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肾淋巴瘤张瑾n淋巴瘤尸检病例中肾脏受侵的比例达30%to60%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n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%Renallymphomaina69-year-oldman.Contrast-enhancedhelicalCTscanshowsadominant5-cmmassintherightkidney(arrow).Thereisnoevidenceofretroperitonealadenopathy.Follicular,mixedsmallcleavedandlargecelllymphomaina74-year-oldman.Contrast-enhancedhelicalCTscanshowsalargemasslocatedintheleftkidneyandextendingintotheperirenalspace.Smallnodesareseenintheretroperitoneum(arrow).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Largecelllymphomainan11-year-oldboy.Thepatientpresentedwithalargeanteriormediastinalmassandrenallesions.Contrast-enhancedhelicalCTscandemonstratessmall,hypoattenuatingmassesbilaterally(arrows),atypicalfindinginrenallymphoma.Thepatientrespondedwelltotreatment,andtherenallesionseventuallyresolved.Largecelllymphomaina73-year-oldwoman.Contrast-enhancedCTscanshowsbilateralrenalmasseswithcharacteristichomogeneousattenuation,smoothborders,andlowcontrastenhancement.Retroperitonealadenopathyisalsopresent(A).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Diffuselymphocyticlymphomaina65-year-oldwoman.Contrast-enhancedhelicalCTscanshowsalarge,homogeneousmassenvelopingtheretroperitoneumandinvadingtherightkidney.Notehowflowismaintainedintherenalarteries(straightarrows)andleftrenalvein(curvedarrow)despitethemassivetumorburden.ThesefindingsarecharacteristicofretroperitoneallymphomaLargecelllymphomaina51-year-oldwoman.Contrast-enhancedhelicalCTscanshowsalargetumormassinvadinganddisplacingtheleftkidney.Thetumoralsoinvolvestherightsideoftheretroperitoneum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，肾周病变完全未侵犯肾实质n相对少见，有一定的特异性Largecelllymphomaina34-year-oldman.Contrast-enhancedhelicalCTscandemonstratesperirenalmassesbilaterally,especiallyontherightside.TheresultingmarkedcompressionanddeformityoftherightkidneyaresomewhatunusualforperirenalinvolvementPerirenallymphomaina64-year-oldman.HelicalCTscansobtainedbefore(a)andafter(b)intravenousadministrationofcontrastmaterialshowaperirenalsoft-tissuemassenvelopingtheleftkidney.Thesymmetricrenalfunctionseeninbreflectsthecharacteristicsoftnatureoflymphomatoustumor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。High-gradelargecelllymphomaina35-year-oldman.(a)Contrast-enhancedCTscandemonstratespatchytumorinfiltrationwithinthekidneys.Thekidneyshaveretainedtheirnormalcontour,afindingthatischaracteristicofinfiltrativelymphoma.(b)OnanunenhancedCTscan,theinfiltrationisundetectable,whichunderscorestheimportanceofcontrast-enhancedCTfordiagnosisInfiltrativerenallymphomainan80-year-oldman.Contrast-enhancedCTscanshowsminimalrenalenlargementbilaterally,afindingthatsuggestssubtleinvolvementbylymphomaInfiltrativerenallymphomaina44-year-oldwoman.Contrast-enhancedCTscanshowsthekidneysasdiffuselyenlargedandreplacedbytumor.ThelobulatedappearanceofthetumorreflectsthetransitiontoamorefocalexpansilemassasitcompressesanddestroysrenalparenchymaRadiographics.2000;20:197-212
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