腹部读片肾脏淋巴瘤课件

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1、20140917腹部读片王莉教授边云男性，46岁，已婚，汉患者2周前在当地体检发现左肾占位患者自发病以来无尿频、尿急、尿痛、腰痛、发热等症状无体重变化，大小便正常，睡眠良好病史介绍？病理描述和结果镜检：瘤内为淋巴样细胞，体积较小，核类圆，排列密集，呈浸润性生长（左侧）肾脏恶性淋巴瘤（弥漫大B细胞型）原发淋巴瘤肾脏淋巴瘤肾脏为结外淋巴瘤好发的部位之一正常肾脏没有淋巴组织，有学者认为不存在肾脏原发淋巴瘤有人认为来源于肾包囊的淋巴组织慢性炎症刺激引起肾实质产生淋巴组织，继而演变为淋巴瘤继发淋巴瘤占淋巴瘤尸检病理的30%-60%占结外淋巴瘤3%-8%Yasunag

2、a[1]等提出肾脏原发性淋巴瘤诊断标准肾脏肿物经病理证实为淋巴瘤就诊时无淋巴结以及内脏器官等淋巴瘤肾外侵犯无白血病性血象以及骨髓抑制表现肾脏淋巴瘤肾脏淋巴瘤分型肾脏淋巴瘤多结节型30-50%单结节型25-30%腹膜后浸润型肾周型少见弥漫型少见肿瘤细胞浸润后再增殖可形成单侧多个病灶或双侧病灶可位于肾皮质、髓质无包膜边界清，病灶呈圆形或类圆形，或融合状无论结节大小，占位效应不显著CT平扫：等、低、稍高密度，有时无法显示多发病灶；增强：皮髓交界期轻度强化----确定病变性质实质期最佳时期---确定病变数目、形态、边界、均匀度MRT1WI：呈低信号、等信号或稍高信

3、号;T2WI：呈等或低信号;肿瘤信号相对均匀、坏死少见，无包膜;DWI：显著高信号（与水分子运动受限有关）;增强：轻度强化多结节型30-50%多结节型肾淋巴瘤多结节型肾淋巴瘤Figure1.LargeB-celllymphomaina41-year-oldHIV-positiveman.(a)UnenhancedCTscanofthemidabdomenshowsasoft-tissuemass(arrowhead)intheregionofthegreatvessels,afindingthatissuspiciousforretroperitoneala

4、denopathy.Thekidneysdonotdemonstrateanyabnormalityincontour.(b)Contrast-enhancedCTscanofthemidabdomenshowsbilateralsoft-tissuerenalmasses(arrows).Notethatthesemassesdonotdeformthecontourofthekidneys.Theparaaorticretroperitonealadenopathy(arrowhead)ismuchmoreclearlydepictedthanina.

5、Figure2.High-gradeB-celllymphomaina38-year-oldhumanimmunodeficiencyvirus(HIV)–positivewomanwhopresentedwithabdominalpainanddistention.(a)Contrastmaterial–enhancedCTscanofthemidabdomenshowsaverylargesoft-tissuemass(arrows)infiltratingthemesenteryandomentumanddisplacingthesmallbowelan

6、dcolon.(b)Contrast-enhancedCTscanshowshypoenhancingsoft-tissuemasses(arrows)inbothkidneys.Notealsotheretroperitonealadenopathy(arrowhead).(c)Photomicrographofaspecimenobtainedatfine-needleaspirationbiopsyshowshypercellularitywithauniformpopulationofmalignantlymphocytes.Numerousapto

7、ticcellsarealsoseen(×200HE)多结节型肾淋巴瘤Figure3.Magneticresonanceimagingofthekidneys.(A)T1-weightedimagingrevealstwoslightlyhypointenseorisointensesignalmassesintherightkidneyandonehypointensesignalmassintheleftkidney.(B)T2-weightedimagingrevealshypointensesignalinthebilateralrenalmass

8、esshownin(A).(C)Contrast-enhanced