《腎淋巴瘤》課件

1、腎淋巴瘤張瑾腎淋巴瘤1腎淋巴瘤張瑾腎淋巴瘤1淋巴瘤尸檢病例中腎臟受侵的比例達(dá) 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2淋巴瘤尸檢病例中腎臟受侵的比例達(dá) 30% to 60%腎淋血源性播散 腹膜后病灶的直接侵犯病變發(fā)展的晚期 臨床上無(wú)癥狀體征腎淋巴瘤3血源性播散 腎淋巴瘤3組織病理學(xué)特征非霍奇金淋巴瘤淋巴瘤多見 B細(xì)胞源常見惡性程度中等或較高更多見于淋巴結(jié)彌漫增大的病例 腎淋巴瘤4組織病理學(xué)特征非霍奇金淋巴瘤淋巴瘤多見 腎淋巴瘤4典型CT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)腎周病變腎淋巴瘤5典型CT征象單發(fā)結(jié)節(jié)多發(fā)結(jié)節(jié)腹膜

2、后病變直接侵犯彌漫浸潤(rùn)腎周病單發(fā)結(jié)節(jié)淋巴瘤的病灶通常為低血供，增強(qiáng)掃描強(qiáng)化不明顯密度均勻，與常見的透明細(xì)胞腎癌不同在所有腎臟受侵病例中發(fā)生率占10%20%腎淋巴瘤6單發(fā)結(jié)節(jié)淋巴瘤的病灶通常為低血供，增強(qiáng)掃描強(qiáng)化不明顯腎淋巴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7Renal

3、 lymphoma in a 69-year-olFollicular, 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). 腎淋巴瘤8Follicular, mixed s

4、mall cleave多發(fā)結(jié)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(cè)發(fā)生，但偶可僅見于單側(cè)腎淋巴瘤9多發(fā)結(jié)節(jié)最常見 腎淋巴瘤9Large cell lymphoma in an 11-year-old boy. The patient presented with a large anterior mediastinal mass and renal lesions. Contrast-enhanced helical CT scan demonstrates small, hypoattenuating masses bilaterally (arrows), a typical

5、 finding in renal lymphoma. The patient responded well to treatment, and the renal lesions eventually resolved. 腎淋巴瘤10Large cell lymphoma in an 11-Large cell lymphoma in a 73-year-old woman. Contrast-enhanced CT scan shows bilateral renal masses with characteristic homogeneous attenuation, smooth bo

6、rders, and low contrast enhancement. Retroperitoneal adenopathy is also present (A). 腎淋巴瘤11Large cell lymphoma in a 73-ye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(jié)構(gòu)密度均勻腎臟動(dòng)靜脈血管保持通暢， 但集合系統(tǒng)?？梢姽Ｗ枘I淋巴瘤12腹膜后病變直接侵犯另一較常見類型，占 25%30% 腎淋Diffuse lymphocytic lymphoma in a 65-year-old woman. Contrast-enhanc

7、ed 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 retroperitone

8、al lymphoma 腎淋巴瘤13Diffuse lymphocytic 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 腎淋巴瘤14Large cell lymphoma in a 51-ye腎周病變腹膜后病變的直

9、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(shí)質(zhì)相對(duì)少見，有一定的特異性腎淋巴瘤15腎周病變腹膜后病變的直接侵犯或腎被膜的侵犯腎淋巴瘤15Large 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

10、kidney are somewhat unusual for perirenal involvement腎淋巴瘤16Large cell lymphoma in a 34-yePerirenal 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 symme

11、tric renal function seen in b reflects the characteristic soft nature of lymphomatous tumor 腎淋巴瘤17Perirenal lymphoma in a 64-ye彌漫浸潤(rùn)多為雙側(cè)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(shí)質(zhì)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(fù)正常。 腎淋巴瘤18彌漫浸潤(rùn)多為雙側(cè)性， 約占20%的病例 腎淋巴瘤18High-grade large cell lymphoma in a 35-year-old man.

12、 (a) Contrast-enhanced CT scan demonstrates patchy tumor infiltration within the kidneys. The kidneys 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 con

13、trast-enhanced CT for diagnosis 腎淋巴瘤19High-grade large cell lymphomaInfiltrative 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20Infiltrative renal lymphoma inInfiltrative renal lymphoma in a 44-year-old woman. Contrast-enhanced CT scan shows the kidneys as diffusely enlarged and replaced by tumor. The lobulated appearance of th