Primary Urinary Tract Lymphoma: Rare but Aggressive

Methotrexate‑associated B‑cell lymphoproliferative disease that exhibits hematuria due to urinary bladder lesions: A case report

Methotrexate (MTX)-related lymphoproliferative disease (LPD) is one of the most prominent late complications associated with MTX treatment. Although MTX-related LPD exhibits a relatively high incidence of extranodal disease, the incidence of disease in a urinary bladder is very low. The present study reports the case of a patient with MTX-related LPD involving a urinary bladder mass. A 75-year-old female patient, who had been receiving MTX for ~15 years, was referred to the hospital due to fever and hematuria. A computed tomography scan revealed the thickening of the urinary bladder wall, hydronephrosis and lymph node swelling. The histopathological findings of the urinary bladder mass resulted in a diagnosis of MTX-related LPD. Although MTX withdrawal did not have any effect, the subsequent chemotherapy resulted in complete remission. Although MTX-related LPD in the bladder is rare, it is pertinent to consider MTX-related LPD when hematuria is observed during MTX therapy.

Current Status and Challenges in Rare Genitourinary Cancer Research and Future Directions

PURPOSE OF REVIEW

In contemporary urological practice, managing rare genitourinary (GU) malignancies presents significant challenges, necessitating a comprehensive understanding of their unique characteristics and tailored treatment approaches.

RECENT FINDINGS

Rare GU malignancies, whether per se, variants of common histologies, or common tumors in uncommon locations, often lack widely available clinical guidelines. Consequently, treatment decisions are frequently based on empirical evidence, risking suboptimal outcomes. However, recent advances in molecular profiling, targeted therapies, and immunotherapy offer promising avenues for improving management strategies and patient outcomes. This review provides a comprehensive overview of some rare GU malignancies encountered in clinical practice, including their distinct pathological features, current management approaches, and ongoing research directions. Understanding the complexities of these rare tumors and implementing multidisciplinary treatment strategies are essential for optimizing patient care and improving survival outcomes.

Primary Bladder Non-Hodgkin Lymphoma: A Case Report

Primary bladder lymphoma, a rare form of non-Hodgkin's lymphoma, is diagnosed through histopathology and immunostaining. Most bladder lymphomas are of the B-cell type, with a higher incidence in women and often presenting with hematuria. This report details an exceptionally rare case of primary bladder T-cell lymphoma. A 50-year-old male, without hematuria or other symptoms, was diagnosed during a routine ultrasound. A computed tomography scan showed a tumor located in the anterior, right, and posterior walls. The patient underwent transurethral resection of the bladder lesion. Pathological examination of the tumor showed that it was composed of lymphoid tissue, in accordance with peripheral T-cell lymphoma of non-Hodgkin subtype.

Complications of lymphoma in the abdomen and pelvis: clinical and imaging review

Involvement of the abdomen and pelvis is common in lymphoma. Nodal and extranodal abdominal and pelvic lymphoma may present with various complications. Complications are most common in high-grade lymphomas, especially diffuse large B-cell lymphoma. Complications may occur as the initial manifestation of lymphoma, during treatment course, or late following complete disease remission. Most complications are associated with worse prognosis and increased mortality. Imaging is essential in evaluation of disease extent and diagnosis of complications. Therefore, radiologists should be familiar with the clinical context and imaging features of abdominal and pelvic lymphoma complications. We provide a comprehensive, organ system-based approach, and clinical and imaging review of complications of abdominal and pelvic lymphoma along with radiologic images of illustrated cases of the most commonly encountered complications.

Primary Diffuse Large B-Cell Lymphoma of the Urinary Tract: A Population-Based Analysis

Objective

Diffuse large B-cell lymphoma (DLBCL) is the most common histopathological type of non-Hodgkin’s lymphoma, which may arise from various extranodal sites. Little is known about the clinical characteristics and survival outcomes of primary DLBCL of the urinary tract (UT). Thus, we conducted this study to explore the independent prognostic factors of patients with UT-DLBCL using the Surveillance, Epidemiology, and End Results (SEER) database.

Materials and Methods

We searched the Surveillance, Epidemiology, and End Results (SEER) database for the data of patients diagnosed with UT-DLBCL between 1975 and 2016. Data, including demographic tumour stage and therapeutic strategies, such as surgical resection, radiation therapy, and chemotherapy, were collected. The impact of these factors on survival outcomes, including overall survival (OS) and disease-specific survival (DSS), was analysed using Kaplan–Meier curves.

Results

Four-hundred and eighty-nine patients who met the inclusion criteria were enrolled in the data analysis. The median age was 69 years old. Most cases of UT-DLBCL (72.39%) originated from the kidney, followed by the urinary bladder (24.95%). Both surgical resection and chemotherapy can significantly improve OS and DSS. Patients older than 75 years had the worst survival outcomes. Stage IV DLBCL may be a poor prognostic factor.

Conclusion

To the best of our knowledge, this is the largest population-based study of UT-DLBCL. Advanced age, male gender, lack of surgical resection or chemotherapy, and stage IV DLBCL were poor prognostic factors.

Multicentric primary diffuse large B-cell lymphoma in genitourinary tract detected on 18F-F-fluorodeoxyglucose positron emission tomography with computed tomography: An uncommon presentation of a common malignancy

Primary extranodal lymphomas (ENLs) are lymphomas with no or minor nodal involvement and a dominant extranodal component originating from any organ. Primary ENL originating in the genitourinary tract is extremely rare. Diffuse large B-cell lymphoma (DLBCL) is the most frequent histological subtype in primary genitourinary lymphoma. Lymphomatous involvement of genitourinary system organs is common in the setting of disseminated disease. Herein, we present a unique case of primary multicentric extranodal DLBCL of the urogenital system involving ureter, seminal vesicle, and penis detected on 18fluro-deoxyglucose positron emission tomography with computed tomography, and to the best of our knowledge, it is the first case report with multiorgan involvement within a single (urogenital) organ system in a patient without disseminated disease, i.e., with no other nodal or extranodal organ system involvement.

Primary lymphomas of the genitourinary tract: A population-based study

OBJECTIVE

We performed a population-based analysis focusing on primary extranodal lymphoma of either testis, kidney, bladder or prostate (PGUL).

METHODS

We identified all cases of localized testis, renal, bladder and prostate primary lymphomas (PL) versus primary testis, kidney, bladder and prostate cancers within the Surveillance, Epidemiology, and End Results database (1998-2015). Estimated annual proportion change methodology (EAPC), multivariable logistic regression models, cumulative incidence plots and multivariable competing risks regression models were used.

RESULTS

The rates of testis-PL, renal-PL, bladder-PL and prostate-PL were 3.04%, 0.22%, 0.18% and 0.01%, respectively. Patients with PGUL were older and more frequently Caucasian. Annual rates significantly decreased for renal-PL (EAPC: -5.6%; p=0.004) and prostate-PL (EAPC: -3.6%; p=0.03). In multivariable logistic regression models, older ager independently predicted testis-PL (odds ratio [OR]: 16.4; p<0.001) and renal-PL (OR: 3.5; p<0.001), while female gender independently predicted bladder-PL (OR: 5.5; p<0.001). In surgically treated patients, cumulative incidence plots showed significantly higher 10-year cancer-specific mortality (CSM) rates for testis-PL, renal-PL and prostate-PL versus their primary genitourinary tumors. In multivariable competing risks regression models, only testis-PL (hazard ratio [HR]: 16.7; p<0.001) and renal-PL (HR: 2.52; p<0.001) independently predicted higher CSM rates.

CONCLUSION

PGUL rates are extremely low and on the decrease in kidney and prostate but stable in testis and bladder. Relative to primary genitourinary tumors, PGUL are associated with worse CSM for testis-PL and renal-PL but not for bladder-PL and prostate-PL, even after adjustment for other-cause mortality.

Lymphoma and the Kidney: A Kidney Biopsy Teaching Case

Lymphomatous infiltration of kidney parenchyma is a frequent complication of systemic hematologic malignancies and often shows subtle clinical presentation. Diffuse large B-cell lymphoma represents the most frequent form involving the kidney, with advanced stage at diagnosis, poor outcome, and risk for central nervous system relapse if not adequately treated. Kidney biopsy can provide specific and early detection of these cases, helping in the differential diagnosis with more frequent entities. Finally, further hematologic workup (bone marrow biopsy, complete blood cell count, and positron emission tomography) can distinguish secondary involvement of the kidney from the rarer kidney-limited forms, especially in patients without a previous diagnosis of lymphoma. Making a prompt and correct diagnosis directs the management of these cases and may improve the outcome, as described in the present report.

An unusual presentation of diffuse large B-cell lymphoma with ureteric involvement: A case report

INTRODUCTION

Non-Hodgkin's lymphomas are a heterogeneous group of malignancies in the lymphoid system and ureteric involvement by non-Hodgkin's lymphoma is very rare.

CASE PRESENTATION

We present a 37-year-old male, presenting with lower urinary tract symptoms and right flank pain. Initially, he presented with lower urinary tract symptoms without having any evidence of urinary tract infection and was managed for nonspecific cystitis. His ureteral histopathology report indicated a diffused infiltration by malignant lymphoid cells and the final diagnosis revealed diffuse large B-cell lymphoma. His positron-emission tomography scan indicated stage 4 disease with skeletal involvement and he was then treated by rituximab, cyclophosphamide, liposomal doxorubicin, vincristine, and methylprednisolone chemotherapy. Later, he was also diagnosed with central nervous system lymphoma and died during his stay in the hospital.

CONCLUSION

Primary diffuse large B-cell lymphoma of the ureter is extremely rare; however, it should be considered in the differential diagnosis for patients presenting with obstructive uropathy as its early detection is crucial for diagnostic and therapeutic treatment.