肾上腺淋巴瘤的临床与病理特点分析

目的 探讨肾上腺淋巴瘤的临床和病理特征。方法 回顾性分析1994年至2004年收治的6例以肾上腺肿瘤为首发表现的淋巴瘤患者资料。6例均为男性。中位年龄55岁（35～75岁）。单侧2例、双侧4例，伴脾肿大4例、伴同侧肾上极受累3例、骨受侵1例。腹部CT均表现为肾上腺肿瘤，形态不规则，密度较均匀，增强后肿瘤轻度强化，未见出血和钙化。结果 6例中术前误诊5例，均行左侧肾上腺肿瘤切除，其中行同侧肾切除2例，胰尾切除1例；穿刺活检证实1例。病理报告均为非霍奇金淋巴瘤，弥漫性大细胞型，B细胞型。术后5例中接受化疗3例，化放疗1例，失访1例，1例化疗后无瘤生存28个月后失访，余3例术后分别生存6、17和24个月后死亡；穿刺活检后接受化放疗联合利妥昔单抗（美罗华）治疗1例，随访16个月无瘤健在。结论 肾上腺肿瘤患者特别是双侧或伴脾肿大，影像学表现形态不规则、密度较均匀、增强不明显者，应高度怀疑淋巴瘤的可能。以肾上腺肿瘤为首发表现的淋巴瘤不管是原发或同时伴有其他器官受累者，恶性程度较高，预后相对不良。

Clinical and pathological features of adrenal lymphoma

Objective To discuss the clinical and pathological characters of lymphoma of the ad- renal gland.Methods The data of 6 adrenal lymphoma cases with adrenal mass as the primary rep- resentation were retrospectively analysed.These 6 patients were all male with the average age of 55 (35-75)years.Two patients presented with unilateral and 4 cases with bilateral involved.Four pa- tients were found to have enlarged spleen.Three cases had the upper pole of kidney involved.One case had bone involved.The CT showed irregular,homogeneous adrenal mass which was mildly enhanced. Results Five of the 6 patients were misdiagnosed before operation and received resection of adrenal mass.Two of this 5 cases received nephreetomy during operation,and one received partial pancreatec- tomy.One patient was diagnosed as adrenal lymphoma by biopsy and didn't receive adrenal mass resec- tion.Eventually they were all diagnosed as diffuse large B cell Non-Hodgkin's lymphoma by pathology. Among the 5 patients having their adrenal mass removed,3 received chemotherapy alone,1 chemother- apy and radiation therapy post-operation.One patient lost follow-up immediately after operation,while another one case lost follow-up after a disease free survival of 28 months.Three patients died at 6,17, 24 month after operation.One patient was still alive without disease relapse after 16 months follow- up.Conclusions It should be suspected the diagnosis as adrenal lymphoma when the adrenal mass is bilateral and irregular,homogeneous and mildly enhanced on CT scan.The prognosis of adrenal lym- phoma with adrenal mass as the primary presentation is relatively poor.