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1、淋巴瘤尸检病例中肾脏受侵的比例达 30%to 60%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 第1页/共22页血源性播散 腹膜后病灶的直接侵犯病变发展的晚期 临床上无症状体征第2页/共22页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 第3页/共22页典型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第4页/共22页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%第5页/共22页Renal lymphoma in a 6
2、9-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.第6页/共22页Follicular,mixed small cleaved and large cell lymphoma in a 74-year-old man.Contrast-enhanced helical CT scan shows a large mass located i
3、n the left kidney and extending into the perirenal space.Small nodes are seen in the retroperitoneum(arrow).第7页/共22页多发结节最常见 在所有肾脏受侵病例中发生率占60%常为双侧发生，但偶可仅见于单侧第8页/共22页Largecelllymphomainan11-year-oldboy.Thepatientpresentedwithalargeanteriormediastinalmassandrenallesions.Contrast-enhancedhelicalCTscande
4、monstratessmall,hypoattenuatingmassesbilaterally(arrows),atypicalfindinginrenallymphoma.Thepatientrespondedwelltotreatment,andtherenallesionseventuallyresolved.第9页/共22页Large cell lymphoma in a 73-year-old woman.Contrast-enhanced CT scan shows bilateral renal masses with characteristic homogeneous at
5、tenuation,smooth borders,and low contrast enhancement.Retroperitoneal adenopathy is also present(A).第10页/共22页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第11页/共22页Diffuse lymphocytic lymphoma in a 65-year-old woman.Contrast-enhanced helical CT scan shows a large,homogen
6、eous 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 retroperitoneal lymphoma 第12页/共22页Large cell lymphoma in a 5
7、1-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 第13页/共22页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，有一定的特异性第14页/共22页Large cell lymphoma in a 34-year-old
8、 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第15页/共22页Perirenal lymphoma in a 64-year-old man.Helical CT scans obtained be
9、fore(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 第16页/共22页弥漫浸润多为双侧性，约占20%的病例 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 受侵的肾脏功能下降，但肾功能常
10、能保持不出现临床症状多数病例通过化疗后能恢复正常。第17页/共22页High-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 that is characteristic of infiltrative lymphoma.(b)On an unenhanced CT
11、 scan,the infiltration is undetectable,which underscores the importance of contrast-enhanced CT for diagnosis 第18页/共22页Infiltrative 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 第19页/共
12、22页Infiltrative 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 第20页/共22页Radiographics.2000;20:197-212 第21页/共22页感谢您的观看！第22页/共22页