L'Imperio Vincenzo, Rossi Mattia, Abdul Afu, Mehta Satyen R, Shaver Aaron C, Fogo Agnes B
Department of Medicine and Surgery, Pathology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN.
Kidney Med. 2020 Aug 8;2(5):663-666. doi: 10.1016/j.xkme.2020.06.011. eCollection 2020 Sep-Oct.
Lymphomatous infiltration of kidney parenchyma is a frequent complication of systemic hematologic malignancies and often shows subtle clinical presentation. Diffuse large B-cell lymphoma represents the most frequent form involving the kidney, with advanced stage at diagnosis, poor outcome, and risk for central nervous system relapse if not adequately treated. Kidney biopsy can provide specific and early detection of these cases, helping in the differential diagnosis with more frequent entities. Finally, further hematologic workup (bone marrow biopsy, complete blood cell count, and positron emission tomography) can distinguish secondary involvement of the kidney from the rarer kidney-limited forms, especially in patients without a previous diagnosis of lymphoma. Making a prompt and correct diagnosis directs the management of these cases and may improve the outcome, as described in the present report.
肾实质的淋巴瘤浸润是全身性血液系统恶性肿瘤的常见并发症,临床表现往往不明显。弥漫性大B细胞淋巴瘤是累及肾脏最常见的形式,诊断时多处于晚期,预后较差,若治疗不充分有中枢神经系统复发风险。肾活检可对这些病例进行特异性早期检测,有助于与更常见的疾病进行鉴别诊断。最后,进一步的血液学检查(骨髓活检、全血细胞计数和正电子发射断层扫描)可区分肾脏的继发性受累与较罕见的局限于肾脏的形式,尤其是在既往无淋巴瘤诊断的患者中。如本报告所述,及时正确的诊断指导这些病例的管理,并可能改善预后。