CAJ | 학술논문

目的：探讨肾脏原发性淋巴瘤( primary renal lymphoma, PRL)的临床病理学特征、免疫表型、诊断和鉴别诊断以及治疗和预后。方法回顾性分析19例PRL的临床病理学特征、免疫表型、治疗及预后。结果19例PRL中男性11例,女性8例,年龄37~85岁,平均55岁。以单侧肾脏发病为主,腰痛为最常见的首发症状。13例行肾脏切除术,6例行肾脏肿物穿刺活检,其中17例接受化疗。病理检查均为非霍奇金淋巴瘤( non-hodgkin’ s lymphoma, NHL),其中14例为弥漫性大B细胞淋巴瘤(diffuse large B cell lymphoma, DLBCL),占73．684%(14/19)；4例为小淋巴细胞性淋巴瘤,占21．053%(4/19)；1例为外周T细胞淋巴瘤,占5．263%(1/19)。15例获得随访资料,12例存活,生存时间1~78个月；3例死亡,生存时间3~38个月,平均生存时间为23个月(1例死于脑梗)。结论 PRL是一种罕见的结外淋巴瘤,临床症状不典型,易误诊为肾癌,确诊依赖于病理检查,免疫组化及分子生物学检测有助于分型；组织学类型多为B细胞来源的NHL,以DLBCL多见；治疗方式推荐手术切除+化疗。预后可能与患者年龄、临床病理特点、肿瘤分型和治疗方式有关。
목적：탐토신장원발성림파류( primary renal lymphoma, PRL)적림상병이학특정、면역표형、진단화감별진단이급치료화예후。방법회고성분석19례PRL적림상병이학특정、면역표형、치료급예후。결과19례PRL중남성11례,녀성8례,년령37~85세,평균55세。이단측신장발병위주,요통위최상견적수발증상。13례행신장절제술,6례행신장종물천자활검,기중17례접수화료。병리검사균위비곽기금림파류( non-hodgkin’ s lymphoma, NHL),기중14례위미만성대B세포림파류(diffuse large B cell lymphoma, DLBCL),점73．684%(14/19)；4례위소림파세포성림파류,점21．053%(4/19)；1례위외주T세포림파류,점5．263%(1/19)。15례획득수방자료,12례존활,생존시간1~78개월；3례사망,생존시간3~38개월,평균생존시간위23개월(1례사우뇌경)。결론 PRL시일충한견적결외림파류,림상증상불전형,역오진위신암,학진의뢰우병리검사,면역조화급분자생물학검측유조우분형；조직학류형다위B세포래원적NHL,이DLBCL다견；치료방식추천수술절제+화료。예후가능여환자년령、림상병리특점、종류분형화치료방식유관。
Purpose To investigate the clinicopathological and immunohistochemical features of primary renal lymphomas ( PRL) , and to discuss the diagnosis, differential diagnosis, treatment and prognosis of the tumors. Methods Clinical data of 19 patients with PRL from January 2005 to October 2014 were retrospectively analyzed. Result The 19 patients in this study, there were 11 males and 8 females and the age ranged from 37 to 85 years old (averaged 55). Patients were mainly presented with unilateral renal masses, with lumbodynia as the main symptom. 13 patients underwent nephrectomy, 6 patients underwent renal biopsy and 17 patients received CHOP or R-CHOP chemotherapy. All of them were diagnosed as non-Hodgkin’ s lymphoma, with 14 cases of diffuse large B cell lym-phoma (DLBCL) (73. 684%, 14/19), 4 cases of B cell small cell lymphoma (21. 053%, 4/19), and 1 cases of T cell lymphoma (5. 263%, 1/19). Follow-up information was available in 15 patients. 12 were still alive and survived for 1~78 months, while the other 3 were dead with 1 case who died of cerebral infarction, and survived for 3~38 months ( averaged 23 months) . Conclusion PRL is an extranodal lymphoma which is rare in kidney and is often misdiagnosed as renal carcinomas due to its nonspecific clinical manifestations. The diagnosis of PRL can be confirmed by histopathological examination, immunohistochemistry and molecular analy-sis. The majority of the lymphomas are B cell lymphomas and most of them are DLBCL. The recommended treatment is surgery com-bined with chemotherapy and the prognosis is associated with the age, clinicopathological characteristics, tumor types and treatment.