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Lee SB, Yoon YM, Hong R. Primary renal lymphoma presenting as renal failure: A case report and review of literature from 1989. World J Clin Cases 2023; 11:7113-7126. [PMID: 37946781 PMCID: PMC10631424 DOI: 10.12998/wjcc.v11.i29.7113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/21/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Primary renal lymphoma (PRL) is extremely rare with an incidence of 0.7% among extranodal lymphomas. Occult renal lymphoma, which mimics medical renal disease and bilateral renal involvement, presents a diagnostic challenge to nephrologists and radiologists as the clinical and radiological findings are mostly non-specific or inconclusive. Acute kidney injury (AKI) is not an uncommon finding in renal infiltration due to malignant lymphoma. However, only 14% of cases are detected before death, and the low diagnostic rate may be due to the non-specific clinical manifestations of renal involvement, with only 0.5% of these cases presenting with AKI. Moreover, PRL is difficult to diagnose based on clinical, biochemical, and radiologic features, especially, in the case of bilateral diffuse involvement. CASE SUMMARY Herein, we report a 74-year-old woman with primary diffuse large B-cell lymphoma who presented with AKI diagnosed by ultrasound-guided needle biopsy. We also report the clinicopathologic findings of 121 PRL cases reported since 1989, by conducting a literature review of published cases. CONCLUSION A timely renal biopsy provides the most expedient means of establishing the diagnosis. Thus, early identification of the disease by the clinician facilitates early diagnosis toward effective treatment.
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Affiliation(s)
- Seul-Bi Lee
- Department of Hemato-Oncology, Medical School, Chosun University, Gwangju 61453, South Korea
| | - Young-Min Yoon
- Department of Nephrology, Medical School, Chosun University, Gwangju 61453, South Korea
| | - Ran Hong
- Department of Pathology, Medical School, Chosun University, Gwangju 61453, South Korea
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2
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Renal involvement of lymphomas proven by kidney biopsy: report of 10 cases from a tertiary care center and comparison with the literature. Int J Hematol 2022; 116:678-695. [PMID: 35829895 DOI: 10.1007/s12185-022-03411-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
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.
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He J, Mu Y, Che BW, Liu M, Zhang WJ, Xu SH, Tang KF. Comprehensive treatment for primary right renal diffuse large B-cell lymphoma with a renal vein tumor thrombus: A case report. World J Clin Cases 2022; 10:5352-5358. [PMID: 35812668 PMCID: PMC9210905 DOI: 10.12998/wjcc.v10.i16.5352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/21/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Renal involvement in lymphoma is commonly associated with widespread nodal or extranodal lymphoma. Primary renal diffuse large B-cell lymphoma is an extremely rare extranodal lymphoma, accounting for fewer than 1% of all renal masses. Interestingly, the patient in this study had a renal vein tumor thrombus that was observed after laparoscopic radical nephrectomy.
CASE SUMMARY We report the case of a 56-year-old female patient with primary renal lymphoma and a renal vein tumor thrombus whose first symptom was right pain in the back and gross hematuria. Histopathology revealed primary renal diffuse large B-cell lymphoma. The patient received 8 standard cycles of rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy after surgery, and no obvious signs of recurrence were observed during the one-year follow-up.
CONCLUSION We evaluated comprehensive treatment of primary renal diffuse large B-cell lymphoma and multidisciplinary management of this malignancy.
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Affiliation(s)
- Jun He
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Yi Mu
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Bang-Wei Che
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Miao Liu
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Wen-Jun Zhang
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Sheng-Han Xu
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Kai-Fa Tang
- Department of Urology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
- Institute of Medical Science, Guizhou Medical University, Guiyang 550004, Guizhou Province, China
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Swain M, Nuguri S, De Padua M, Gowrishankar S. Renal lymphoma diagnosed on kidney biopsy presenting as acute kidney injury. Indian J Nephrol 2022; 32:342-347. [PMID: 35967526 PMCID: PMC9364996 DOI: 10.4103/ijn.ijn_345_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/04/2021] [Accepted: 10/17/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction: Renal manifestations associated with hematolymphoid malignancies are known. Primary or secondary involvement of the kidney by lymphomatous infiltration has various clinical presentations. Acute kidney injury is not an uncommon finding in relation to lymphomatous interstitial infiltration proven on kidney biopsy. However, diagnosing it solely on renal biopsy remains a challenge and needs expertise and aid of immunohistochemistry as the prognosis is dismal. Methods: This is a retrospective study of kidney biopsy-proven cases of renal lymphoma presenting with acute kidney injury. Results: The study included 12 patients with ages ranging from 4 to 50 years who presented with serum creatinine ranging 2.1–9.6 mg%. Renal biopsy findings showed interstitial lymphomatous infiltrate. Two cases were diagnosed as primary lymphoma and the other 10 as secondary lymphomas. Among the 12 cases, nine were B-cell non-Hodgkin lymphoma, of which diffuse large B-cell lymphoma was diagnosed in six (50%), low-grade B-cell type in two (16.6%), chronic lymphocytic leukemia in one (8.3%), and three were T-cell-type. Two were acute T-cell lymphoblastic lymphoma and one other was a high-grade T-cell lymphoma. Four patients succumbed. The other four patients are alive; one is on chemotherapy, while two of them are on hemodialysis. Conclusion: Acute kidney injury as a presenting feature with lymphomatous infiltration of renal parenchyma is not uncommon. The patchy involvement makes it challenging on kidney biopsy with definitive diagnosis being made with the help of immunohistochemistry. Appropriate multidisciplinary involvement improves patient outcome.
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Benameur Y, Hammani A, Doghmi K, Doudouh A. Bilateral renal involvement in diffuse large B-cell lymphoma on fluorodeoxyglucose positron emission tomography/computed tomography. World J Nucl Med 2021; 20:195-197. [PMID: 34321975 PMCID: PMC8285998 DOI: 10.4103/wjnm.wjnm_111_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/16/2020] [Accepted: 10/04/2020] [Indexed: 11/21/2022] Open
Abstract
Secondary renal involvement in patients with diffuse large B-cell lymphoma (DLBCL) is rare and associated with poor prognosis. We, hereby, described a case of a patient diagnosed with DLBCL, in whom bilateral renal involvement was detected on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). The patient received 4 courses of chemotherapy, and follow-up 18F-FDG PET/ CT revealed the complete resolution of the diffuse increased renal 18F-FDG uptake. Renal lymphoma is uncommon and 18F-FDG PET/CT is particularly useful for detecting extranodal involvement in DLBLC.
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Affiliation(s)
- Yassir Benameur
- Department of Nuclear Medicine, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University in Rabat, Morocco
| | - Adnane Hammani
- Department of Clinical Hematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University in Rabat, Morocco
| | - Kamal Doghmi
- Department of Clinical Hematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University in Rabat, Morocco
| | - Abderrahim Doudouh
- Department of Nuclear Medicine, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University in Rabat, Morocco
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Geramizadeh B, Shojazadeh A, Marzban M. Primary renal non-Hodgkin's lymphoma: A narrative review of literature. Urologia 2021; 89:185-194. [PMID: 33506743 DOI: 10.1177/0391560321990271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal involvement by Non-Hodgkin's lymphoma (NHL) is very rare, and involvement of the kidney as the primary site of NHL (PRNHL) is much more uncommon. Gold standard for the diagnosis of PRNHL is histology and imaging modalities although helpful are not specific. Nephrectomy has been mostly recommended for low grade lymphomas, and for high grade PRNHLs, chemotherapy without nephrectomy has been recommended as the treatment of choice. This tumor is aggressive with poor prognosis. This poor prognosis is partly because of delayed diagnosis and partly because of unnecessary surgeries, so it should be kept in mind, especially in bilateral renal tumors with unusual imaging characteristics, to take a tissue biopsy before nephrectomy. In this review, we will discuss all the detailed aspects of clinical, pathologic, and imaging characteristics of 83 cases of PRNHL reported in the last 20 years in the English literature so far. For this purpose, all the published cases of the primary non-Hodgkin's lymphoma of kidney were reviewed via a search in PubMed, Scopus, and Google Scholar, (1999-2019), using the keywords of "Primary renal lymphoma" and "Non-Hodgkin's lymphoma and kidney," "renal Non-Hodgkin's lymphoma," "renal lymphoma," and "lymphoma and kidney." There were 83 cases in the published English literature which were reviewed for this article. There was some missing information in some cases which has been recorded as "not reported."
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Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran.,Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Shojazadeh
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Marzban
- University of British Columbia, Vancouver, BC, Canada
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Zhao K, Zhang Q, Cong R, Wang Y, Wang Z, Song N. Primary renal lymphoma: a case report and review of the literature. AME Case Rep 2020; 4:8. [PMID: 32420531 DOI: 10.21037/acr.2019.12.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/21/2019] [Indexed: 11/06/2022]
Abstract
Although renal involvement is common in non-Hodgkin's lymphoma (NHL), primary renal NHL is a rare disease. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of NHL and is responsible for 30-40% of adult NHL cases globally. Here, we present a case of a 68-year-old man with right flank pain who underwent retroperitoneal laparoscopic radical nephrectomy for an enlarged right kidney, with evidence of an infiltrating mass. Postoperative histopathological examination revealed primary renal DLBCL. Primary renal lymphoma (PRL) is quite rare, and clinicians should try to ensure early diagnosis and treatment with standardized and systematic chemotherapy.
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Affiliation(s)
- Kai Zhao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Qijie Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Rong Cong
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yamin Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zengjun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ninghong Song
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Samarasinghe A, Wong D, Cull G, Chakera A. Marginal zone lymphoma causing accelerated progression of chronic kidney disease. BMJ Case Rep 2019; 12:12/11/e230270. [PMID: 31712228 PMCID: PMC6855851 DOI: 10.1136/bcr-2019-230270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 75-year-old man with stage IV chronic kidney disease due to type 2 diabetes mellitus, presented with increasing proteinuria and rapidly declining renal function despite excellent glycaemic control. Investigations organised to assess his suitability for renal transplantation included an abdominal CT scan, which revealed extensive intra-abdominal lymphadenopathy. A 17fluorodeoxyglucose (FDG)-positron emission tomography scan to further characterise the lymphadenopathy demonstrated activity in the lymph nodes, as well as both kidneys. Following a lymph node biopsy and flow cytometry he was diagnosed with a marginal zone lymphoma. A subsequent kidney biopsy confirmed lymphomatous infiltration of the kidney. Marginal zone lymphoma is an uncommon type of non-Hodgkin's lymphoma, and renal involvement is rare. This case highlights the importance of considering alternative diagnoses when there is deviation from the expected clinical trajectory and the importance of liaising with colleagues in other disciplines to enable an accurate diagnosis to be made.
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Affiliation(s)
- Amali Samarasinghe
- Medical, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Daniel Wong
- Pathology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Gavin Cull
- Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Aron Chakera
- Renal, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Kaur A, Abughanimeh O, Zafar Y, Pluard T. Diffuse Large B-cell Lymphoma Presenting as Bilateral Renal Masses: Successful Treatment with Dose-adjusted REPOCH (Rituximab, Etoposide, Prednisone, Vincristine, Cyclophosphamide, Doxorubicin) Chemotherapy Regimen. Cureus 2019; 11:e3814. [PMID: 30868028 PMCID: PMC6402740 DOI: 10.7759/cureus.3814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/31/2018] [Indexed: 12/15/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBL) is an aggressive type of non-Hodgkin lymphoma (NHL). Renal involvement in NHL is not uncommon in advanced stages; however, it is rare to have kidneys affected early in the course of the disease. Usual chemotherapy regimen for DLBL is rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone (R-CHOP). This is a case of a 50-year-old female diagnosed with DLBL who presented with bilateral renal involvement at disease onset and also underwent complete remission after six cycles of dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (DA-REPOCH). Limited data exist on outcomes of patients with DLBL and renal disease who are treated with high-intensity regimes such as DA-REPOCH. It would be worth looking further into outcomes of DLBL patients especially with renal involvement on DA-REPOCH. Multicenter trials are required to demonstrate which of the two chemotherapy regimens (R-CHOP vs. DA-REPOCH) have better progression-free survival in this particular subset of patients.
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Affiliation(s)
- Anahat Kaur
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Omar Abughanimeh
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Yousaf Zafar
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Timothy Pluard
- Hematology and Oncology, Saint Luke's Hospital, Kansas City, USA
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A Rare Cause of Acute Kidney Injury: Primary Renal Lymphoma in a Patient with Human Immunodeficiency Virus. Case Rep Med 2018; 2018:8425985. [PMID: 30186328 PMCID: PMC6110045 DOI: 10.1155/2018/8425985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/10/2018] [Indexed: 12/14/2022] Open
Abstract
We reported a case of primary renal lymphoma (PRL) presented with non-oliguric acute kidney injury and bilateral kidney infiltrates in an individual with human immunodeficiency virus (HIV) disease. Acute kidney injury secondary to lymphoma infiltrates is very rare (less than 1% of hematological malignancy). A 37-year-old gentleman with underlying human immunodeficiency virus (HIV) disease was on combined antiretroviral therapy since diagnosis. He presented to our center with uremic symptoms and gross hematuria. Clinically, bilateral kidneys massively enlarged and were ballotable. Blood investigations showed hemoglobin of 3.7 g/L, urea of 65.6 mmol/L, and serum creatinine of 1630 µmol/L with hyperkalemia and metabolic acidosis. An urgent hemodialysis was initiated, and he was dependent on regular hemodialysis subsequently. Computed tomography renal scan showed diffuse nonenhancing hypodense lesion in both renal parenchyma. Diagnosis of diffuse large B cell lymphoma with germinal center type, CD20 positive, and proliferative index 95% was confirmed via renal biopsy, and there was no bone marrow infiltrates. Unfortunately, the patient succumbs prior to initiation of chemotherapy.
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Occult Renal Granulomatous Inflammatory Lesions in Granulomatosis with Polyangiitis Detected by 18F-FDG PET/CT. Clin Nucl Med 2017. [DOI: 10.1097/rlu.0000000000001746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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