CAJ | 학술논문

目的提高肾脏原发性淋巴瘤的诊治水平.方法回顾性分析1例肾脏原发性淋巴瘤患者的临床病理资料,结合文献复习讨论.患者,女,61岁.因左侧腰痛2周入院.查体:左上腹压痛,左肾区叩击痛.B超检查见左肾正常结构未显示,集合系统分离,最宽处约1.0 cm,左肾区可探及一巨大低回声肿物,大小9.7cm×5.3cm,边界模糊.CT检查见左肾中下极肿物,大小9.8 cm×8.9 cm ×8.8 cm,边界不清,平扫CT值为39 HU,增强后为61 HU,强化不明显.术前诊断:左肾恶性肿瘤.结果患者行根治性左肾切除术.病理报告:左肾大部分被肿瘤组织占据,中下极见10.0cm×9.5 cm ×8.5 cm类圆形肿物,质硬,肿物切面呈灰白色,质地细腻.镜下瘤细胞呈弥漫性浸润,卵圆形或多边形,略大于正常淋巴细胞,核大深染呈不规则形.病理诊断:肾弥漫性大B细胞性淋巴瘤.骨髓穿刺检查未见异常.行环磷酰胺+吡喃阿霉素+长春新碱+泼尼松+利妥昔单抗方案化疗6周期.术后每3个月复查胸部X线片、腹部B超及CT等.随访20个月,未见肿瘤复发.结论肾脏原发性淋巴瘤临床罕见,症状与肾癌相似,影像学检查无特征性改变,确诊需依靠病理学检查.本病预后不良,手术切除患肾联合规范的全身化疗,可延长患者的生存期.
목적 제고신장원발성림파류적진치수평.방법 회고성분석1례신장원발성림파류환자적림상병리자료,결합문헌복습토론.환자,녀,61세.인좌측요통2주입원.사체:좌상복압통,좌신구고격통.B초검사견좌신정상결구미현시,집합계통분리,최관처약1.0 cm,좌신구가탐급일거대저회성종물,대소9.7cm×5.3cm,변계모호.CT검사견좌신중하겁종물,대소9.8 cm×8.9 cm ×8.8 cm,변계불청,평소CT치위39 HU,증강후위61 HU,강화불명현.술전진단:좌신악성종류.결과 환자행근치성좌신절제술.병리보고:좌신대부분피종류조직점거,중하겁견10.0cm×9.5 cm ×8.5 cm류원형종물,질경,종물절면정회백색,질지세니.경하류세포정미만성침윤,란원형혹다변형,략대우정상림파세포,핵대심염정불규칙형.병리진단:신미만성대B세포성림파류.골수천자검사미견이상.행배린선알+필남아매소+장춘신감+발니송+리타석단항방안화료6주기.술후매3개월복사흉부X선편、복부B초급CT등.수방20개월,미견종류복발.결론 신장원발성림파류림상한견,증상여신암상사,영상학검사무특정성개변,학진수의고병이학검사.본병예후불량,수술절제환신연합규범적전신화료,가연장환자적생존기.
Objective To improve the clinical diagnosis and treatment outcome of primary renal lymphoma.Methods The clinical data of one primary renal lymphoma case were reviewed with its clinical manifestation,imaging,pathological study results and treatment outcome in our institute.This was a 61 yrs female patient presented with progressive left flank pain.The abdominal CT scan revealed enlarged left kidney lost ocortico-medullary differentiation and with a lower kidney pole 9.8 cm × 8.9 cm × 8.8 cm hypodensity mass.Results The patient was diagnosed with B-cell non-Hodgkinˊs lymphoma after radical nephrectomy.Extrarenal origin was ruled out by bone marrow biopsy.The pathological results showed that the tumor was limited to the lower kidney pole.Microscopically,there were large sheets of lymphoma cell infiltration in kidney parenchyma.The lymphoma cells were oval or polygonal.The nuclei of the lymphoma cells were anachromasised and irregular in size.The final pathological diagnosis was diffused large B cell lymphoma.The patient was subsequently given six cycles of CHOP (cyclophosphamide,adriamycin,vincristine and prednisone) in conjunction with rituximab.Twenty months post chemotherapy the patient was diseas-free at follow-up.Conclusions Primary renal lymphoma is rare and the mechanism of its development is unclear.Most of the cases reported showed rapid systemic progression and poor prognosis.The clinical manifestation is similar to renal cell carcinoma.Ultrasound and CT have no distinct characteristic.Diagnosis is established on renal biopsy or radical nephrectomy.Effective post-operative treatment is chemotherapy (CHOP) in conjunction with rituximab.