1
|
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.
Collapse
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
| |
Collapse
|
2
|
He X, Di M, Wang GN, Gao JB. Pediatric primary renal lymphoma presenting with multiple masses: A challenging case report and narrative review. Medicine (Baltimore) 2023; 102:e33850. [PMID: 37335697 DOI: 10.1097/md.0000000000033850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
RATIONALE Only 20 cases of pediatric primary renal non-Hodgkin's lymphoma have been reported since 1995, rare cases and a variety of imaging manifestations have led to difficulties in its diagnosis and treatment. PATIENT CONCERNS Herein, we share in detail a case of primary renal lymphoma (PRL) in a child and summarize the common clinical manifestations, imaging features, and prognostic factors of pediatric PRL by retrospectively analyzing cases reported in the literature. A 2-year-old boy presented to the clinic with a large mass on the right side of his abdomen along with loss of appetite. DIAGNOSES Imaging revealed a large right renal mass, nearly replacing the entire renal tissue, along with numerous small nodules in the left kidney. Given no local adenopathy and metastases, the diagnosis was unclear. A percutaneous renal puncture was performed, which proved the diagnosis of Burkitt's lymphoma. Since no bone marrow involvement, this child was diagnosed with pediatric PRL. INTERVENTIONS This PRL boy was treated with the NHL-BFM95 protocol and supportive care. OUTCOMES Unfortunately, this boy died of multiple organ failure in the fifth month of treatment. LESSONS As per literature review, the presentation of pediatric PRL is fatigue, loss of appetite, weight loss, abdominal swelling, or other nonspecific symptoms. Although in 81% of cases it often infiltrates the bilateral kidneys, urine abnormalities caused by pediatric PRL are uncommon. 76.2% of pediatric PRL were boys and 2/3 of all cases presented as diffuse renal enlargement. Those PRL presented as masses could easily be misdiagnosed as WT or other malignancies. Absent of local enlarged lymph node, no necrosis or calcification suggest atypical presentation of renal masses and a percutaneous biopsy is needed in timely establishing the accurate diagnosis for appropriate treatment. Based on our experience, percutaneous renal puncture core biopsy is a safe procedure.
Collapse
Affiliation(s)
- Xiao He
- Ultrasound Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Min Di
- Ultrasound Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guan-Nan Wang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jian-Bo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
3
|
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.
Collapse
|
4
|
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."
Collapse
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
| |
Collapse
|
5
|
Bruce G, Chaudhury S, Reynolds B. Bilateral primary renal diffuse large B-cell lymphoma: a rare presentation of paediatric renal disease mimicking juvenile nephronophthisis. BMJ Case Rep 2020; 13:13/7/e234810. [PMID: 32675115 DOI: 10.1136/bcr-2020-234810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 12-year-old boy presented with a prolonged history of headache, fatigue and hypertension. Initial investigations were consistent with presumed non-oliguric end-stage renal disease, leading to a provisional diagnosis of juvenile nephronophthisis. Subsequent imaging demonstrated bilaterally enlarged kidneys without cystic change. Mutation analysis was negative for nephronophthisis, causing diagnostic uncertainty which prompted renal biopsy. Histology revealed a primary renal diffuse large B-cell lymphoma which was highly responsive to chemotherapy, including the anti-CD20 monoclonal agent, rituximab. Renal function improved during lymphoma treatment, with residual chronic kidney disease stage 3a once chemotherapy was completed. Atypical diagnostic features should always prompt re-evaluation of a patient. In this case, the delayed malignancy diagnosis did not have an adverse effect on patient survival or morbidity. The outcome for primary renal lymphoma (PRL) has improved markedly following the introduction of rituximab.
Collapse
Affiliation(s)
- Gordon Bruce
- Department of Paediatrics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Shahzya Chaudhury
- Department of Paediatrics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Ben Reynolds
- Department of Paediatrics, NHS Greater Glasgow and Clyde, Glasgow, UK
| |
Collapse
|
6
|
Cheng X, Huang Z, Li D, Wang Y. Enormous primary renal diffuse large B-cell lymphoma: A case report and literature review. J Int Med Res 2019; 47:2728-2739. [PMID: 31066322 PMCID: PMC6567734 DOI: 10.1177/0300060519842049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Primary renal lymphoma is a rare malignant lymphoma that is difficult to differentiate from renal cell carcinoma. Positron emission tomography/computed tomography and image-guided percutaneous biopsy are valuable tools for diagnosis. Case report A 64-year-old woman presented with a 2-year history of repeated right waist pain and a 1-month history of nausea, vomiting, and frequent and urgent urination. A computed tomography scan showed a huge mass that was initially considered to be renal cell carcinoma at the upper pole of the right kidney. The mass had invaded the renal pelvis, narrowed the right renal artery, and constricted the inferior vena cava and liver. Postoperative examination of the tumor confirmed lymphoma. We herein present this case and its multidisciplinary team management. Conclusion Multidisciplinary team management is efficient for preoperative assessment and surgery in difficult and high-risk cases. Based on our literature review, we suggest biopsy before chemotherapy whenever possible. Chemotherapy can be implemented after surgery for better survival outcomes.
Collapse
Affiliation(s)
- Xu Cheng
- 1 Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhichao Huang
- 1 Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Daiqiang Li
- 2 Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yinhuai Wang
- 1 Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| |
Collapse
|
7
|
Coca P, Linga VG, Gundeti S, Tandon A. Renal Lymphoma: Primary or First Manifestation of Aggressive Pediatric B-cell Lymphoma. Indian J Med Paediatr Oncol 2017; 38:538-541. [PMID: 29333026 PMCID: PMC5759078 DOI: 10.4103/ijmpo.ijmpo_48_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Renal lymphoma is an uncommon renal tumor in children. Unlike renal lymphomas presenting as bilateral disease and renal failure, we report a boy who presented with unilateral renal involvement. After initial nephrectomy, he achieved remission with multiagent chemotherapy but relapsed systemically within 3 months. He was initiated on salvage chemotherapy with autologous bone marrow transplant. Even though the initial manifestation was localized lymphoma eventually, it turned out to be a systemic disease. He succumbed to disease at 14 months from diagnosis.
Collapse
Affiliation(s)
- Pragnya Coca
- Department of Medical Oncology, Mazumdar-Shaw Cancer Center, Bangalore, Karnataka, India
| | | | - Sadashivudu Gundeti
- Department of Medical Oncology, Nizams Institute of Medical Science, Hyderabad, Telangana, India
| | - Ashwani Tandon
- Department of Pathology, Nizams Institute of Medical Science, Hyderabad, Telangana, India
| |
Collapse
|
8
|
Chen X, Hu D, Fang L, Chen Y, Che X, Tao J, Weng G, Ye X. Primary renal lymphoma: A case report and literature review. Oncol Lett 2016; 12:4001-4008. [PMID: 27895762 DOI: 10.3892/ol.2016.5173] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/04/2016] [Indexed: 02/07/2023] Open
Abstract
Primary renal lymphoma (PRL) is a rare disease, with no more than 70 cases reported in the literature. The present study reports the case of a 70-year-old woman with PRL. The patient was asymptomatic, however, a mass on the right kidney was identified incidentally during routine physical examination. Computed tomography revealed a mass in the right kidney that was 3.6 cm in diameter. Subsequently, right nephrectomy was performed. The histological evaluation of the nephrectomy specimen showed diffuse large B-cell non-Hodgkin's lymphoma. The patient was treated with 6-8 cycles of a cyclophosphamide, epirubicin, vindesine and dexamethasone regimen. Follow-up examination performed after 2 months of treatment revealed no evidence of local recurrence. The present study also reviewed 49 cases of PRL that have been reported since 1989. It was found that a shorter survival time was experienced by patients with bilateral PRL (mean, 21 months) compared with unilateral PRL (mean, 68 months). A shorter survival time was also experienced by patients who were treated with chemotherapy only (mean, 15.8 months) compared with those who were treated with combination chemotherapy and surgery (mean, 49.4 months).
Collapse
Affiliation(s)
- Xiaodong Chen
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo University, Ningbo, Zhejiang 315100, P.R. China
| | - Danfei Hu
- Department of Radiation Therapy, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, Zhejiang 315020, P.R. China
| | - Laifu Fang
- Department of Pathology, Ningbo Yin Zhou Hospital, Ningbo, Zhejiang 315020, P.R. China
| | - Yichen Chen
- Division of Drugs and Pharmacology, Ningbo Institute of Medical Sciences, Ningbo, Zhejiang 315020, P.R. China
| | - Xiaohang Che
- Division of Drugs and Pharmacology, Ningbo Institute of Medical Sciences, Ningbo, Zhejiang 315020, P.R. China
| | - Jin Tao
- Division of Drugs and Pharmacology, Ningbo Institute of Medical Sciences, Ningbo, Zhejiang 315020, P.R. China
| | - Guobin Weng
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo University, Ningbo, Zhejiang 315100, P.R. China
| | - Xiaolei Ye
- Division of Drugs and Pharmacology, Ningbo Institute of Medical Sciences, Ningbo, Zhejiang 315020, P.R. China
| |
Collapse
|
9
|
Wang Y, Guo S. Primary renal diffuse large B-cell lymphoma with central nervous system involvement: a rare case report and literature review. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:7045-7049. [PMID: 26261597 PMCID: PMC4525931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/21/2015] [Indexed: 06/04/2023]
Abstract
Primary renal lymphoma is a rare entity. Of these, diffuse large B-cell lymphoma is the most common pathological type and, R-CHOP regimen was the preferred chemotherapy for it. Here we present an adult case of primary renal diffuse large B-cell lymphoma.
Collapse
MESH Headings
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biopsy
- Central Nervous System Neoplasms/chemistry
- Central Nervous System Neoplasms/drug therapy
- Central Nervous System Neoplasms/pathology
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Humans
- Immunohistochemistry
- Kidney Neoplasms/chemistry
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/pathology
- Lymphoma, Large B-Cell, Diffuse/chemistry
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Multimodal Imaging/methods
- Positron-Emission Tomography
- Prednisone/therapeutic use
- Rituximab
- Tomography, X-Ray Computed
- Treatment Outcome
- Vincristine/therapeutic use
Collapse
|
10
|
Tumor Thrombus as a Rare Presentation of Lymphoma: A Case Series of 14 Patients. AJR Am J Roentgenol 2015; 204:W398-404. [DOI: 10.2214/ajr.14.12782] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|