INTRODUCTION

Renal involvement in lymphoma is generally associated with widespread nodal or extranodal lymphoma, which is classified as secondary renal lymphoma. Primary renal lymphoma (PRL) is rare and may involve the kidneys alone without evidence of disease elsewhere[1]. Very few patients have been diagnosed with PRL, and the present case is particularly rare due to simultaneous right renal vein tumor thrombus. PRL and other renal cancers share a number of key features; thus, making a diagnosis is difficult. The standard management of PRL is radical or partial nephrectomy. Although aggressive, PRLs respond well to rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP). Currently, surgery or systemic chemotherapy are widely used for the treatment of PRL. The overall survival rate and long-term disease-free interval of PRL patients are relatively better when surgery and chemotherapy are combined.

The authors declare that they have no conflicts of interest.

CASE PRESENTATION

Chief complaints

Proliferating B cells in or around germinal centers is a principal determining factor of lymphoma, and systemic symptoms become more obvious due to cytokine production. Lymphoma enlarges and compresses the surrounding renal parenchyma, which forms a solitary nodule or multiple nodules. In addition, heterogeneous infiltrative growth may cause extracapsular dilation into the perirenal space. Primary renal diffuse large B-cell lymphoma patients who present with typical symptoms of renal cell carcinoma, such as gross hematuria, lower back pain, abdominal masses or acute or chronic renal failure, are often misdiagnosed with the more common renal cell carcinoma or nephroblastoma. In previous studies, lymphoma parenchymal infiltration and hypercalcemia caused by excessive production of vitamin D in the ureter have been found to be related to renal failure[2].

History of present illness

The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

本文利用數(shù)字仿真技術(shù)對運載器數(shù)字樣機和制造資源開展構(gòu)建，構(gòu)造了虛擬裝配環(huán)境，規(guī)劃運載器的裝配路徑并完成裝配過程碰撞檢查，在虛擬裝配仿真過程中引入人的因素，實現(xiàn)了對人的裝配動作仿真，驗證了操作過程的合理性和裝配資源可達性；對輸出結(jié)果進行工程判讀，并根據(jù)需求進行優(yōu)化，研究了可視化工藝文件在工藝設(shè)計系統(tǒng)中的應(yīng)用。

History of past illness

The patient’s past medical history was insignificant.

Personal and family history

Laparoscopic radical resection of the right renal tumor was performed on October 10, 2019. Under laparoscopy, we observed that a large mass had compressed the inferior vena cava and part of the liver. During surgical exploration, it was found that the tumor thrombus continued to the right, not involving the inferior vena cava. The thrombus was graded 0 using the Mayo system (Figure 1B).

Physical examination

The physical examination revealed only tenderness in the right renal area.

Laboratory examinations

The laboratory examination showed normal coagulation function, kidney function and electrolyte levels with only slightly higher serum creatinine and uric acid levels. Hepatitis B serology revealed a previously unknown hepatitis B infection.

Imaging examinations

The ultrasound showed a large hypoechoic mass in the upper pole of the right kidney, 9.3 cm × 7.4 cm × 8.0 cm in size, with a regular shape, clear boundary, and uneven internal echo, which had a high-speed and high-block blood flow spectrum, indicating multiple perforating blood flow signals. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a space-occupying lesion in the right kidney that did not invade the surrounding tissues (Figure 1A).

FINAL DIAGNOSIS

According to the pathological examination, the gross specimen was a total kidney with partial ureteral resection, and its volume was 14.0 cm × 9.0 cm × 8.2 cm (Figure 1C). The contiguous ureteral length was 5.5 cm, and the diameter was 0.4 cm-0.5 cm. The boundary between the renal tissue and the medulla was unclear, and the renal pelvis and calyces were extruded and deformed. A gray–white mass was observed on the cut surface (Figure 1C). In addition, the ureter and blood vessels were cut without tumor involvement, and metastatic lymph nodes were not found in the gray parenchyma of the cut surface. Immunohistochemical profiling revealed diffuse and intense expression of CD20 and CD79, along with expression of Bcl-6, Vim, INI-1, ALK1, Ki-67 and PAX-8. The tumor was negative for CD30, CD56, NSE, S100, desmin and WT expression (Figure 1D-1F). The pathological diagnosis was non-Hodgkin's lymphoma of the right kidney, which was consistent with a diffuse large B lymphocyte tumor and tended to be the source of germinal center cells.

TREATMENT

The patient admitted a previous history of hypertension and denied any medical history of coronary heart disease, diabetes or tuberculosis. The patient had no relevant family history.

5.強競爭意識，促業(yè)務(wù)技能提高平臺建設(shè)。舉行國土資源系統(tǒng)法規(guī)政策業(yè)務(wù)知識大比拼活動，采取網(wǎng)上答題方式進行，國土資源業(yè)務(wù)技能涵蓋了涉土相關(guān)法律法規(guī)政策知識，內(nèi)容包羅萬象、覆蓋面廣，題型涉及全面、重點突出，分為單選、多選、判斷三大類，涉及利用、規(guī)劃、土地登記、違法處罰等各條業(yè)務(wù)線的專業(yè)知識。

OUTCOME AND FOLLOW-UP

This patient was stable after surgery. She presented at the Department of Hematology on October 30, 2019, and was diagnosed with diffuse large B-cell lymphoma of the right kidney (stage IV Group A). Her IPI score was low-medium-risk; thus, the patient received R-CHOP treatment. The initial regimen was rituximab 100 mg d1, cyclophosphamide 1260 mg d1, epirubicin 100 mg d1, vindesine 4 mg d1, and dexamethasone 15 mg d1-d5. Subsequently, the dose of rituximab was adjusted based on the patient's condition. The patient was followed up until the completion of 8 cycles of R-CHOP chemotherapy. In the fourth month after surgery, a CT scan indicated that the right renal lymphoma resection was successful and without obvious signs of recurrence (Figure 2A-2C). The patient attended a follow-up appointment on July 24, 2020, and presented with no complications; the images did not show obvious abnormalities (Figure 2D-2F). Satisfactory results were maintained over the past year.

DISCUSSION

Primary renal diffuse large B-cell lymphoma is an extremely rare extranodal lymphoma, accounting for fewer than 1% of all renal masses. It is a unique clinical and pathological entity that is highly aggressive. These tumors present as solitary nodules (10%-20%), multiple nodules (60%), adjacent retroperitoneal lesions with renal involvement (25-30%), diffuse infiltration (20%) or perirenal involvement (10%). The origin of primary renal lymphoma remains unclear because a normal kidney is an extranodal organ without lymphatic vessels. The studies that have been conducted to date indicate that the use of immunosuppressive drugs for transplant patients is a risk factor for the development of B-cell lymphoma. Chemical agents such as dyes and pesticides may also increase the risk[1].

A 56-year-old female presented to the hospital on October 3, 2019 due to right waist pain and gross hematuria that had persisted for 15 d.

Central to the diagnosis of lymphoma is the concept of detailed physical examination and laboratory tests. Whole-body lymph node examination should be performed, including the head, neck, supraclavicular, axillary, femoral and inguinal lymph nodes. Abdominal examination should also be performed to assess liver and spleen enlargement. Simultaneously, there is a major need to address the abnormal problems caused by complete blood count with differential, lactate dehydrogenase (LDH), HIV and hepatitis B and C serologies. In this patient, hepatitis B antigen levels were elevated without her knowledge, and the patient was not treated in time, decreasing the ability of her immune system to regulate malignant cells. The current study highlights the importance of blood urea nitrogen and creatinine levels. The results of one study indicated that swollen retroperitoneal lymph node enlargement causes ureteral obstruction or adverse reactions to nephrotoxic chemotherapy drugs as their level increases[3]. An intermediate relationship between LDH and lymphoma has been reported in the literature, and high LDH indicates a high turnover rate of lymphoma cells and the release of degradation products into the blood (Figure 3). Therefore, LDH may be a predictor of lymphoma patient survival[4].

In clinical practice, doctors should emphasize the importance of imaging in renal lymphoma diagnoses, as imaging allows for the most complete diagnosis, including the tumor grade and stage. On CT scans, primary renal diffuse large B-cell lymphoma is a homogeneous or slightly low-density mass with unclear borders. Enhanced CT shows mild enhancement, and the enhancement degree is lower than that of normal renal parenchyma. Primary renal diffuse large B-cell lymphoma lacks a blood supply and rarely invades the inferior vena cava, as was also observed in the present case. If both kidneys are extensively infiltrated, CT enhancement will show uneven kidney enhancement, normal cortical and medulla differentiation enhancement, and enveloping and deforming glomerular systems. It has been suggested that primary renal diffuse large B-cell lymphoma shows low to moderate signal intensity on T1- and T2-weighted MRI sequences[5]. New findings with positron emission tomography provide further evidence that primary renal diffuse large B-cell lymphoma with a high standard intake value may indicate aggressive disease. Using this approach, imaging experts have been able to show abnormal uptake in the mass for staging and perform follow-up analyses after treatment using fluorodeoxyglucose-positron emission tomography[6]. Morphology, immunophenotyping, and staining for B-cell markers are required to obtain the diagnosis, as the imaging findings were nonspecific. The current staging system classification is based on the Ann Arbor classification[7]. In this patient, PRL had spread into one lymphatic organ, and as the postoperative images suggested, the tumor was stage IV (Figure 3).

2.來自國內(nèi)的競爭。黑龍江省是我國冰雪產(chǎn)業(yè)的龍頭，哈爾濱國際冰雪節(jié)是世界四大冰雪節(jié)之一，哈爾濱冰雪大世界、太陽島雪博會、亞布力滑雪場和雪鄉(xiāng)都是中國知名冰雪旅游品牌。哈爾濱市已經(jīng)成為國際冰雪旅游服務(wù)的核心，也是我國冬季冰雪旅行目的地首選城市。[7]此外，主打冰雪休閑的大慶和齊齊哈爾、主打民俗文化的佳木斯、主打森林旅游的伊春也都在快速發(fā)展。黑龍江省近六年的春節(jié)黃金周累計接待國內(nèi)外游客超過8000萬人，是吉林省游客數(shù)量的2倍。

The standard treatment for primary diffuse renal large B-cell lymphoma is radical nephrectomy and postoperative systemic chemotherapy. Data from several studies suggest that multidrug chemotherapy is often necessary for high-grade lymphoma before surgery. The R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) has been studied using several animal models. Many patients receive 8 cycles of standard treatment, and a greater degree of relief is achieved for most patients. For our patient, vincristine was replaced by vindesine because vincristine was unavailable. In general, the prognosis of patients with primary renal lymphoma is improved after rituximab is added to the CHOP regimen[8]. Emerging immunotherapy options and targeted therapies may provide chemotherapy-free first-line approaches for DLBCL[9]. However, recent evidence suggests that COO, concurrent rearrangements of MYC/BCL2/BCL6, the characterization of DH/TH HGBL, and the overexpression of MYC/BCL2 result in highly aggressive clinical behavior, resistance to standard chemotherapy and extremely poor outcomes[10,11]. Side effect management and challenges to effective therapy, including unfavorable biological features, individual vulnerabilities and toxicities of cytotoxic chemotherapy, are the main concerns.

The prognosis of renal diffuse large B-cell lymphoma patients depends on the stage of the disease, histopathology, extranodal involvement, and the patient’s age and condition. There are similarities between the views expressed in our case report and those described in a previously published epidemiological and final results database study covering 1984 to 2015[12]. In other words, the above factors affect the overall survival outcomes of patients. In addition, age over 60 years, Eastern Cooperative Oncology Group (ECOG) performance greater than 2, elevated LDH, clinical stage III/IV, and more than 1 extranodal involvement have been found to reduce overall survival times. Some immune markers confer a favorable prognosis, such as CD19, CD20, CD22, and CD45. Very rarely, these tumors can express CD5, which has a poor prognosis[13]

CONCLUSION

In primary diffuse renal large B-cell lymphoma, the main challenge faced by many doctors is differentiating renal lymphoma from other renal masses, especially in the case of unilateral lesions. Clinical, physical, laboratory, imaging, morphology and immunophenotyping analyses are used to diagnose the patients and monitor the treatment effects. The standard treatment is radical nephrectomy, and systemic chemotherapy using the R-CHOP regimen is the subsequent treatment of choice. When surgery is combined with chemotherapy, the overall survival rates and long-term progression outcomes are relatively better. However, some epidemiological factors and gene rearrangements result in highly aggressive clinical behaviors and extremely poor prognoses.

表9～表12所示為LAS方法及本文方法的迭代過程和設(shè)計點處可靠度值。表13給出了本文方法迭代點處的局部采樣半徑值。可以看出，相較于LAS方法，本文方法在MPP附近采樣并更新Kriging近似，其局部建模效率更高，求解也更為準確。

FOOTNOTES

He J performed the case study and wrote the manuscript; Mu Y and Liu M conducted the clinical examination of the patient; Che BW, Zhang WJ and Xu SH edited the manuscript; Tang KF performed the operation and supervised the work; all authors provided final approval of the version to be submitted.

Foundation of Health Commission of Guizhou Province of China, No. gzwkj2021-211.

Written informed consent was obtained from the patient for publication of this report and any accompanying images.

Here, we report the case of a 56-year-old female with PRL and a renal vein tumor thrombus. After laparoscopic radical nephrectomy, R-CHOP chemotherapy was given, and satisfactory results were achieved.

隨著對慢性前列腺炎研究的深入,病原體在前列腺炎發(fā)病中的作用也愈發(fā)得到了重視,目前有大量研究數(shù)據(jù)表明凝固酶陰性葡萄球菌為慢性前列腺炎的最主要的致病菌,特別是凝固酶陰性葡萄球菌中的表皮球菌以及溶血性葡萄球菌應(yīng)引起重視[1-2]。因此本次對凝固酶陰性葡萄球菌檢測在慢性前列腺炎的臨床意義進行了研究,選取我院在2017年1月-2018年2月期間收治并確診的100例慢性前列腺炎患者為研究對象,對100例慢性前列腺炎患者的前列腺液進行了細菌培養(yǎng)以及藥敏試驗,并對凝固酶陰性葡萄球菌的感染率以及其對抗生素的敏感性進行了記錄,研究報告如下。

The patient presented with urgency and dysuria accompanied by nausea and vomiting. The patient’s vomiting comprised stomach contents, and her pain was slightly relieved after vomiting.

據(jù)2010年印尼的人口普查，“有283.25萬國民承認自己是華人，占印尼總?cè)丝诘?.2%”。[12]印尼的華人華僑主要來自中國南方的一些省份，在幾個世紀中不斷地移居到后來成為一個獨立國家的印尼。印尼是一個多民族國家，華族長期被視作外來民族。

This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BYNC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

第一，制定并落實科學(xué)的激勵機制，激發(fā)員工奮發(fā)進取意識，全面發(fā)揮員工創(chuàng)新性，為從根本上提升企業(yè)創(chuàng)新能力奠定良好基礎(chǔ)；第二，注重對員工頑強意志的培養(yǎng)，為高效、快捷完成任務(wù)績效提供保障；第三，給予服務(wù)型企業(yè)員工樂觀與希望，為促使其積極主動參與到工作當(dāng)中，提升工作效率奠定基礎(chǔ)。

China

Jun He 0000-0002-0919-3094; Yi Mu 0000-0002-4180-3382; Bang-Wei Che 0000-0003-4973-282X; Miao Liu 0000-0003-3888-8853; Wen-Jun Zhang 0000-0003-4378-6536; Sheng-Han Xu 0000-0002-7011-6899; Kai-Fa Tang 0000-0001-7578-0679.

教學(xué)重點：用聯(lián)系的觀點，發(fā)現(xiàn)并證明誘導(dǎo)公式二，并對其進行升級，體會把未知問題化歸為已知問題的思想方法。

Xing YX

A

Xing YX

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