Intravascular large B-cell lymphoma of the kidney: A case report
Intravascular large B-cell lymphoma of the kidney: A case report
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DOI：
10.1186/1746-1596-6-86
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发表时间：
2011-09-23
影响因子：
2.6
通讯作者：
Geng, Jian
中科院分区：
文献类型：
--
作者：
Bai, Xiaoyan;Li, Xiao;Geng, Jian
我们报告一位41岁的中国女性，经皮肾活检确诊为血管内大B细胞淋巴瘤。患者中国在广州南方医科大学南方医院住院，主诉高峰热1个月，双侧下肢乏力，行走困难近5个月，肾功能不全，尿总蛋白5.61g/dL(56.1g/L)，血清白蛋白2.89g/dL(28.9g/L)，尿素氮2.24 mg/dL(1.6 mmoL/L)，血肌酐0.54 mg/dL(48mU/L)。骨髓活检显示骨髓增殖性疾病，无髓系或淋巴细胞异常增殖。正电子发射计算机断层扫描(PET-CT)显示双侧肾实质明显肿胀和增大，脾增大，累及多个椎体。经皮肾活检显示中至大淋巴样细胞在间质的许多区域呈岛状聚集，圆形的囊状核含有不同的嗜碱性核仁。免疫组织化学分析结合其他支持性研究证实了血管内大B细胞淋巴瘤的诊断。10天后，她开始接受CHOP(环磷酰胺、阿霉素、利尿舒和泼尼松)为期一周的化疗。胸骨髓腔转移灶T1~T7行姑息性放射治疗，DT40Gy20F，辅以其他支持治疗。患者的双腿肌肉力量恢复，三周后能够再次行走。患者在肝肾功能和蛋白尿值恢复正常后出院。随访数据显示，患者在出院后九个月仍活着。
We report a 41-year-old Chinese woman with intravascular large B-cell lymphoma diagnosed by percutaneous renal biopsy. The patient was admitted to Nanfang Hospital of Southern Medical University, Guangzhou, China with complaints of high spiking fever for a month and bilateral lower limb fatigue with difficulty ambulating for the past 5 months.She had renal dysfunction with a total urinary protein of 5.61 g/dL (56.1 g/L), serum albumin of 2.89 g/dL (28.9 g/L), urea nitrogen of 2.24 mg/dL (1.6 mmol/L), and serum creatinine of 0.54 mg/dL (48 mu mol/L). Bone marrow biopsy revealed myeloproliferative disorder without abnormal myeloid or lymphocytic proliferation. Positron Emission Tomography-Computed Tomography (PET-CT) showed marked bilateral swelling and enlargement of the renal parenchyma with splenic enlargement and involvement of multiple vertebrae. Percutaneous renal biopsy showed island-like accumulations of medium to large lymphoid cells in many areas of the interstitium, with round vesicular nuclei containing distinct basophilic nucleoli. Immunohistochemical analysis together with other supportive investigation confirmed the diagnosis of intravascular large B-cell lymphoma. Ten days later, she was started on chemotherapy with CHOP (cyclophosphamide, doxorubicin, leurocristime and prednisone) for a week. Palliative radiotherapy DT 40Gy/20F with other supportive treatment was provided for metastatic foci in the medullary cavity of the sternum, T1-T7. The patient regained muscle strength in both lower limbs and was able to walk again after three weeks. The patient was discharged after hepatic and renal function and proteinuria values had returned to normal. Follow-up data shows the patient to be alive nine months after discharge.