二例肾脏原发性非霍奇金淋巴瘤临床病理观察  

Clinicopathological Observation of Primary Renal Non-Hodgkin's Lymphoma——A Report of Two Cases

作　　者：孙阳阳[1] 周晓莉[1] 高蔚[1] 程羽青[1] SUN Yang-Yang;ZHOU Xiao-Li;GAO Wei;CHENG Yu-Qing(Department of Pathology,The Changzhou Municipal Second People's Hospital,Affiliated to Nanjing Medical University,Changzhou 213000,Jiangsu Province,China)

机构地区：[1]南京医科大学附属常州市第二人民医院病理科,江苏常州213000

出　　处：《中国实验血液学杂志》2019年第1期86-90,共5页Journal of Experimental Hematology

摘　　要：目的:探讨肾脏原发性非霍奇金淋巴瘤(primary renal non-hodgkin's lymphoma,PRNHL)的临床病理学特征、免疫表型、诊断和鉴别诊断以及治疗和预后。方法:回顾性分析2例PRNHL的临床病理学特征、免疫表型、治疗及预后。结果:2例PRNHL均为男性,例1年龄51岁,因右侧腰部胀痛入院,B超示右肾上极实性占位,腹部CT平扫+增强示右肾软组织密度影,大小约10. 5×8. 6 cm。术前诊断为右肾癌,行右肾癌根治术,术后病理诊断为右肾弥漫大B细胞淋巴瘤(DLBCL)。免疫组织化学检测显示,肿瘤细胞表达CD20、CD79a、Mum-1、BCL-2、BCL-6,Ki-67增殖指数为90%。术后采用R-CHOP方案化疗6个疗程,辅以局部放疗,随访32个月患者一般状态良好,病情稳定。例2年龄65岁,无明显临床症状,体检时B超发现左肾占位性病变;入院后腹部CT平扫+增强显示左肾下极见不均匀强化病灶,大小约9 cm×5 cm。术前诊断左肾癌,行左肾癌根治术,术后病理诊断为左肾小B细胞性淋巴瘤。免疫组织化学检测肿瘤细胞表达CD20、CD79α、PAX-5、BCL-2,Ki-67增殖指数为10%。术后采用CHOP方案化疗6个疗程,随访20个月患者一般状况良好,病情稳定。结论:PRNHL发病率比较低,在临床可无明显症状,也可表现为腰部胀痛,术前易误诊为肾癌,确诊依赖病理及免疫组织化学检查。2例PRNHL均为B细胞淋巴瘤,患者预后相对较好。Objective: To investigate the clinicopathological and immunohistochemical features as w ell as diagnosis,differential diagnosis,treatment and prognosis of patients w ith primary renal non-hodgkin’ s lymphoma( PRNHL).Methods: Clinical data of 2 patients w ith PRNHL from January 2013 to October 2017 w ere retrospectively analyzed.Results: One of the tw o male patients PRNHL aged 51 years old,admitted to hospital for sw elling and pain in the right w aist,B-ultra sonic examination show ed a very solid upper right renal space occupying lesion. CT show ed the soft tissue mass of the right kidney about 10. 5 cmx 8. 6 cm. Preoperative diagnosis w as a right kidney cancer subjected to radical surgery,and the postoperative pathological diagnosis w as a right renal diffuse large B cell lymphoma( DLBCL).Expression of CD20,CD79 a,M um-1,BCL-2,BCL-6 in tumor cells w as identified by inmmunohistochemistry,and Ki-67 proliferation index w as 90%. Six courses of chemotherapy w ith R-CHOPE regimen w ere carried out supplemented local radiotherapy. The patients w ere follow ed up for 32 months,w hich w ere generally in good condition and stable.The another patient w as 65 years old,no w ithout obvious clinical symptoms,B-ultrasonic examination found a space occupying lesion in the left kidney. Abdomind CT scan plus enhancement show ed the left kidneydisplayed uneven enhanced lesions of size 9 cm x 5 cm,the preoperative diagnosis w as left kidney cancer,the pathological diagnosis w as diagnosed as mall B cell lymphoma of the left kidney after the radical operation. Immunohistochemistry determined expression of CD20, CD79 a, pax-5, BCL-2 in tumor cells and Ki-67 proliferation index 10%. 6 courses of chemotherapy w ith CHOPE regimen had been performed and follow ed up for 20 months,the conditions w ere generally good and stable. Conclusion: PRNHL is a rare extranodal non-Hodgkin lymphoma w ith atypical clinical symptoms characterized by lumbar sw elling pain. It is easy to be misdiagnosed as renal cell carcinoma before operation. Th

关 键 词：非霍奇金淋巴瘤 肾脏原发性非霍奇金淋巴瘤 弥漫大B细胞淋巴瘤 

分 类 号：R.733.1[医药卫生]