Japanese

Title	リンパ腫様型/形質細胞腫型尿路上皮癌との鑑別に苦慮した腎門部発生悪性リンパ腫の1例
Subtitle	症例
Authors	神田真規, 中嶋愛海, 羽原幸輝, 佐々木健司, 米原修治
Authors (kana)
Organization	JA広島厚生連尾道総合病院病理研究検査科
Journal	日本臨床細胞学会雑誌
Volume	61
Number	6
Page	419-423
Year/Month	2022 / 11
Article	報告
Publisher	日本臨床細胞学会
Abstract	背景:今回われわれは術前尿細胞診にてリンパ腫様型/形質細胞腫型尿路上皮癌(PUC)と誤診した腎門部発生のびまん性大細胞型悪性リンパ腫(DLBCL)を経験したので, 細胞所見を中心に報告する. 症例:60歳代, 男性. 腎門部腫瘤の精査・治療目的で当院泌尿器科を紹介受診された. 術前自然尿細胞診では, 変性した細胞や炎症細胞と混在して小型異型細胞を散在性に認めた. 細胞質は薄く, 核は中心性からやや偏在性を示し, クロマチンは濃縮状から微細顆粒状に増量していた. 核にくびれをもつ細胞もみられた. また形質細胞様異型細胞も散見されたため, PUCと診断した. 摘出腎の病理組織像では, 尿路上皮下に類円形核をもつ腫瘍細胞がびまん性に増殖していた. 腫瘍細胞のN/C比は高く, 単核で類円形, 核型不整や一部にくびれをもつ細胞を認めた. 単個で目立つ核小体をもち, 腫瘍細胞間にはリンパ球, 形質細胞が混在していた. 以上の組織所見と免疫染色結果よりDLBCLと診断した. 結論:腎盂原発のリンパ腫は非常にまれな腫瘍で, 細胞診での鑑別には苦慮するが, 異型細胞の集塊状出現や核のくびれの有無, 異型細胞径の多形性に着目することにより推定は可能であると考えた.
Practice	臨床医学：一般
Keywords	Malignant lymphoma, Urinary cytology, Invasive urothelial carcinoma, Lymphoma-like/plasmacytoid variant, Case report

English

Title	A case of primary renal lymphoma that was difficult to differentiate from invasive urothelial carcinoma, lymphoma-like/plasmacytoid variant
Subtitle	Clinical Articles
Authors	Masanori KODA, Manami NAKASHIMA, Kouki HABARA, Kenji SASAKI, Shuji YONEHARA
Authors (kana)
Organization	Department of Pathology, JA Onomichi General Hospital
Journal	The Journal of the Japanese Society of Clinical Cytology
Volume	61
Number	6
Page	419-423
Year/Month	2022 / 11
Article	Report
Publisher	The Japanese Society of Clinical Cytology
Abstract	[Abstract] Background:We report a case of diffuse large B-cell lymphoma (DLBCL)arising in the renal pelvis, that was misdiagnosed by preoperative urinary cytology as invasive urothelial carcinoma, lymphoma-like/plasmacytoid variant(PUC). Case:The patient was a man in his 60 s who was suspected as having a left renal tumor and referred to the urology department of our hospital. Urinary cytology showed scattered small tumor cells with round nuclei in an inflammatory background. The tumor cells showed a high N/C ratio and the nuclei contained fine granular chromatin. A few atypical cells were also seen, with irregular nuclei and prominent nucleoli. Based on these cytological findings, we diagnosed the tumor as PUC. Histopathological examination of the excised kidney specimen revealed a diffuse proliferation of tumor cells with round nuclei in the subepithelium of the renal pelvis. The tumor cells were round and mononuclear, had a high N/C ratio and irregular nuclei containing prominent nucleoli, and lymphocytes and plasma cells were admixed with the tumor cells. Based on the above histological findings and results of immunostaining, we diagnosed the tumor as a DLBCL. Conclusion:Primary renal lymphoma is a very rare tumor, and it is difficult to distinguish DLBCL from PUC by urinary cytology alone. However, this tumor should be borne in mind in cases showing atypical cells in clusters, with irregular and constricted nuclei, and polymorphic cell diameters.
Practice	Clinical medicine
Keywords	Malignant lymphoma, Urinary cytology, Invasive urothelial carcinoma, Lymphoma-like/plasmacytoid variant, Case report

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