肾淋巴瘤 ppt课件

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1、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组织病理学特征非霍奇金淋巴瘤淋巴瘤多见B细胞源常见恶性程度中等或较高更多见于淋巴结弥漫增大的病例典型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淋巴瘤的病灶通常为低血供，增强扫描强化不明显密度均匀，与常见的透明细胞肾癌不同在所有肾脏受侵病例中发生率占10%–20%Renallymphomaina69-year-oldman.Contrast-enhanc

2、edhelicalCTscanshowsadominant5-cmmassintherightkidney(arrow).Thereisnoevidenceofretroperitonealadenopathy.Follicular,mixedsmallcleavedandlargecelllymphomaina74-year-oldman.Contrast-enhancedhelicalCTscanshowsalargemasslocatedintheleftkidneyandextendingintotheperirenalspace.Smallnodesa

3、reseenintheretroperitoneum(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),atypicalfindinginr

4、enallymphoma.Thepatientrespondedwelltotreatment,andtherenallesionseventuallyresolved.Largecelllymphomaina73-year-oldwoman.Contrast-enhancedCTscanshowsbilateralrenalmasseswithcharacteristichomogeneousattenuation,smoothborders,andlowcontrastenhancement.Retroperitonealadenopathyisalsopr

5、esent(A).腹膜后病变直接侵犯另一较常见类型，占25%–30%表现为较大且边界不清的肿物包裹肾门及肾脏血管结构密度均匀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(s

6、traightarrows)andleftrenalvein(curvedarrow)despitethemassivetumorburden.ThesefindingsarecharacteristicofretroperitoneallymphomaLargecelllymphomaina51-year-oldwoman.Contrast-enhancedhelicalCTscanshowsalargetumormassinvadinganddisplacingtheleftkidney.Thetumoralsoinvolvestherightsideoft

7、heretroperitoneum肾周病变腹膜后病变的直接侵犯或肾被膜的侵犯表现为肾窦受侵，肾周筋膜增厚，肾周肿物偶尔，肾周病变完全未侵犯肾实质相对少见，有一定的特异性Largecelllymphomaina34-year-oldman.Contrast-enhancedhelicalCTscandemonstratesperirenalmassesbilaterally,especiallyontherightside.Theresultingmarkedcompressionanddeformityoftherightkidneyaresomewhatunu

8、sualforperir