原发性肾淋巴瘤的临床病理分析

Clinicopathological studies on primary renal lymphoma

目的:探讨原发性肾淋巴瘤(primary renal lymphoma,PRL)的临床病理、诊断及预后特征。方法:回顾性分析2011年1月至2016年7月就诊于郑州大学第一附属医院22例PRL患者的临床特征、病理学特征、免疫表型、诊断、治疗及预后。结果:22例PRL患者的年龄2~72岁,平均年龄54.3岁,≥50岁为13例(59.1%)。病理学检查以非霍奇金淋巴瘤常见,其中B细胞淋巴瘤20例,T细胞淋巴瘤2例。PRL:7例生存,生存时间6~50个月;15例死亡,生存时间5~35个月。结论:PRL临床比较罕见,临床表现及影像学表现特异性小,容易漏诊或误诊,组织病理学仍是确诊该病的金标准。组织学类型以B细胞性为主,弥漫性大B细胞性淋巴瘤(diffuse large B-cell lymphoma,DLBCL)最常见。根据随访结果得出生存时间与发病年龄、性别、组织学类型等有关。PRL暂无成熟的治疗经验,治疗方案亟待临床病例数的扩大,以及临床诊治经验的进一步积累。目前临床针对该病主要以行手术为主,辅助以化疗的综合治疗方式;对于局部晚期或高恶性度的肿瘤,单纯化疗通常疗效满意。

Objective： To explore the characteristics of clinical pathology, diagnosis, and prognosis of primary renal lymphoma （PRL）. Methods： The clinical features, pathological features, immune phenotypes, treatment, and prognosis of 22 patients were retrospectively analyzed. Results： The PRL patients＇ ages ranged from 2 to 72 years （mean, 54.3 years）, of which 13 patients were older than 50 years （59.1%）. All of the 22 patients were diagnosed with non-Hodgkin＇s lymphoma （NHL）, including 20 cases of B-cell lymphoma and 2 cases of T-cell lymphoma. Seven patients were still alive and survived for 6-50 months, but the other 15 were dead and survived for only 5-35 months. Conclusion： PRL is uncommon. Clinical manifestations and imaging performance specificity are not obvious, and eas- ily misdiagnosed. Histopathology is still the golden standard for the final diagnosis of this entity. The kidney is most easily involved followed by the bladder. B-cell NHL is the common subtype, and the most common type is the diffuse large B-cell lymphoma. Up to now, no standard regime could be performed for PRL patients. At present, comprehensive therapy, including surgery and chemotherapy, is recommended. For patients with locally advanced or highly aggressive status, therapeutic effect with chemotherapy alone is usually satisfied.