原发性肾淋巴瘤(PRL)的超声诊断与鉴别诊断

The value of ultrasound in the diagnosis and differential diagnosis of primary renal lymphoma(PRL)

目的探讨超声对原发性肾淋巴瘤(primary renal lymphoma,PRL)的诊断价值。方法回顾性总结经手术或超声引导下穿刺后病理证实的15例PRL患者的16个患肾病灶的超声表现、超声分型及诊断。结果本组15例患者中,男性13例,女性2例;年龄35~81岁,平均年龄(62.1±14.2)岁;单侧患病14例,双侧患病1例,共计16个病灶。超声声像图表现为肾内肿块型7个,弥漫型1个,肾周肿块型及混合型各4个,肿块最大径41~164 mm。超声诊断:恶性肿瘤10例(其中6例7个患肾诊断为淋巴瘤),性质待定3例,肾周出血及错构瘤出血各1例,确诊率为43.8%(7/16),误诊率为12.5%(2/16);超声引导下穿刺12例,手术5例(2例穿刺后再手术);病理诊断:弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)9例,外周T细胞淋巴瘤、黏膜相关性淋巴瘤、非霍奇金淋巴瘤NKT细胞型及Burkitt淋巴瘤各1例,另2例门诊患者仅诊断为淋巴瘤,无进一步分型诊断。结论PRL的超声表现分型有:肾内肿块型、肾周型、弥漫型及混合型,其中肾周型及弥漫型为特异性超声表现,肿块型需与常见的肾肿瘤鉴别,超声引导下穿刺活检是术前明确诊断的首选方法。

Objective To analyze the value of ultrasound in the diagnosis of primary renal lymphoma(PRL).Methods Ultrasound findings,classifications and diagnosis of 16 PRL in 15 patients were retrospectively summarized.All cases confirmed with pathology after surgery or ultrasound-guided biopsy.Results Fifteen patients were 13 males and 2 females,with age ranged from 35 to 81(62.1±14.2) years old.Fourteen patients were unilateral,and one was bilateral.The ultrasonographic appearance of PRL included 7 cases of intrarenal type,1 case of diffuse type,4 cases of perirenal type and 4 cases of mixed type,respectively.The maximum diameters of PRL lesions ranged from 41-164 mm.The diagnosis of ultrasound was as follows:10 cases of malignant tumors(7 lesions in 6 cases with diagnosis of lymphoma),3 undetermined cases,1 case of perirenal hemorrhage,and 1 case of hamartoma hemorrhage.The diagnosis and misdiagnosis rate were 43.8%(7/16) and 12.5%(2/16),respectively.The pathology was derived from surgery and biopsy in 5 and 12 cases,respectively.The final diagnosis was 9 diffuse large B-cell lymphoma(DLBCL),1 peripheral T-cell lymphoma,1 mucosa-associated lymphoma,1 non-Hodgkin’ s lymphoma NKT cell type,and 1 Burkitt’ s lymphoma.The other 2 cases were only diagnosed as lymphoma without further classification.Conclusions The ultrasound manifestations of PRL included intrarenal type,perirenal type,diffuse type and mixed type.The perirenal and diffuse types are specific for PRL.The intrarenal type should be distinguished from other renal solid lesions with ultrasound-guided biopsy preferred for preoperative diagnosis.