《腎淋巴瘤》

1、精選ppt腎淋巴瘤張瑾精選pptn淋巴瘤尸檢病例中腎臟受侵的比例達(dá) 30% to 60%nCT 僅發(fā)現(xiàn)3%8%受侵n 原因：多數(shù)侵犯較為隱匿，病灶較小，CT不能顯示 精選pptn血源性播散 腹膜后病灶的直接侵犯n病變發(fā)展的晚期 n臨床上無(wú)癥狀體征精選ppt組織病理學(xué)特征組織病理學(xué)特征n非霍奇金淋巴瘤淋巴瘤多見 nB細(xì)胞源常見n惡性程度中等或較高n更多見于淋巴結(jié)彌漫增大的病例 精選ppt典型典型CT征象征象單發(fā)結(jié)節(jié)多發(fā)結(jié)節(jié)腹膜后病變直接侵犯彌漫浸潤(rùn)腎周病變精選ppt單發(fā)結(jié)節(jié)單發(fā)結(jié)節(jié)n淋巴瘤的病灶通常為低血供，增強(qiáng)掃描強(qiáng)化不明顯n密度均勻，與常見的透明細(xì)胞腎癌不同n在所有腎臟受侵病例中發(fā)生率占10

2、%20%精選pptRenal 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. 精選pptFollicular, mixed small cleaved and large cell lymphoma in a 74-year-old man. Contrast-enhanced helical CT

3、scan shows a large mass located in the left kidney and extending into the perirenal space. Small nodes are seen in the retroperitoneum (arrow). 精選ppt多發(fā)結(jié)節(jié)多發(fā)結(jié)節(jié)n最常見 n在所有腎臟受侵病例中發(fā)生率占60%n常為雙側(cè)發(fā)生，但偶可僅見于單側(cè)精選ppt Large cell lymphoma in an 11-year-old boy. The patient presented with a large anterior mediastinal

4、 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. 精選pptLarge cell lymphoma in a 73-year-old woman. Contra

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

6、phocytic 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 b

7、urden. These findings are characteristic of retroperitoneal lymphoma 精選pptLarge 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 精選ppt腎周病變腎周病變n腹膜后病變的

8、直接侵犯或腎被膜的侵犯n表現(xiàn)為腎竇受侵，腎周筋膜增厚， 腎周腫物 n偶爾，腎周病變完全未侵犯腎實(shí)質(zhì)n相對(duì)少見，有一定的特異性精選pptLarge 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 unus

9、ual for perirenal involvement精選ppt 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 characteris

10、tic soft nature of lymphomatous tumor 精選ppt彌漫浸潤(rùn)彌漫浸潤(rùn)n多為雙側(cè)性， 約占20%的病例 n表現(xiàn)為受侵腎臟彌漫增大，密度減低，病變與腎實(shí)質(zhì)界限不清 n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n多數(shù)病例通過化療后能恢復(fù)正常。 精選pptHigh-grade large cell lymphoma in a 35-year-old man. (a) Contrast-enhanced CT scan demonstrates patchy tumor infiltration within the kidneys. The kidneys h

11、ave 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 精選pptInfiltrative 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 精選pptInfiltrative renal lymphoma in a 44-year-old woman. Contrast-enhanced CT scan shows the kidneys as diffusely enlarged and replaced