二例肾脏原发性非霍奇金淋巴瘤临床病理观察
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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. The diagnosis depends on pathology and immunohisto-chemistry. The prognosis of 2 patients w as relatively good. PRNHL should be differetiated w ith renal sarcomatoid cancer,nephroblastoma and other diseases. Surgical resection plus chemotherapy is recommended.
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. The diagnosis depends on pathology and immunohisto-chemistry. The prognosis of 2 patients w as relatively good. PRNHL should be differetiated w ith renal sarcomatoid cancer,nephroblastoma and other diseases. Surgical resection plus chemotherapy is recommended.
引文
1 Belbaraka R,Elyoubi MB,Boutayeb S,et al.Primary renal nonHodgkin lymphoma:An unusual diagnosis for a renal mass.Indian JCancer,2011;48(2):255-256.
2 Yasunaga Y,Hoshida Y,Hashimoto M,et al.Malignant lympho ma of the kidney.J Surg Oncol,1997;64(3):207-211.
3 Arranz Arija JA,Carrion JR,Garcia FR,et al.Primary renal lymphoma:report of 3 cases and review of the literature.Am J Nephrol,1994;14(2):148-153.
4张强,赵彦宗,岳中瑾,等.原发性肾脏淋巴瘤2例报道并文献复习.现代泌尿外科杂志,2012;17(2):183-184.
5 Ferry JA,Harris NL,Papanicolaou N,et al.Lymphoma of the kideney:A repaor of 11 case.Am J Sueg Pathol,1995;19(2):134-144.
6 Pinggera GM,Peschel R,Buttazzoni A,et al.A possible case of primary renal lymphoma:a case report.Cases J,2009;12(2):6233.
7 Salem Y,Pagliaro L,Mangak M.Primary small noncleaved cell lymphoma of kidney.Urology,1993;42(3):331-335.
8 Truong L D,Caraway N,Ngo T,et al.Renal lymphoma:the diagnostic and therapeutic roles of fine-needle aspiration.Am J Clin Pathol,2001;115(1):18-31.
9 Stallone G,Infante B,Manno C,et al.Primary renal lymphoma does exist:case report and review of the literature.J Nephrol,2000;13(5):367-372.
10 Ladha A,Haider G.Primary renal lymphoma.J Coll Physicians Surg Pak,2008;18(9):584-855.
11 Hans CP,Weisenburger DD,Greiner TC,et al.Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray.Blood,2004;103(1):275-282.
12 Cupisti A,Riccioni R,Carulli G,et al.Bilateral primary renal lymphoma treated by surgery and chemotherapy.Nephrol Dial Transplant,2004;19(6):1629-1633.
13 Tornroth T,Heiro M,Marcussen N,et al.Lymphomas diagnosed by percutaneous kidney biopsy.Am J Kidney Dis,2003;42(5):960-971.
14 Hu R,Zhang R,Miao M,et al.Central nervous system involvement of primary renal lymphoma with diffuse large B-cell type lymphoma.Am J Case Rep,2013;14:292-294.
2 Yasunaga Y,Hoshida Y,Hashimoto M,et al.Malignant lympho ma of the kidney.J Surg Oncol,1997;64(3):207-211.
3 Arranz Arija JA,Carrion JR,Garcia FR,et al.Primary renal lymphoma:report of 3 cases and review of the literature.Am J Nephrol,1994;14(2):148-153.
4张强,赵彦宗,岳中瑾,等.原发性肾脏淋巴瘤2例报道并文献复习.现代泌尿外科杂志,2012;17(2):183-184.
5 Ferry JA,Harris NL,Papanicolaou N,et al.Lymphoma of the kideney:A repaor of 11 case.Am J Sueg Pathol,1995;19(2):134-144.
6 Pinggera GM,Peschel R,Buttazzoni A,et al.A possible case of primary renal lymphoma:a case report.Cases J,2009;12(2):6233.
7 Salem Y,Pagliaro L,Mangak M.Primary small noncleaved cell lymphoma of kidney.Urology,1993;42(3):331-335.
8 Truong L D,Caraway N,Ngo T,et al.Renal lymphoma:the diagnostic and therapeutic roles of fine-needle aspiration.Am J Clin Pathol,2001;115(1):18-31.
9 Stallone G,Infante B,Manno C,et al.Primary renal lymphoma does exist:case report and review of the literature.J Nephrol,2000;13(5):367-372.
10 Ladha A,Haider G.Primary renal lymphoma.J Coll Physicians Surg Pak,2008;18(9):584-855.
11 Hans CP,Weisenburger DD,Greiner TC,et al.Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray.Blood,2004;103(1):275-282.
12 Cupisti A,Riccioni R,Carulli G,et al.Bilateral primary renal lymphoma treated by surgery and chemotherapy.Nephrol Dial Transplant,2004;19(6):1629-1633.
13 Tornroth T,Heiro M,Marcussen N,et al.Lymphomas diagnosed by percutaneous kidney biopsy.Am J Kidney Dis,2003;42(5):960-971.
14 Hu R,Zhang R,Miao M,et al.Central nervous system involvement of primary renal lymphoma with diffuse large B-cell type lymphoma.Am J Case Rep,2013;14:292-294.