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1、会计学1肾淋巴瘤肾淋巴瘤第一页，共22页。n n血源性播散血源性播散 n n 腹膜后病灶的直接腹膜后病灶的直接(zhji)(zhji)侵犯侵犯n n病变发展的晚期病变发展的晚期 n n临床上无症状体征临床上无症状体征第2页/共22页第二页，共22页。组织组织(zzh)病理学特征病理学特征n n非霍奇金淋巴瘤淋巴瘤多见 n nB细胞源常见n n恶性程度中等或较高n n更多见于淋巴结弥漫(mmn)增大的病例 第3页/共22页第三页，共22页。典型典型(dinxng)CT征象征象单发(dnf)结节多发(duf)结节腹膜后病变直接侵犯弥漫浸润肾周病变第4页/共22页第四页，共22页。单发单发(dn f
2、)结节结节n n淋巴瘤的病灶淋巴瘤的病灶(bngzo)(bngzo)通常为低血供，通常为低血供，增强扫描强化不明显增强扫描强化不明显n n密度均匀，与常见的透明细胞肾癌不密度均匀，与常见的透明细胞肾癌不同同n n在所有肾脏受侵病例中发生率占在所有肾脏受侵病例中发生率占10%10%20%20%第5页/共22页第五页，共22页。Renal lymphoma in a Renal lymphoma in a 69-69-year-oldyear-old man.Contrast-man.Contrast-enhanced helical CT scan enhanced helical CT sca
3、n shows a dominant 5-cm mass shows a dominant 5-cm mass in the right kidney(arrow).in the right kidney(arrow).There is no evidence of There is no evidence of retroperitoneal retroperitoneal adenopathyadenopathy.第6页/共22页第六页，共22页。Follicular,mixed small cleaved Follicular,mixed small cleaved and large
4、cell lymphoma in a and large cell lymphoma in a 74-74-year-old manyear-old man.Contrast-.Contrast-enhanced helical CT scan enhanced helical CT scan shows a large mass located shows a large mass located in the left kidney and in the left kidney and extending into the perirenal extending into the peri
5、renal space.space.Small nodesSmall nodes are seen in are seen in the retroperitoneum(arrow).the retroperitoneum(arrow).第7页/共22页第七页，共22页。多发多发(du f)结节结节n n最常见 n n在所有(suyu)肾脏受侵病例中发生率占60%n n常为双侧发生，但偶可仅见于单侧第8页/共22页第八页，共22页。Largecelllymphomainan11-year-oldboy.Thepatientpresentedwithalargeanteriormediastin
6、almassandrenallesions.Contrast-enhancedhelicalCTscandemonstratessmall,hypoattenuatingmassesbilaterally(arrows),atypicalfindinginrenallymphoma.Thepatientrespondedwelltotreatment,andtherenallesionseventuallyresolved.第9页/共22页第九页，共22页。Large cell lymphomaLarge cell lymphoma in a in a 73-year-73-year-oldo
7、ld woman.Contrast-enhanced CT woman.Contrast-enhanced CT scan shows bilateral renal masses scan shows bilateral renal masses with characteristic homogeneous with characteristic homogeneous attenuation,smooth borders,and attenuation,smooth borders,and low contrast enhancement.low contrast enhancement
8、.Retroperitoneal adenopathyRetroperitoneal adenopathy is is also present(also present(AA).).第10页/共22页第十页，共22页。腹膜后病变腹膜后病变(bngbin)直接侵犯直接侵犯n n另一较常见类型，占 25%30%n n表现为较大且边界不清的肿物(zhn w)包裹肾门及肾脏血管结构n n密度均匀n n肾脏动静脉血管保持通畅，但集合系统常可见梗阻第11页/共22页第十一页，共22页。Diffuse lymphocytic Diffuse lymphocytic lymphomalymphoma in
9、a in a 65-year-old woman65-year-old woman.Contrast-enhanced.Contrast-enhanced helical CT scan shows a large,helical CT scan shows a large,homogeneous mass enveloping the homogeneous mass enveloping the retroperitoneum and invading the right retroperitoneum and invading the right kidney.Note how flow
10、 is maintained in kidney.Note how flow is maintained in the renal arteries(straight arrows)and the renal arteries(straight arrows)and left renal vein(curved arrow)despite left renal vein(curved arrow)despite the massive tumor burden.These the massive tumor burden.These findings are characteristic of
11、 findings are characteristic of retroperitoneal lymphoma retroperitoneal lymphoma 第12页/共22页第十二页，共22页。Large cell lymphoma in a Large cell lymphoma in a 51-year-old 51-year-old woman.woman.Contrast-enhanced helical Contrast-enhanced helical CT scan shows a large CT scan shows a large tumor mass invadi
12、ng and tumor mass invading and displacing the left kidney.displacing the left kidney.The tumor also involves The tumor also involves the right side of the the right side of the retroperitoneum retroperitoneum 第13页/共22页第十三页，共22页。肾周病变肾周病变(bngbin)n n腹膜后病变的直接侵犯或肾被膜的侵腹膜后病变的直接侵犯或肾被膜的侵犯犯n n表现为肾窦受侵，肾周筋膜增厚，表
13、现为肾窦受侵，肾周筋膜增厚，肾肾周肿物周肿物 n n偶尔，肾周病变完全未侵犯肾实质偶尔，肾周病变完全未侵犯肾实质n n相对少见相对少见(sh(sh o jin)o jin)，有一定的特异，有一定的特异性性第14页/共22页第十四页，共22页。Large cell lymphomaLarge cell lymphoma in a in a 34-34-year-oldyear-old man.Contrast-enhanced man.Contrast-enhanced helical CT scan demonstrates helical CT scan demonstrates perir
14、enal masses bilaterally,perirenal masses bilaterally,especially on the right side.The especially on the right side.The resulting marked compression and resulting marked compression and deformity of the right kidney are deformity of the right kidney are somewhat unusual for perirenal somewhat unusual
15、 for perirenal involvementinvolvement第15页/共22页第十五页，共22页。Perirenal Perirenal lymphomalymphoma in a in a 64-year-64-year-old manold man.Helical CT scans.Helical CT scans obtained before obtained before(a)(a)and after and after(b)(b)intravenous administration of contrast intravenous administration of c
16、ontrast material show a perirenal soft-tissue material show a perirenal soft-tissue mass enveloping the left kidney.The mass enveloping the left kidney.The symmetric renal function seen in symmetric renal function seen in b b reflects the characteristic soft reflects the characteristic soft nature o
17、f lymphomatous tumor nature of lymphomatous tumor 第16页/共22页第十六页，共22页。弥漫弥漫(mmn)浸润浸润n n多为双侧性，约占20%的病例 n 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 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 n多数(dush)病例通过化疗后能恢复正常。第17页/共22页第十七页，共22页。High-grade large cell High-grade large cell lymphomalymphoma in a in a 35-year-old35-year-old man.
18、man.(a)(a)Contrast-enhanced CT scan Contrast-enhanced CT scan demonstrates patchy tumor demonstrates patchy tumor infiltration within the kidneys.infiltration within the kidneys.The kidneys have retained their The kidneys have retained their normal contour,a finding that is normal contour,a finding
19、that is characteristic of infiltrative characteristic of infiltrative lymphomalymphoma.(b)(b)On an On an unenhanced CT scan,the infiltration unenhanced CT scan,the infiltration is undetectable,which underscores is undetectable,which underscores the importance of contrast-enhanced the importance of c
20、ontrast-enhanced CT for diagnosis CT for diagnosis 第18页/共22页第十八页，共22页。Infiltrative renal Infiltrative renal lymphoma in an lymphoma in an 80-80-year-old manyear-old man.Contrast-.Contrast-enhanced CT scan enhanced CT scan shows minimal renal shows minimal renal enlargement bilaterally,enlargement bi
21、laterally,a finding that suggests a finding that suggests subtle involvement by subtle involvement by lymphomalymphoma 第19页/共22页第十九页，共22页。Infiltrative renal lymphoma in Infiltrative renal lymphoma in a a 44-year-old44-year-old woman.Contrast-woman.Contrast-enhanced CT scan shows the enhanced CT scan
22、 shows the kidneys as diffusely enlarged and kidneys as diffusely enlarged and replaced by tumor.The lobulated replaced by tumor.The lobulated appearance of the tumor reflects the appearance of the tumor reflects the transition to a more focal expansile transition to a more focal expansile mass as it compresses and destroys mass as it compresses and destroys renal parenchyma renal parenchyma 第20页/共22页第二十页，共22页。Radiographics.2000;20:197-212 第21页/共22页第二十一页，共22页。感谢您的观看感谢您的观看(gunkn)！第22页/共22页第二十二页，共22页。