肾原发性淋巴瘤二例报告并文献复习

目的探讨肾脏原发性恶性淋巴瘤的临床病理特点、影像学特征及诊治。方法总结2例肾脏原发性淋巴瘤患者的临床病理、影像学特点、诊断、鉴别诊断及治疗预后资料,并结合文献复习讨论。结果2例患者均为中老年人,发病后均有腰部隐痛或钝痛;影像学检查均显示肾脏占位性病变;病理诊断均为肾脏原发性恶性淋巴瘤,其中1例为霍奇金淋巴瘤（以结节硬化型为主）,1例为非霍奇金淋巴瘤（B细胞性）。1例行手术加化疗,1例单纯化疗;患者预后佳,目前分别存活1年和5年8个月。结论肾脏原发性恶性淋巴瘤十分罕见,尤其是霍奇金淋巴瘤;确诊需病理组织学检查,治疗主要是单纯化疗或根治性肾切除加化疗。     

原发性肾脏淋巴瘤1例报道并文献复习

目的：探讨原发性肾脏淋巴瘤的临床特征、影像学特点、治疗方法及预后。方法回顾性分析1例原发性肾脏淋巴瘤患者的临床资料,结合相关文献资料探讨肾脏原发性淋巴瘤的临床表现、影像学特点、治疗方法及预后。结果1例影像学诊断肾癌患者行根治性肾切除,术后病理诊断低度恶性B细胞淋巴瘤,术后给予化疗,随访12个月,患者生活状况良好。结论原发性肾脏淋巴瘤是比较罕见的肾脏原发肿瘤,患者早期无不适症状,早期较难诊断,影像学特点与肾癌极为相似,往往误诊为肾癌,确诊主要靠病理诊断。手术切除原发灶及化疗是治疗肾脏原发性淋巴瘤的最佳治疗方案。     

肾脏原发性恶性淋巴瘤(附三例报告)

目的 探讨肾脏原发性恶性淋巴瘤的临床特点。方法 总结3例肾脏原发性恶性淋巴瘤患者临床诊治资料，结合文献讨论其发病特点，影像学特征，治疗和预后。结果 3例患者中手术治疗2例，术后行化疗和放疗，l例病理确诊后单纯行化疗，3例病理均诊断为非霍奇金淋巴瘤(弥漫型)。l例术后1年3个月死于肾衰；另2例分别存活1年和2年1个月，仍在随访中。结论 肾脏原发性恶性淋巴瘤影像学征象与肾细胞癌相似，治疗应根据组织学分型、分期及肿瘤大小，采取手术联合化疗及放疗。     

原发性肾脏淋巴瘤2例报道并文献复习

目的探讨原发性肾脏淋巴瘤的临床特点。方法总结2例原发性肾脏淋巴瘤患者的临床资料,结合文献讨论其发病特点、影像学特征、治疗及预后。结果 2例患者均实施手术加化疗,病理诊断均为非何杰金淋巴瘤,1例死于术后2月,另1例已存活1年,仍在随访中。结论原发性肾脏淋巴瘤是一种罕见的恶性淋巴瘤,影像学征象与肾细胞癌相似,以成人发病为主,易误诊为肾癌,病理类型多为B细胞来源的非何杰金淋巴瘤,综合治疗是延长生存的较好方式。     

原发性直肠恶性淋巴瘤诊治分析

目的探讨原发性直肠恶性淋巴瘤的诊断和治疗方法。方法回顾性分析1994～2011年我院收治的7例原发性直肠恶性淋巴瘤诊断、治疗的临床资料。结果ⅡE期1例因患有肾功能衰竭放弃治疗并于1个月后死于急性肾衰外。ⅠE期2例经肛门手术,ⅡE期2例行根治手术,其无病生存期均达5年以上。ⅡE期1例仅做化疗,生存43个月。ⅣE期1例行姑息性手术加化疗,生存20个月。结论原发性直肠恶性淋巴瘤误诊率高、早期诊断对改善预后十分重要,手术切除加规范放、化疗,可明显延长生存期。     

原发性肾上腺非霍奇金淋巴瘤(附2例报告并文献复习)

目的:探讨原发性肾上腺恶性淋巴瘤的临床特征。方法:报告2例本病患临床资料。2例临床及影像学上均无特异性。CT示不规则肿块,伴血清乳酸脱氢酶和β2微球蛋白升高。组织学上瘤细胞呈弥漫分布,多呈圆形或卵圆形,核分裂像易见。免疫组化CD3、CD45-RO、L26、CD79a阳性。手术切除肿瘤后均正规联合化疗4个疗程。结果:2例患者随访半年,均健在。结论:原发性肾上腺恶性淋巴瘤恶性度较高,预后差,影像学和酶学检查可提示本病可能,可进一步行骨髓穿刺及经皮针吸活检术以明确诊断。治疗上主要是手术加联合化疗。     

21例胃原发恶性淋巴瘤的诊治体会

为总结胃原发恶性淋巴瘤的诊治经验。回顾分析21例胃原发恶性淋巴瘤的临床情况。胃原发性恶性淋巴瘤的诊断依赖于上消化道造影、胃镜和活检；治疗采用手术加化疗。21例患者中ⅠE，ⅡE期术后5，10年生存率分别为100％，83．3％和84．6％，74．2％。早期诊断，采用手术加化疗是提高胃原发恶性淋巴瘤生存率的关键。     

原发性肾上腺恶性淋巴瘤3例报告

目的:提高临床对原发性肾上腺恶性淋巴瘤(PAL)的诊治水平。方法:报告收治的3例PAL患者的临床资料,3例的临床表现和影像学检查均无特异性。2例经手术探查明确诊断,1例在CT导引下行肿瘤穿刺活检后明确诊断。病理检查均诊为弥漫型、大B细胞性肾上腺非霍奇金PAL,术后均常规行CHOP化疗。结果:1例患者随访1年后失访,另2例分别于诊断后1年8个月、5年2个月死亡。结论:PAL恶性度较高,预后不良,临床表现和影像学检查缺乏特异性,CT或超声导引下的活检穿刺是明确诊断的好方法,手术及化疗对PAL有效。     

原发性直肠恶性淋巴瘤7例诊治分析

目的:探讨提高对原发性直肠恶性淋巴瘤的诊断和治疗最佳方法。方法:回顾性总结1990~2005年我院原发性直肠恶性淋巴瘤诊断、治疗及随访结果。结果:本组7例均获随访,其中1例仅作化疗,未作手术和放疗的病人仅生存3个月;1例行Dixon手术仅生存8个月;5例行Miles手术中,2例联合化疗的病人生存2·5~5年,3例联合放、化疗的病人均生存5年以上。结论:早期诊断并手术切除,加规范的化、放疗,可明显延长生存期。     

原发性乳腺恶性淋巴瘤九例诊治体会

目的总结原发性乳腺恶性淋巴瘤临床特征及诊疗方法。方法回顾性分析9例原发性乳腺恶性淋巴瘤患者的临床资料。结果 9例患者中,6例患者术前行粗针穿刺活检,仅2例术前诊断为乳腺恶性淋巴瘤;9例患者均行手术治疗,其中6例行乳腺癌改良根治术,1例行单纯乳房切除术,2例因术前诊断为乳腺恶性淋巴瘤仅行肿瘤切除术;9例患者术后均给予环磷酰胺+阿霉素+长春新碱+泼尼松(CHOP)方案化疗,2例患者后续行局部放疗;9例患者初治后均获得完全缓解,随访期间死亡2例,分别死于脑转移和骨髓转移。结论手术切除是乳腺恶性淋巴瘤主要治疗手段,术后辅助化疗及局部放疗可提高治疗效果。     

肾脏原发性淋巴瘤一例报告并文献复习

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显示,集合系统分离,最宽处约1.0 cm,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9.8 cm×8.9 cm ×8.8 cm,边界不清,平扫CT值为39 HU,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×9.5 cm ×8.5 cm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,卵圆形或多边形,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周期.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.     

泌尿男生殖系统淋巴瘤的临床特征及预后分析

目的探讨泌尿男生殖系统淋巴瘤患者的临床特征,并对其预后进行分析。方法回顾性分析2014年8月至2019年8月北京友谊医院收治的9例泌尿男生殖系统淋巴瘤患者的临床资料。男5例,女4例。平均年龄62(50~69)岁。肿瘤位于肾脏3例,膀胱2例,睾丸4例。首发症状:肾肿瘤3例中2例为发热(1例伴腹痛及体重减轻),1例为体检发现肾盂占位;膀胱肿瘤1例为肉眼血尿伴腹痛,1例为尿急、尿痛;4例睾丸肿瘤均为睾丸无痛性肿大。5例行CT检查见低密度肿物伴轻中度强化,4例睾丸肿瘤行B超检查提示不规则、不均质肿块内见血流信号。术前诊断均为泌尿男生殖系统肿瘤。6例接受手术,3例行病灶穿刺获取病理。9例中4例接受手术治疗联合化疗,2例仅接受化疗,2例仅接受手术治疗,1例未治疗。肾肿瘤3例中,1例行B超引导下病灶穿刺活检术,术后予环磷酰胺+阿霉素+长春新碱+泼尼松+利妥昔单抗(R-CHOP)方案静脉化疗;1例肾盂占位性病变者行腹腔镜肾输尿管全长切除术,术后予R-CHOP方案静脉化疗;1例行B超引导下病灶穿刺活检术,术后患者拒绝进一步治疗。2例膀胱肿瘤者均行TURBT,术后均拒绝放化疗。4例睾丸肿瘤者中,3例行患侧睾丸切除术,1例行B超引导下病灶穿刺活检术;3例行R-CHOP方案化疗,1例于外院行化疗及对侧睾丸放疗,具体方案不详;4例均行鞘内注射化疗药物(甲氨蝶呤15 mg+阿糖胞苷50 mg+地塞米松5 mg)预防中枢神经系统浸润。结果本组9例术后恢复顺利,无手术及穿刺相关并发症发生。术后病理诊断均为非霍奇金淋巴瘤,其中8例为弥漫性大B细胞淋巴瘤,1例睾丸淋巴瘤为间变性大细胞淋巴瘤。按照Ann Arbor分期标准进行临床分期,确诊时Ⅰ~ⅡE期4例,ⅢE~ⅣE期5例。国际预后指数(IPI)评分0~2分6例,≥3分3例。随访时间平均18(6~66)个月。7例存活,其中3例完成化疗者中,2例完全缓解(睾丸淋巴瘤ⅡE期IPI评分1分和ⅣE期IPI评分2分各1例),1例部分缓解(肾盂淋巴瘤ⅣE期IPI评分3分);3例拒绝化疗者未见肿瘤复发或进展(膀胱淋巴瘤2例和肾盂淋巴瘤1例,均为ⅠE期IPI评分1分);1例化疗2个周期后因出现细菌真菌混合感染性肺炎停止化疗(睾丸淋巴瘤ⅢE期IPI评分3分)。肾淋巴瘤ⅢE期IPI评分3分1例和睾丸淋巴瘤Ⅲ期IPI评分2分1例,分别于确诊后6个月、17个月因肿瘤进展死亡。结论泌尿男生殖系统淋巴瘤以弥漫大B细胞淋巴瘤为主,临床表现特异性差,诊断时应根据症状及影像学表现与其他常见肿瘤进行鉴别,避免误诊误治。组织病理学是诊断的金标准,R-CHOP方案化疗为首选治疗手段。     

Renal insufficiency due to bilateral primary renal lymphoma.

Diffusely enlarged nonhydronephrotic kidneys on ultrasound and computer-tomographic examination in a case of progressive preterminal renal insufficiency were very suggestive of extensive lymphomatous infiltration. Diffuse infiltration of the kidney by centrocytic/centroblastic non-Hodgkin lymphoma was confirmed upon renal biopsy. No other localizations of lymphoma could be found. After four courses of CHOP chemotherapy there was a complete remission of this primary renal non-Hodgkin lymphoma, with complete recovery of renal function.     

Primary mucosa-associated lymphoid tissue-type lymphoma arising in the kidney

Abstract:   We report a case of primary low-grade lymphoma of mucosa-associated lymphoid tissue (MALT) arising from the kidney in a 30-year-old man with an abdominal mass in the right flank detected by ultrasonography. Radical nephrectomy was performed under a preliminary diagnosis of renal cell carcinoma. The final histological diagnosis was MALT-type lymphoma. To the best of our knowledge, only five reports of primary MALT-type lymphoma in the kidney have been published in the literature so far. All cases were surgically treated and only one case went on to chemotherapy postoperatively.     

肾脏和睾丸原发性非霍奇金淋巴瘤(附八例报告)

目的探讨泌尿生殖系原发性恶性淋巴瘤的临床特点。方法总结１９８０～１９９７年收治肾脏和睾丸原发性恶性淋巴瘤共８例,其中肾脏２例,睾丸６例,病理类型均为非霍奇金淋巴瘤。结果全部患者均手术治疗,术后１例行化疗和放疗,２例行单纯放疗,５例单纯化疗。２例生存已超过３年和２年。结论对肾脏和睾丸原发性非霍奇金淋巴瘤应积极采取手术治疗,术后辅以化疗、放疗,以提高生存率     

Primary cerebral lymphoma: report of 24 patients and review of the literature.

A retrospective study of 24 patients with primary non-Hodgkin's cerebral lymphoma (non-immunocompromised) is presented. All patients were seen at the Royal Preston Hospital, Lancashire between 1976 and 1991. Fifteen patients were over the age of 50 years (range 27-84). The commonest clinical presentation, seen in 16 patients was of an expanding space-occupying lesion. The diagnosis was suspected from the radiological findings but confirmation in every case was by histological examination of biopsy or necropsy material. The tumours were treated either by surgical excision or by biopsy and radiotherapy. Chemotherapy was given in two patients. Despite these measures the mean survival time was 3.6 months. The clinical radiological and pathological features of these tumours are highlighted with particular emphasis on the use of stereotactic biopsy, immunohistochemistry and chemotherapy in diagnosis and treatment.     

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。     

Presentation, diagnosis, and treatment outcome of tuberculous-mediated tubulointerstitial nephritis

Insidious Mycobacterium tuberculosis infection causing tubulointerstitial nephritis is a rare disorder. Here we report on a single-center case series of patients with tubulointerstitial nephritis due to tuberculosis, addressing clinicopathologic features and treatment outcome. Twenty-five adult patients with clinical evidence of tuberculosis and significant renal disease were assessed, 17 of whom had a kidney biopsy and were subsequently diagnosed with chronic granulomatous tubulointerstitial nephritis as the primary lesion. All patients were given standard antitubercular treatment, with some receiving corticosteroids, and showed a good response in clinical symptoms and inflammatory markers. Nine of the 25 patients, however, started renal replacement therapy within 6 months of presentation. Of the remaining 16, renal function improved for up to a year after presentation but subsequently declined through a median follow-up of 36 months. This case series supports that chronic tubulointerstitial nephritis is the most frequent kidney biopsy finding in patients with renal involvement from tuberculosis. Thus, a kidney biopsy should be considered in the clinical evaluation of kidney dysfunction with tuberculosis since tubulointerstitial nephritis presents late with advanced disease. A low threshold of suspicion in high-risk populations might lead to earlier diagnosis and treatment, preserving renal function and delaying initiation of renal replacement therapy.