正常,腎淋巴瘤,19,High-grade large cell lymphoma in a 35-year-old man. (a) Contrast-enhanced CT scan demonstrates patchy tumor infiltration within the kidneys. The kidn

11、eys have retained their normal contour, a finding that is characteristic of infiltrative lymphoma. (b) On an unenhanced CT scan, the infiltration is undetectable, which underscores the importance of contrast-enhanced CT for diagnosis,腎淋巴瘤,20,Infiltrative renal lymphoma in an 80-year-old man. Contrast-enhanced CT scan shows minimal renal enlargement bilaterally, a finding that suggests subtle involvement by lymphoma,腎淋巴瘤,21,Infiltrative renal lymphoma in a 44-year-old woman. Contrast-enhanced CT scan shows the kidneys as diffusely enlarged and replaced b