恶性淋巴瘤侵及泌尿生殖系统三例报告及文献复习

Genitourinary invasion by malignant lymphoma (report of 3 cases and review of the literature)

目的探讨恶性淋巴瘤侵及泌尿生殖系的临床特点。方法报告恶性淋巴瘤侵及泌尿生殖系3例。例1,男,68岁,主诉为右侧腰部不适1个月。CT扫描示右肾门处4.0 cm×5.5 cm软组织影,密度均匀,右腰大肌自肾下极至髂内肌水平弥漫增粗,内见低密度软组织影。例2,男,72岁,主诉为左下肢肿胀2周。CT检查示左精囊软组织肿物,直径2.5 cm;左髂动脉分叉处6.5 cm×4.5 cm软组织肿块。例3,女,48岁,主诉为发热1个月。CT检查示双侧肾上腺区8.0 cm×6.0 cm,7.0 cm×6.5 cm实性占位,界限清晰,密度不均。结合文献复习,对此类疾病的发病率、临床特点、手术治疗和预后进行总结。结果3例患者均手术治疗,原发部位分别为腹膜后及盆腔淋巴结,肾脏、精囊、肾上腺受累各1例,病理类型均为非霍奇金弥漫性大B细胞淋巴瘤。例1术后2个月死亡。例2、3术后行CHOP方案化疗,分别随访4个月、2年,均无瘤生存。结论淋巴瘤侵及泌尿生殖系统临床症状不典型,预后较差。此类患者手术效果不佳,治疗应以化疗、放疗为主。手术探查对于明确诊断有积极意义。

Objective To investigate the clinical features of genitourinary invasion by malignant lymphoma. Methods Three cases of genitourinary invasion by malignant lymphoma were reported. Case 1 ,a 68-year-old man,complained of right flank malaise for 1 month. CT showed a soft tissue shadow of 4.0 cm × 5.5 cm with homogeneous density at right renal hilus, and diffusely thickened right greater psoas muscle at the level from lower pole of the kidney to internal iliac muscle with low-density soft tissue shadow inside. Case 2,a 72-year-old man, presented with distended left leg for 2 weeks. CT indicated left seminal vesicle mass with soft tissue density of 2.5 cm in diameter, and a soft tissue mass of 6.5 cm × 4.5 cm at the left iliac artery furcation. Case 3, a 48-year-old woman, complained of fever for 1 month. CT showed well-defined, solid masses of 8.0 cm × 6.0 cm and 7.0 cm × 6.5 cm, respectively,in diameter with inhomogeneous density at bilateral adrenal gland areas. The incidence, clinical features, prognosis and surgical treatment of this disease were summarized in combination with review of the literature. Results All 3 cases underwent operations. The primary foci originated from pelvic or retroperitoneal lymph nodes. The kidney,seminal vesicle and adrenal gland were involved in each of the 3 cases. The pathological types were all non-Hodgkin diffusive big B cell lymphoma. One case died 2 months after operation. The other 2 received CHOP chemotherapy after operation,and were followed for 4 months and 2 years,respectively. They were both alive with no recurrence at last time of the follow-up. Conclusions Genitourinary invasion by malignant lymphoma is an uncommon disease with atypical clinical presentations and poor prognosis. Surgical treatment has little effect ,while radiotherapy and chemotherapy should be the first choice. Explorative surgery has positive significance for definite diagnosis.