The Clinical Features Of Primary Genitourinary Lymphoma(Report Of 12 Cases)

Objective:To explore the clinical characteristics,diagnosis and treatment methods and prognosis of primary genitourinary lymphoma,so as to improve the understanding of diagnosis and treatment of this disease.Methods : Clinical data of 12 patients with primary genitourinary lymphoma of the urinary system admitted to the department of urology of fujian provincial hospital from January 2012 to June 2019 were collected,including 3 cases of adrenal gland,1 case of kidney,4 cases of bladder,3 cases of testis and 1 case of spermatic cord.Results:The age of onset of the cases in this group ranged from 48 to 84 years old,with an average age of 64.4 years.Among them,9 cases(75%)were ≥60 years old.The ratio of male to female was 1:1.The clinical manifestations were atypical,including 3 cases of primary adrenal lymphoma,1 case of left,right and bilateral involvement,presenting lumbar pain,fatigue and emaciation on the affected side,1 case of complicated systemic symptoms(also known as symptom B: fever,sweating or night sweats,weight loss,etc.),and increased LDH.One case of primary renal lymphoma occurred in the left kidney,presenting with lateral lumbago with irregular low fever and increased LDH.There were 4 cases of primary bladder lymphoma(male to female ratio 1:3).Patients were treated for dysuria,repeated hematuria,lower abdominal pain and urethral stimulation.There were 3 cases of primary testicular lymphoma,2 cases on the left side and 1 case on the right side.Primary spermatic lymphoma in 1 case,due to the discovery of scrotal root and inguinal region of mass to visit.Imaging examination can often find local masses,but lack of specificity.The pathological types were all non-hodgkin’s lymphoma(NHL),among which 2 cases of primary adrenal gland,kidney,testis,spermatic cord and bladder lymphoma were diffuse large B cell lymphoma(DLBCL),and the other 2 cases of bladder lymphoma were MALT lymphoma and follicular lymphoma respectively.Immunohistochemistry: all CD20 positive expression.Three cases of primary adrenal gland and one case of primary renal lymphoma were confirmed pathologically by ultrasound-guided puncture biopsy,and then systemic chemotherapy was adopted with r-echop or r-chop.Four patients with primary bladder lymphoma underwent transurethral resection of bladder tumor(tur-bt),3 patients received r-chop chemotherapy and 1 patient refused chemotherapy.Three patients with primary testicular lymphoma underwent radical orchiectomy and received r-chop chemotherapy.One patient with primary spermatic lymphoma received left spermatic mass,left testis and left epididymis resection,and received r-chop chemotherapy.All patients were followed up for 6 months to 7 years,with an average follow-up time of4.5 years.There were 4 cases with complete remission(CR),6 cases with partial remission(PR),2 cases with death(1 case each of renal and bladder lymphoma),and 3cases with overall survival(OS)of more than 80 months.Conclusion:Primary lymphoma clinical urogenital system lack of specificity,prognosis is poorer,easily confused with other malignant tumor related parts,the misdiagnosis rate is high,imaging examination is helpful to further differentiate diagnose,lesion biopsy pathology can provide effective support,treatment favours surgery combined with systemic chemotherapy.