Renal lymphoma. The diagnostic and therapeutic roles of fine-needle aspiration

Renal involvement of lymphomas proven by kidney biopsy: report of 10 cases from a tertiary care center and comparison with the literature

Lymphomas localized in the kidney are a rare entity that may be challenging to diagnose. We analyzed data from 10 patients with renal involvement of lymphoma diagnosed between 2009 and 2019 on fine needle biopsy from our tertiary center, and compared these with findings of 160 cases reported in the literature. Diffuse large B-cell lymphoma was the main histology subtype (40 and 38% in our sample and in the literature, respectively), followed by low-grade B-cell lymphomas, mostly from the marginal zone (MZ). Altogether, 106 patients had urological inaugural symptoms and 64 had general symptoms. Patients with urological presentation more often had renal masses than diffuse infiltration (p < 0.001), unilateral tumors (p = 0.0036) and low-grade B-cell lymphomas (17 vs 6%, p = 0.043). In both groups, nearly one-fourth of patients had diffuse (stage IV) lymphomas. Overall survival did not differ by the presence of urological/systemic symptoms, stage or aggressive lymphoma status. Notably, 3 of 10 patients from our series had MZ lymphomas associated with primary Sjögren syndrome revealed by acute kidney injury, including one where the autoimmune disease was detected. Lymphoproliferative disorders localized in the kidney are a challenging condition that can lead to detection of aggressive or diffuse lymphomas.

Acute kidney injury as initial presentation of renal lymphoma: Diagnostic and therapeutic challenges in a resource-limited setting

Non-Hodgkin’s lymphoma is reportedly common in Africa; however, there is limited data on renal involvement. Acute kidney injury only at presentation is rare for lymphoproliferative malignancies. A 7-year old presented to our facility with a 2-week history of progressive abdominal distension and pain, examination revealed anasarca and hypertension. On further evaluation, there were bilateral nephromegaly, acute kidney injury (AKI) and cytomorphological findings suggestive of lymphoma. Patient management was mostly supportive, and evolution was unfavourable leading to his demise. We discuss diagnostic and therapeutic challenges due to unavailability of state-of-the-art facilities in resource-constrained settings.

Imaging of Extranodal Genitourinary Lymphoma

The genitourinary (GU) system is commonly affected by disseminated lymphoma. Rarely, lymphoma can originate from and remain localized to one of the GU organs and thus presents as primary extranodal disease. Up to 40% of lymphomas present as extranodal disease, with only 3% having the GU system as the primary site of involvement. This article describes and correlates the radiologic and pathologic features of extranodal lymphomatous disease affecting the GU system with specific focus on the kidneys, adrenal glands, testicles, and ovaries. Lymphoma of the uterine body and cervix, external female genitalia, urinary bladder, and prostate gland is briefly discussed.

Imaging of primary and secondary renal lymphoma

OBJECTIVE

This article reviews the CT and MRI patterns of primary and secondary renal lymphomas and discusses the role of percutaneous biopsy in diagnosis and management.

CONCLUSION

Renal lymphoma has a variable imaging spectrum and may mimic renal cell carcinoma. An awareness of the typical and atypical imaging features of both primary and secondary renal lymphomas can help the radiologist to suggest these diagnoses and recommend biopsy when appropriate.

Multiple hypovascular tumors in kidney: a rare case report and differential diagnosis

The most common malignant renal tumor is renal cell carcinoma and surgery is the standard treatment. The proportion of lymphoma with renal involvement is 2~15% and lymphoma could be cured by chemotherapy without nephrectomy. Sonography, computed tomography (CT), and magnetic resonance imaging (MRI) can detect and characterize a renal mass. We present a case of right renal hypovascular tumors and differential diagnosis of hypovascular tumors by image study. CT scan showed hypovascular tumors and MRI image revealed multifocal hypovascular solid tumors with significantly increased apparent diffusion coefficient (ADC) of diffusion weighted imaging (DWI). Based on image finding, renal lymphoma was highly suspected. Renal lymphoma was confirmed by renal biopsy and this patient received chemotherapy without surgery. The noninvasive CT scan and MRI image can help clinicians to diagnose the characteristics of renal mass and to avoid unnecessary nephrectomy.

[Primary lymphomas of the urinary in the urological service of the Yaounde Central Hospital]

OBJECTIVE

The objective of this study were to recruit and present epidemiological, clinical, histological and therapeutic aspects of primary lymphomas of the urogenital tract in Cameroon.

MATERIAL AND METHOD

This was a retrospective study over a 10-year period (1999-2008) done on clinical records of the Urological Unit of the Yaounde Central Hospital. From these records, we noted the age and the sex of the patients, their clinical presentation and histological aspect. The patients were treated by surgical resection and chemotherapy.

RESULTS

Twenty cases were recruited between this period of the study. The age of the patients varied from 6 to 60 years with a mean age of 35 years. There were 19 men and one woman. Eighteen cases involved the testis, one case the kidney and one penile involvement. On histology, there were 19 cases of Burkitt's lymphoma and one case of large B cell lymphoma involving the penis. Three patients had positive syphilis serology and two other were HIV positive. All the patients in this series had a complete remission after treatment but the tumour recurs after 6 to 9 months.

CONCLUSION

Burkitt's lymphoma is the first malignant tumour of the testis in Cameroonian. Unfortunately, patients consult late, there are no supports for the treatment and this will lead to a poor prognosis.

Primary Lymphoma of the Kidney in an Adult Male - The First Reported Case from Iran

We report a case of primary renal lymphoma in a 48-year-old man. He was admitted with a large homogenous right renal mass that was revealed by computed tomography scan of the abdomen and pelvis. The patient underwent transperitoneal right radical nephrectomy. Pathologic diagnosis was in favor of primary renal lymphoma.

A possible case of primary renal lymphoma: a case report

Introduction

The entity primary renal lymphoma is controversial and rare.

Case presentation

We report a case in a 60-year-old man. Computed tomography revealed a large, homogeneous, retroperitoneal mass with 14.8 × 11.5 cm size arising from the right kidney. An ultrasound guided percutaneous biopsy was performed and the tumour was diagnosed histopathological as non-Hodgkin lymphoma. The patient was treated by systemic chemotherapy and thereafter a nephrectomy was performed.

Conclusion

Primary renal lymphoma is a controversial and infrequent disease. However, there is growing evidence that it does exist.

Diffuse large B-cell lymphoma in a renal allograft associated with Epstein-Barr virus in the recipient: a case report and a review of lymphomas presenting in a transplanted kidney

The purpose of this review was to evaluate the case reports with lymphoproliferative disorders exclusively localized in the allograft transplanted kidney. We also report a rare case of diffuse large B-cell lymphoma originated from the lymphocytes of the recipient with exclusive localization in the kidney allograft. We searched the medical literature for case reports of this condition. We found only 16 cases of lymphoma presenting in the kidney allograft without systemic affectation. The most frequent clinical manifestations were graft dysfunction and fever. In the majority of patients included in this review, the diagnosis was established from the tissue of explanted allograft. Seven patients were diagnosed with B-cell lymphoma, and the relationship with Epstein-Barr virus could only be demonstrated in four patients. However, the outcome was satisfactory in all cases, except in one case in which death was not related with the lymphoma etiology. Health care providers should be aware of this clinical entity and heightened index of suspicion should be used so as not to delay diagnosis and not to lose the allograft.

Lymphoma of the kidney: Primary or initial manifestation of rapidly progressive systemic disease?

Primary renal lymphoma is a controversial and rare disease. There is no agreement whether or not it is an initial manifestation of a rapidly systemic disease. Most reported cases are questionable because of incomplete staging and lack of autopsy studies. Herein, we present a 71-year-old woman, initially diagnosed with primary non-Hodgkin lymphoma of the kidney, but was lost 4 months after radical nephrectomy due to systemic disease despite aggressive chemotherapy, and suggest that, the kidney of the patient was the initial presenting site of a rapidly progressive systemic disease.

Imaging of renal lymphoma: patterns of disease with pathologic correlation

Extranodal spread of lymphoma often affects the genitourinary system, with the kidneys being the most commonly involved organs. Contrast material-enhanced computed tomography (CT) remains the modality of choice for the detection, diagnosis, staging, and monitoring of renal lymphoma. Magnetic resonance (MR) imaging is particularly useful in patients in whom intravenous administration of iodinated contrast material is contraindicated. Ultrasonography (US), although very valuable for diagnosing lymphoma in the testis or epididymis, is less sensitive than CT and MR imaging for detecting renal lymphoma. Typical imaging findings of renal lymphoma include multiple poorly enhancing or hypoechoic masses, retroperitoneal tumors directly invading the kidneys, bilateral renal enlargement, and perirenal soft-tissue masses. Cystic lesions and tumors predominantly affecting the renal sinus and collecting system are uncommon. Unless the renal lesions manifest in the setting of widespread lymphoma, percutaneous biopsy is indicated to differentiate lymphoma from metastases, hypovascular renal cell carcinoma, uroepithelial carcinoma, or atypical infection, with US routinely being used to guide the procedure. Current immunohistochemical techniques allow accurate diagnosis and characterization of renal lymphoma. Radiologists should be familiar with both typical and atypical manifestations of renal lymphoma and should recommend imaging-guided percutaneous biopsy for diagnostic confirmation to avoid unnecessary nephrectomy.

Renal Masses in the Adult Patient: The Role of Percutaneous Biopsy

Although percutaneous renal mass biopsy with cross-sectional imaging guidance has long been considered to be safe and accurate, there have been recent advances in imaging, interventional, and cytologic techniques that have increased the role of percutaneous biopsy in the diagnosis of renal masses. Today, biopsy plays a fundamental role in the care of patients with a renal mass. Biopsy results are used to confirm the diagnosis of renal cancers, metastases, and infections, and there is increasing evidence to suggest that biopsy can help subtype and grade many primary renal cancers. Because a considerable fraction of small solid renal masses are benign and do not need treatment, there is an increasing need to diagnose them. Biopsy after a full imaging work-up can help prevent unnecessary and potentially morbid surgical and ablation procedures in a substantial number of patients. Although more data are needed to understand the overall accuracy of biopsy for the diagnosis of benign lesions, many can be diagnosed with the aid of biopsy findings. This article reviews reported experience with percutaneous renal mass biopsy, discusses the technical factors that contribute to results, and details seven specific clinical settings that should prompt the clinician to consider percutaneous biopsy when encountering a renal mass.

Long-term survival after combination chemotherapy for bilateral renal malignant lymphoma in a dog

CASE HISTORY

A 6-year-old, entire male Flat-coated Retriever was presented with a history of lethargy, polydipsia and seizures. Clinical chemistry had shown marked azotaemia.

CLINICAL FINDINGS AND DIAGNOSIS

Radiography and ultrasonography revealed bilateral renomegaly, and cytology of fine needle aspirates from the kidneys was diagnostic of malignant lymphoma. The dog was treated with a modified high-dose cyclophosphamide-, vincristine-, and prednisolone-based chemotherapy protocol, achieved remission, and returned to normal quality of life. Survival time was 346 days from the time of diagnosis.

CLINICAL RELEVANCE

Malignant lymphoma in the kidneys of dogs has been considered to carry a uniformly poor prognosis. Long-term remission after medical treatment has not previously been reported. The favourable outcome in this case illustrates the limitations of clinical staging in determining the outcome for individual patients.

Low-grade mucosa-associated lymphoid tissue lymphoma involving the kidney: report of 3 cases and review of the literature

Low-grade B-cell lymphoma of mucosa-associated lymphoid tissue involving the kidney is rare. We report a series of 3 cases. The first case occurred in an 83-year-old woman who presented with back pain. The second case was a 53-year-old man with a history of sarcoidosis who was found, in the course of evaluation of sarcoidosis, to have a right renal mass. The third case occurred in a 72-year-old man who had a history of periorbital mucosa-associated lymphoid tissue lymphoma and had been treated with surgery and radiation 1 year prior to this presentation. Histologically, all 3 patients showed infiltrate of uniform small-to-medium-sized lymphocytes with irregular nuclear contours and abundant cytoplasm resembling centrocytes or monocytoid lymphoid cells. The first patient received chemotherapy without complications. The second patient underwent a partial nephrectomy and was asymptomatic at the subsequent follow-up. The third patient developed a pulmonary embolism following nephrectomy, and further follow-up is not available.

Intraoperative pathology consultation for kidney and urinary bladder specimens

CONTEXT

Intraoperative pathology consultation for kidney and urinary bladder specimens is relatively infrequent. Scant literature is devoted to this topic.

OBJECTIVE

The clinical indications and diagnostic usefulness and pitfalls of intraoperative pathology consultation of kidney and urinary bladder specimens will be reviewed, based on literature and personally encountered cases.

DATA SOURCES

The indications for intraoperative pathology consultation for renal lesions included (1) surgical margins in partial nephrectomy specimens, (2) solid renal mass in unusual clinical or radiologic settings, (3) synchronous renal and extrarenal masses, (4) cystic renal lesions, (5) ureteral surgical margin for transitional cell carcinoma, (6) multiple renal masses, (7) solid mass in a diffusely cystic kidney, and (8) evaluation of renal injury. The indications for urinary bladder included (1) status of the surgical margins, (2) diagnosis of bladder tumor biopsy, (3) diagnosis of extravesical tumors with vesical extension, (4) diagnosis of extravesical mass, including pelvic lymph nodes encountered during cystectomy, and (5) status of bladder neck margin during radical prostatectomy for cancer. The frequent problematic areas for the kidney included misdiagnosis or incorrect classification of cystic tumors or spindle cell tumors, and confusion of clear cell renal cell carcinoma with inflammatory lesions. The problematic areas for urinary bladder included the differential diagnoses of high-grade dysplasia/carcinoma in situ with reactive changes at the ureteral or urethral surgical margins.

CONCLUSIONS

Distinctive indications and diagnostic pitfalls are recognized for intraoperative consultation of renal or urinary bladder lesions. Awareness of the pertinent problems should improve diagnostic accuracy and facilitate the proper management of these lesions.

Metastases to the kidney: eleven cases diagnosed by aspiration biopsy with histological correlation

Metastases to the kidney from extrarenal primary tumors are uncommon and may mimic renal-cell carcinoma clinically when presenting as a single mass with hematuria. Fine-needle aspiration biopsy (FNAB) is a useful diagnostic method for the evaluation of primary renal tumors. Only a few studies have investigated the value of cytological evaluation of secondary renal tumors. We report our experience with these tumors. Eleven cases of extrarenal primary tumors metastatic to the kidney, diagnosed by aspiration biopsy with histological correlation, are discussed. The diagnosis of metastatic disease to the kidney was accurately made by aspiration biopsy. Knowledge of the patients' history, histological correlation with the primary tumor, and the radiological characteristics of the renal masses were helpful in achieving a correct diagnosis. FNA cytology (FNAC) is an accurate method for the diagnosis of tumors metastatic to the kidney. Distinction between primary and secondary tumors of the kidney is crucial to guide management and prevent unnecessary surgery.

Precursor B-cell lymphoblastic leukemia as a cause of a bilateral nephromegaly

Nephromegaly and non-oliguric acute renal failure is an unusual manifestation of lymphoblastic infiltration of the kidneys. We report the clinical history of a female child where a precursor B-cell lymphoblastic proliferation was diagnosed at the age of 21 months by a surgical renal biopsy for an unexplained bilateral nephromegaly. Lymphoblastic infiltration should be suspected in any patient presenting with unexplained renal failure and enlarged kidneys. The importance of renal biopsy to identify the etiology of renal failure and nephromegaly is emphasized.

Primary Renal Lymphoma Presenting with Chronic Low-Grade Fever

Primary renal lymphoma (PRL) is a rare form of extranodal non-Hodgkin's lymphoma often diagnosed and treated by oncologists and urologists. Pathophysiological and clinical data on PRL are sparse, but the limited reported experience suggests the disease usually has an ominous outcome. As in other renal tumors, comprehensive radiological investigations have a central role in the recognition and final diagnosis of PRL. We describe the presenting features and clinical course of an elderly woman who was found to have PRL after evaluation for persistent low-grade fever. Diagnostic and therapeutic caveats are discussed on the basis of a critical literature review of case reports and descriptions of small series of patients.

Primary anaplastic large cell lymphoma of the kidney

Primary renal lymphoma is a rare disease. There is still no agreement on its development primarily in this non-lymphoid organ. Some of the reported cases are questionable because of the incomplete staging of extrarenal disease. In the present study, we describe a rare case of a 73-year-old white man presenting with right flank pain. Physical examination did not reveal any peripheral lymphadenopathy or hepatosplenomegaly. An abdominal computerized tomography (CT) showed a large tumor in the right kidney with no enlarged liver, spleen or lymph nodes. On morphological and immunohistochemical examination, the tumor fulfilled the criteria of anaplastic large cell lymphoma (ALCL). A review of the literature revealed that this is the first reported case of primary ALCL of the kidney.