肾脏原发性淋巴瘤一例报告并文献复习

Primary renal lymphoma： one case report with literature review

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湿示，集合系统分离，最宽处约1．0cm，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9．8cm×8．9cm×8．8cm，边界不清，平扫CT值为39HU，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×9．5cm×8．5cm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，印圆形或多边形，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圳期。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。

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 ocortieo-medullary differentiation and with a lower kidney pole 9.8cm×8.9cm×8.8cm hypo- density mass. Results The patient was diagnosed with B-cell non-Hodgkin＇s 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 infil- tration 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 lympho- ma. 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.