文档介绍：肾淋巴瘤
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
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
肾淋巴瘤
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
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%
Renal lymphoma in a 69-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.
Follicular, mixed small cleaved and large cell lymphoma in a 74-year-old man. Contrast-enhanced helical CT scan shows a large mass located in the left kidney and extending into the perirenal space. Small nodes are seen in the retroperitoneum (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
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
Large cell lymphoma in a 34-year-old 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
Perirenal lymphoma in a 64-year-old man. Helical CT scans obtained before (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
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-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 scan, the infiltration is undetectable, which undersco