Sawa Naoki, Ubara Yoshibumi, Katori Hideyuki, Hoshino Junichi, Suwabe Tatsuya, Tagami Tetuo, Takemoto Fumi, Miyakoshi Shigesaburo, Taniguchi Shuichi, Ohashi Kenichi, Takaichi Kenmei
Department of Nephrology, Toranomon Hospital, Tokyo, Japan.
Intern Med. 2007;46(10):657-62. doi: 10.2169/internalmedicine.46.6333. Epub 2007 May 24.
We report a 35-year-old Japanese woman with intravascular large B-cell lymphoma diagnosed by percutaneous renal biopsy. The patient was referred to our institution for further examination of fever of unknown origin. She had renal dysfunction with a creatinine clearance of 44.1 mL/min, and daily urinary excretion of 0.22 g of protein and 21.5 mg of beta 2 microglobulin. Computed tomography showed markedly enlarged kidneys bilaterally. Percutaneous renal biopsy showed that an island-like atypical lymphoid cell accumulation was encircled with the peritubular capillary walls in many areas of the tubulo-interstitium, resulting in marked destruction of tubular structure. However, almost all the glomeruli were intact. Immunohistochemical analysis confirmed the diagnosis of intravascular large B-cell lymphoma. Shortly after diagnosis, she was treated with rituximab, cyclophosphamide, hydroxydaunomycin, oncovin, and prednisolone, and her renal function and size improved. Renal involvement by lymphoma has been classified into two categories: intraglomerular intravascular lymphoma and tubulointerstitial diffuse invasion type that is distinct from intravascular lymphoma. For the latter cases with renal dysfunction and marked bilateral nephromegaly but without proteinuria, intravascular lymphoma within intra-peritublar capillaries should be considered as a possible diagnosis.
我们报告了一名35岁的日本女性，通过经皮肾活检诊断为血管内大B细胞淋巴瘤。该患者因不明原因发热被转诊至我院进一步检查。她存在肾功能不全，肌酐清除率为44.1 mL/分钟，每日尿蛋白排泄量为0.22 g，β2微球蛋白排泄量为21.5 mg。计算机断层扫描显示双侧肾脏明显肿大。经皮肾活检显示，在肾小管间质的许多区域，岛状非典型淋巴细胞聚集被肾小管周围毛细血管壁包围，导致肾小管结构明显破坏。然而，几乎所有肾小球均完整。免疫组织化学分析证实了血管内大B细胞淋巴瘤的诊断。诊断后不久，她接受了利妥昔单抗、环磷酰胺、羟基柔红霉素、长春新碱和泼尼松龙治疗，其肾功能和肾脏大小得到改善。淋巴瘤的肾脏受累已分为两类：肾小球内血管淋巴瘤和与血管内淋巴瘤不同的肾小管间质弥漫浸润型。对于后一种伴有肾功能不全和明显双侧肾肿大但无蛋白尿的病例，应考虑肾小管周围毛细血管内血管淋巴瘤为可能的诊断。
