《肾淋巴瘤》ppt课件.ppt

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 enhancedhelicalCTscanshowsadominant5 cmmassintherightkidney arrow Thereisnoevidenceofretroperitonealadenopathy Follicular mixedsmallcleavedandlargecelllymphomaina74 year oldman Contrast enhancedhelicalCTscanshowsalargemasslocatedintheleftkidneyandextendingintotheperirenalspace Smallnodesareseenintheretroperitoneum 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 atypicalfindinginrenallymphoma Thepatientrespondedwelltotreatment andtherenallesionseventuallyresolved Largecelllymphomaina73 year oldwoman Contrast enhancedCTscanshowsbilateralrenalmasseswithcharacteristichomogeneousattenuation smoothborders andlowcontrastenhancement Retroperitonealadenopathyisalsopresent 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 straightarrows andleftrenalvein curvedarrow despitethemassivetumorburden Thesefindingsarecharacteristicofretroperitoneallymphoma Largecelllymphomaina51 year oldwoman Contrast enhancedhelicalCTscanshowsalargetumormassinvadinganddisplacingtheleftkidney Thetumoralsoinvolvestherightsideoftheretroperitoneum 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 Theresultingmarkedcompressionanddeformityoftherightkidneyaresomewhatunusualforperirenalinvolvement Perirenallymphomaina64 year oldman HelicalCTscansobtainedbefore a andafter b intravenousadministrationofcontrastmaterialshowaperirenalsoft tissuemassenvelopingtheleftkidney Thesymmetricrenalfunctionseeninbreflectsthecharacteristic soft natureoflymphomatoustumor 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 但肾功能常能保持不出现临床症状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 enhancedCTfordiagnosis Infiltrativerenallymphomainan80 year oldman Contrast enhancedCTscanshowsminimalrenalenlargementbilaterally afindingthatsuggestssubtleinvolvementbylymphoma Infiltrativerenallymphomaina44 year oldwoman Contrast enhancedCTscanshowsthekidneysasdiffuselyenlargedandreplacedbytumor Thelobulatedappearanceofthetumorreflectsthetransitiontoamorefocalexpansilemassasitcompressesanddestroysrenalparenchyma Radiographics 2000 20 197 212