1、肾淋巴瘤n张瑾肾淋巴瘤1n淋巴瘤尸检病例中肾脏受侵的比例达 30%to 60%nCT 仅发现3%8%受侵n 原因：多数侵犯较为隐匿，病灶较小，CT不能显示 肾淋巴瘤2n血源性播散 腹膜后病灶的直接侵犯n病变发展的晚期 n临床上无症状体征肾淋巴瘤3组织病理学特征组织病理学特征n非霍奇金淋巴瘤淋巴瘤多见 nB细胞源常见n恶性程度中等或较高n更多见于淋巴结弥漫增大的病例 肾淋巴瘤4典型典型CT征象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肾淋巴瘤5单发结节单发结节n淋巴瘤的病灶通常为低血供，增强扫描强化不明显n密度均匀，与常见的透明细胞肾癌不同n在所有肾脏受侵病例中发生率占10%20%肾
2、淋巴瘤6Renal 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.肾淋巴瘤7Follicular,mixed small cleaved and large cell lymphoma in a 74-year-old man.Contrast-enhanced helical CT scan shows
3、a large mass located in the left kidney and extending into the perirenal space.Small nodes are seen in the retroperitoneum(arrow).肾淋巴瘤8多发结节多发结节n最常见 n在所有肾脏受侵病例中发生率占60%n常为双侧发生，但偶可仅见于单侧肾淋巴瘤9 Large cell lymphoma in an 11-year-old boy.The patient presented with a large anterior mediastinal mass and renal
4、 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.肾淋巴瘤10Large cell lymphoma in a 73-year-old woman.Contrast-enhanced CT scan sh
5、ows bilateral renal masses with characteristic homogeneous attenuation,smooth borders,and low contrast enhancement.Retroperitoneal adenopathy is also present(A).肾淋巴瘤11腹膜后病变直接侵犯腹膜后病变直接侵犯n另一较常见类型，占 25%30%n表现为较大且边界不清的肿物包裹肾门及肾脏血管结构n密度均匀n肾脏动静脉血管保持通畅，但集合系统常可见梗阻肾淋巴瘤12 Diffuse lymphocytic lymphoma in a 65-y
6、ear-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 burden.These findings are character
7、istic of retroperitoneal lymphoma 肾淋巴瘤13Large 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 肾淋巴瘤14肾周病变肾周病变n腹膜后病变的直接侵犯或肾被膜的侵犯n表现为肾窦受侵，肾周筋膜增厚，肾周肿物 n偶尔
8、，肾周病变完全未侵犯肾实质n相对少见，有一定的特异性肾淋巴瘤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 kidney are somewhat unusual for perirenal involvement肾淋巴瘤16 Pe
9、rirenal 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 characteristic soft nature of lymphomatous tumor 肾淋巴瘤1
10、7弥漫浸润弥漫浸润n多为双侧性，约占20%的病例 n表现为受侵肾脏弥漫增大，密度减低，病变与肾实质界限不清 n受侵的肾脏功能下降，但肾功能常能保持不出现临床症状n多数病例通过化疗后能恢复正常。肾淋巴瘤18High-grade large cell lymphoma in a 35-year-old man.(a)Contrast-enhanced CT scan demonstrates patchy tumor infiltration within the kidneys.The kidneys have retained their normal contour,a finding th
11、at 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 肾淋巴瘤19Infiltrative renal lymphoma in an 80-year-old man.Contrast-enhanced CT scan shows minimal renal enlargement bilatera
12、lly,a finding that suggests subtle involvement by lymphoma 肾淋巴瘤20Infiltrative 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 the tumor reflects the transition to a more focal expansile mass as it compresses and destroys renal parenchyma 肾淋巴瘤21Radiographics.2000;20:197-212 肾淋巴瘤22
