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1
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Witkowska M, Romejko-Jarosińska J, Giza A, Drozd-Sokołowska J, Mikulski D, Hałka J, Morawska-Krekora A, Paszkiewicz-Kozik E, Wdowiak K, Wołowiec D, on behalf of the Polish Lymphoma Research Group. Primary Renal Lymphoma: Report of 32 Cases-A Retrospective Multicenter PLRG Analysis. Biomedicines 2025; 13:548. [PMID: 40149524 PMCID: PMC11940052 DOI: 10.3390/biomedicines13030548] [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: 01/27/2025] [Revised: 02/10/2025] [Accepted: 02/19/2025] [Indexed: 03/29/2025] Open
Abstract
Introduction: Primary renal lymphoma is extremely rare, accounting for less than 1% of all lymphomas. Objectives: The aim of this study was to describe a group of patients with primary renal lymphoma diagnosed in hematology and oncology centers aligned with the Polish Lymphoma Research Group (PLRG). Patients and methods: This was a retrospective analysis of adult patients with primary renal lymphoma diagnosed at PLRG centers. Results: Thirty-two patients were diagnosed in seven centers over 24 years (2000-2023). The most common type of lymphoma was diffuse large B-cell lymphoma (DLBCL). The median progression-free survival (PFS) after first-line treatment was 2.1 (95% CI: 1.07-4.18) years, while the median overall survival (OS) was 6.3 (95% CI: 1.82-6.34) years. The median age at diagnosis was 63.3 years old, and 59.4% of the patients were females. In multivariate Cox regression for PFS, only creatinine > 1.5 mg/dL (HR 10.2, 95% CI: 2.08-50.09, p = 0.004) and hemoglobin (Hgb) < 10 g/dL (HR 8.39, 95% CI: 1.88-37.49) were associated with inferior PFS. Patients who achieved complete remission (CR) after first-line of treatment had significantly longer PFS (median 4.18, 95% CI: 2.02-4.18 vs. median 0.73, 95% CI: 0.50-0.79, p = 0.004) and OS (median not reached vs. median 1.49, 95% CI: 0.43-6.33, p = 0.001). Patients treated with nephrectomy had longer OS (median not reached vs. median 5.07, 95% CI: 1.32-5.08, p = 0.05). However, in multivariate Cox regression for OS, only hypoalbuminemia was an independent factor for inferior survival (HR 5.44, 95% CI: 1.12-26.38, p = 0.04). Conclusions: Primary renal lymphoma is an extremely rare type of lymphoma with a poor prognosis. The prognosis may improve with future advances in treatment, including nephrectomy.
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Affiliation(s)
| | - Joanna Romejko-Jarosińska
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Agnieszka Giza
- Department of Haematology, Jagiellonian University, 31-007 Krakow, Poland
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Transplantology and Internal Diseases, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Damian Mikulski
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 93-510 Lodz, Poland
- Department of Hematooncology, Copernicus Memorial Hospital, 93-513 Lodz, Poland
| | - Janusz Hałka
- Department of Hematology, Internal Medicine and BMT, Clinical Hospital of the Ministry of Internal Affairs and Administration with the Warmia-Mazury Oncology Center, 10-228 Olsztyn, Poland
- Department of Oncology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Anna Morawska-Krekora
- Department of Hematology and Internal Diseases, Ludwik Rydygier’s Hospital, 31-820 Krakow, Poland
| | - Ewa Paszkiewicz-Kozik
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Kamil Wdowiak
- Department of Internal Diseases and Oncological Chemotherapy, Faculty of Medical Sciences, Medical University of Silesia, 40-055 Katowice, Poland
| | - Dariusz Wołowiec
- Department and Clinics of Hematology Cellular Therapies and Internal Medicine, Wrocław Medical University, 50-367 Wrocław, Poland
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2
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Yokota K, Morimoto K, Yazawa H, Tsuzuki Wada T, Sakamoto T, Terui Y, Kaneko S, Inoue T, Okada H, Akiyama Y, Mimura T. Successful Treatment of Diffuse Large B-cell Lymphoma Involving Multiple Renal and Bone Infiltrations Presenting with Giant Cell Arteritis-like Manifestations. Intern Med 2024; 63:1645-1652. [PMID: 37952957 PMCID: PMC11189708 DOI: 10.2169/internalmedicine.2377-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/14/2023] [Indexed: 11/14/2023] Open
Abstract
We herein report a case of diffuse large B-cell lymphoma (DLBCL) involving multiple renal and bone infiltrations presenting with giant cell arteritis (GCA)-like manifestations. One month prior, the present patient had left-sided temporal headache, jaw claudication, and renal failure. The patient was diagnosed with DLBCL based on a renal biopsy. After rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone plus intrathecal methotrexate/cytarabine/prednisone and rituximab, high-dose methotrexate, and cytarabine chemotherapy, the patient's clinical manifestations improved, and complete remission was achieved. DLBCL rarely but occasionally presents with GCA-like manifestations or multiple renal and bone infiltrations, highlighting the need for prompt and aggressive combination chemotherapy.
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MESH Headings
- Humans
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/therapeutic use
- Doxorubicin/administration & dosage
- Doxorubicin/therapeutic use
- Giant Cell Arteritis/drug therapy
- Giant Cell Arteritis/complications
- Giant Cell Arteritis/diagnosis
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/complications
- Kidney Neoplasms/pathology
- Kidney Neoplasms/diagnostic imaging
- Kidney Neoplasms/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Prednisone/administration & dosage
- Prednisone/therapeutic use
- Rituximab/administration & dosage
- Rituximab/therapeutic use
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/therapeutic use
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Affiliation(s)
- Kazuhiro Yokota
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | - Kota Morimoto
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | - Hiroaki Yazawa
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | - Takuma Tsuzuki Wada
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | - Tomoyuki Sakamoto
- Department of Hematology, Faculty of Medicine, Saitama Medical University, Japan
| | - Yasuhito Terui
- Department of Hematology, Faculty of Medicine, Saitama Medical University, Japan
| | - Satoru Kaneko
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, Japan
| | - Tsutomu Inoue
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, Japan
| | - Hirokazu Okada
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, Japan
| | - Yuji Akiyama
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
| | - Toshihide Mimura
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan
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3
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Klaus M, Sitter T, Hoppe JM. Acute kidney failure reveals primary renal non-Hodgkin lymphoma. BMJ Case Rep 2024; 17:e259137. [PMID: 38569735 PMCID: PMC10989095 DOI: 10.1136/bcr-2023-259137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
A male patient in his 60s was admitted to our hospital with symptoms of dyspnoea, asthenia, diaphoresis and acute kidney failure. No tumour or infection was detected in initial screening. However, laboratory examination suggested that the acute kidney failure was due to an intrarenal cause, exhibiting a tubular injury pattern and indications of tumour lysis syndrome. Initial hydration therapy, paired with intravenous rasburicase, rapidly improved the kidney function. Unfortunately, the kidney function deteriorated once again, prompting a kidney biopsy that revealed an aggressive diffuse large B-cell non-Hodgkin lymphoma of the kidney. The chemotherapy, comprised of R-CHOP scheme, led to a full recovery of the kidney function and complete remission of the lymphoma. Primary renal non-Hodgkin lymphoma without nodal manifestation is rare, and its pathophysiology is poorly understood. Therapy schemes can vary significantly between cases, relying primarily on non-renal-specific haemato-oncological guidelines. Therefore, further studies are needed to develop the best therapeutic approaches.
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Affiliation(s)
- Martin Klaus
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Thomas Sitter
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - John Michael Hoppe
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
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4
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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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5
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Jian Y, Ding G, Yang D, Du J. B‑cell lymphoblastic lymphoma‑associated renal damage: A case report and literature review. Exp Ther Med 2023; 25:85. [PMID: 36684654 PMCID: PMC9849848 DOI: 10.3892/etm.2023.11784] [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] [Received: 08/31/2022] [Accepted: 11/11/2022] [Indexed: 01/04/2023] Open
Abstract
Lymphoblastic lymphoma (LBL) is a highly malignant form of lymphoma with rapid progression and high mortality. According to the World Health Organization immunophenotype, it is classified into T-lymphoblastic lymphoma (T-LBL) and B-lymphoblastic lymphoma (B-LBL). B-LBL often involves lymph nodes and extranodal locations, such as the skin, bones, and soft tissues. However, renal damage as an initial symptom is very rare in B-LBL. The present study presented a rare case of renal involvement in a 30-year-old male patient with B-LBL presenting with acute renal failure with bilateral renal enlargement. Renal involvement is rare in B-LBL, and nephrologists should improve the understanding of this disease.
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Affiliation(s)
- Yonghong Jian
- Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Guohua Ding
- Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Dingping Yang
- Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Juan Du
- Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China,Correspondence to: Dr Juan Du, Department of Nephrology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan, Hubei 430060, P.R. China
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6
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Gromicho A, Araújo D, Oliveira V, Ribeiro A, Ferraz L. Mucosa-Associated Lymphoid Tissue Lymphoma Involving the Kidney and Renal Pelvis. Cureus 2021; 13:e15172. [PMID: 34168933 PMCID: PMC8216313 DOI: 10.7759/cureus.15172] [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: 11/30/2022] Open
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphomas are a distinctive group of B-cell lymphomas. These lymphomas arise from various anatomic sites and are mainly seen in the gastrointestinal tract, but the primary involvement of the kidney is extremely rare. We report a case of a MALT lymphoma involving the kidney and the renal pelvis. A 56-year-old man presented with a history of hematuria and left flank pain. A computed tomography scan showed a marked tissue densification in the renal sinus, suggesting marked thickening of the urothelium, conditioning deformity of the renal pelvis and calyces. A cystoscopy confirmed a 2-cm papillary lesion on the left lateral aspect of the bladder. The patient underwent laparoscopic radical nephoureterectomy and transurethral bladder resection. The pathological diagnosis was MALT lymphoma in the kidney and urothelial carcinoma of the bladder. The patient was referred to a hematologist and was free of disease at 20 months of follow up without additional treatment.
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Affiliation(s)
| | - Débora Araújo
- Urology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, PRT
| | - Vítor Oliveira
- Urology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, PRT
| | - Ana Ribeiro
- Pathology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, PRT
| | - Luís Ferraz
- Urology Department, Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, PRT
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7
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Youssef M, Davis F, Rao P. Primary renal lymphoma: unique presentation in a rare disease. J Surg Case Rep 2021; 2021:rjab011. [PMID: 33732420 PMCID: PMC7947959 DOI: 10.1093/jscr/rjab011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/11/2021] [Indexed: 11/14/2022] Open
Abstract
As the kidney is an extra-nodal organ and does not have lymphatic tissues, the existence of primary renal non-Hodgkin's lymphoma has been continuously questioned. It is very rare. However, differentiation between renal cell carcinoma and renal lymphoma is necessary in patients presenting with solitary renal mass. We present a 70-year-old-man who presented with a renal mass and was diagnosed with diffuse large B-cell lymphoma. We feel that this case report may be of benefit to clinicians who may encounter a similar scenario.
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Affiliation(s)
- Mohamed Youssef
- Department of Urology, Blackpool Victoria Hospital, Blackpool, UK
| | - Faustina Davis
- Department of Urology, Blackpool Victoria Hospital, Blackpool, UK
| | - Praveen Rao
- Department of Urology, Blackpool Victoria Hospital, Blackpool, UK
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8
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Diffuse large B cell lymphoma presenting with renal failure and bone lesions in a 46-year-old woman: a case report and review of literature. CEN Case Rep 2020; 10:165-171. [PMID: 32989684 DOI: 10.1007/s13730-020-00537-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022] Open
Abstract
Renal involvement in large B-cell lymphoma represents an exceptional manifestation of non-Hodgkin lymphomas. Renal failure and bone metastasis by lymphomatous infiltration is extremely rare. We describe a 46-year-old woman presenting with a renal failure and a 5-month history of intermittent left knee pain that was previously misdiagnosed with osteoarthritis. It was due to a bilateral primary renal lymphoma (PRL) associated with bone metastasis. Knee MRI showed a permeative lesion and an abnormal signal in the metaphysis and diaphysis of the left proximal tibia with periosteal reaction and surrounding soft tissue swelling. The CT body scan showed a bilateral nephromegaly and multiple lytic bone lesion of aggressive appearance at the right iliac wing and right sacral ala evoking lymphomatous involvement. Node biopsy with immunohistochemistry study confirmed a diagnosis of large B-cell lymphoblastic lymphoma. In this article, we focus on clinical, radiological, immunohistochemical presentation, differential diagnosis and review the literature. Ten cases including our case were reported in our literature review of both renal and bone lymphoma. There was a male predominance, with a mean age of 55.1 years old. We noted a high frequency of renal failure in diagnosis. In X-rays, the metaphysis is the most common site of occurrence in long bones and the main sign was osteolytic bone destruction. The subtype of lymphoma was DLBCL stage IV in most cases except in one case where it was a hystiocytic lymphoma. Finally, prognosis was poor, more than half of patients died. PRL with bone metastasis is a rare malignancy that is difficult to diagnose. Clinicians should increase the awareness of the disease and consider a differential diagnosis of bone lesions. Early diagnosis and active treatment can improve patient prognosis.
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9
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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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10
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Chen J, Peng J, Zheng Y, Li S, Yang P, Wu X, Tian H, Liu H, Yang S, Wang W, Wu B. Primary renal lymphoma: a population-based study in the United States, 1980-2013. Sci Rep 2019; 9:15125. [PMID: 31641184 PMCID: PMC6805900 DOI: 10.1038/s41598-019-51635-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/03/2019] [Indexed: 01/15/2023] Open
Abstract
Primary renal lymphoma (PRL) is a rare lymphoid malignancy with only a few cases reported in the literature. We performed a population-based study of PRL to determine its incidence, clinical characteristics and factors associated with survival using the Surveillance, Epidemiology, and End Results (SEER) database. We identified 723 patients with PRL. The most common histological subtype of PRL was diffuse large B-cell lymphoma (56.3%). The incidence and mortality rate of PRL was 0.053/100,000 person-years and 0.036/100,000 person-years, respectively. The incidence rate of PRL was increasing significantly with an annual percentage change (APC) of 3.45% (p < 0.001). The 1-year and 5-year relative survival (RS) rates of patients with PRL were 78% and 64%. The RS of patients diagnosed between 2000 to 2013 was better than that of patients diagnosed between 1980–1999. A multivariate Cox hazards regression analysis revealed that older age, male gender, diagnosis before 2000, advanced stage, not receiving surgical treatment, and DLBCL or T/NK cell lymphoma type were independent predictors of unfavorable survival.
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Affiliation(s)
- Jiayuan Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jiangtong Peng
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yongqiang Zheng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Sen Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Pengcheng Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiangyi Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - He Tian
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hui Liu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shengli Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wenjing Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bian Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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11
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Primary renal lymphoma: An incidental finding in an elderly male. Urol Case Rep 2019; 26:100965. [PMID: 31388492 PMCID: PMC6677884 DOI: 10.1016/j.eucr.2019.100965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/10/2019] [Indexed: 01/31/2023] Open
Abstract
Primary renal lymphoma (PRL) is a rare disease process which represents less than 1% of all renal masses and is an uncommon type of Non-Hodgkin's Lymphoma. PRL is of clinical significance due to the fact that unlike the more commonly seen renal cell carcinoma, PRL is treated with neoadjuvant chemotherapy followed by nephrectomy. This challenges the long held notion that preoperative biopsies are not necessary prior to nephrectomy for renal masses. In this paper, we present a case of a primary renal lymphoma and discuss its clinical significance.
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12
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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: 0.8] [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.
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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
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13
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Lontos K, Tsagianni A, Msaouel P, Appleman LJ, Nasioudis D. Primary Urinary Tract Lymphoma: Rare but Aggressive. Anticancer Res 2017; 37:6989-6995. [PMID: 29187485 PMCID: PMC5726395 DOI: 10.21873/anticanres.12167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/07/2017] [Accepted: 10/13/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Primary urinary tract lymphoma (PUTL) is an uncommon disease with only a few case reports in the literature. MATERIALS AND METHODS Information about 1,264 patients diagnosed between 1983 and 2013 with PUTL was extracted from the Surveillance, Epidemiology and End Results database. Kaplan-Meier curves and multivariable regression analysis were used to analyze the survival and identify prognostic factors. A comparison of nodal diffuse large B-cell lymphoma (DLBCL) with PUTL DLBCL was performed. In addition, we compared the characteristics of kidney and bladder lymphoma. RESULTS PUTL incidence was 1 case/1,000,000 people per year. DLBCL was found to be the predominant histology. Five-year overall survival and cancer-specific survival were 49% and 58%, respectively. DLBCL histology, male gender, stage III-IV disease, and advanced age were found to be poor prognostic factors. Surgery may be beneficial. Urinary tract DLBCL has a worse prognosis than nodal DLBCL. CONCLUSION To our knowledge, this is the largest population-based study of PUTL in the literature. The survival of patients has not improved in the era of modern therapies therefore new treatments are needed.
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Affiliation(s)
- Konstantinos Lontos
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, U.S.A.
| | - Anastasia Tsagianni
- Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, U.S.A
| | - Pavlos Msaouel
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - Leonard Joseph Appleman
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, U.S.A
| | - Dimitrios Nasioudis
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, U.S.A
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14
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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: 37] [Impact Index Per Article: 4.1] [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).
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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
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15
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Erdoğmuş Ş, Aktürk S, Kendi Çelebi Z, Kiremitçi S, Kaygusuz G, Altınbaş NK, Üstüner E, Keven K. Diffuse Large B-Cell Lymphoma Presenting with Bilateral Renal Masses and Hematuria: A Case Report. Turk J Haematol 2016; 33:159-62. [PMID: 27095511 PMCID: PMC5100730 DOI: 10.4274/tjh.2015.0238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Renal involvement is most often seen in conjunction with multisystemic, disseminated lymphoma either by direct extension from a retroperitoneal mass or via hematogenous spread. Primary lymphoma of the kidney is not a common entity and it is a controversial issue on account of the absence of lymphatic tissues in the normal kidney. In this case report, we describe a 19-year-old male with hematuria, acute kidney injury, and bilateral renal masses due to massive lymphomatous infiltration of the kidneys, which was diagnosed as diffuse large B-cell non-Hodgkin lymphoma by Tru-Cut biopsy.
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Affiliation(s)
- Şiyar Erdoğmuş
- Ankara University Faculty of Medicine, Department of Nephrology, Ankara, Turkey, Phone : +90 312 508 21 68, E-mail :
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16
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Huang H, Tamboli P, Karam JA, Vikram R, Zhang M. Secondary malignancies diagnosed using kidney needle core biopsies: a clinical and pathological study of 75 cases. Hum Pathol 2016; 52:55-60. [PMID: 26980018 DOI: 10.1016/j.humpath.2015.12.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 12/19/2022]
Abstract
Involvement of the kidney by secondary malignancies is uncommon. Differentiating secondary malignancies from primary kidney/urothelial tumors can be challenging, especially on limited biopsy material. A retrospective search of our institutional archive from January 2002 to May 2015 identified 1572 cases of imaging-guided needle core biopsies of the kidney. Of these, 75 (5%) cases revealed a secondary malignancy; 48 (64%) patients had undergone the biopsy with a primary kidney tumor favored clinically. There were 39 male and 36 female patients with a mean age of 59.4 years (range, 21-83 years). The majority of the cases (n = 55, 73%) were metastases from solid tumors, with lung being the most common primary site (n = 22, 29%). Diffuse large B-cell lymphoma was the most common hematological malignancy (n = 6) secondarily involving the kidney. Radiographically, 58 (77%) cases presented as a solitary kidney mass. The primary malignancy was known prior to the kidney biopsy in 66 (88%) cases. The mean interval between diagnoses of the primary tumor and secondary involvement of the kidney was 4.5 years. Immunohistochemical stains were performed in 65 (87%) cases. Follow-up information was available for 73 patients; mean survival was 19.4 months, with 43 patients dead of their disease (mean, 12 months) and 30 patients alive at last follow-up (21 with and 9 without disease; mean, 30 months). Secondary malignancy in the kidney may clinically and pathologically mimic primary kidney tumors. Accurate diagnosis can be rendered by correlating pathological features with clinical and radiographic findings and judicious use of ancillary studies.
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Affiliation(s)
- He Huang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Pheroze Tamboli
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Jose A Karam
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Raghu Vikram
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Miao Zhang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
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17
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Mitome T, Furuya K, Imano M, Osaka K, Yokomizo Y, Hayashi N, Nakaigawa N, Yamanaka S, Yao M. Bilateral renal lymphoma: rapid recovery from an acute kidney injury after open renal biopsy. Clin Case Rep 2016; 4:5-8. [PMID: 26783426 PMCID: PMC4706393 DOI: 10.1002/ccr3.401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/13/2015] [Accepted: 08/27/2015] [Indexed: 12/31/2022] Open
Abstract
Renal lymphoma as an initial lesion is relatively rare. Bilateral renal lymphoma frequently presents as acute kidney injury. With systematic chemotherapy for the lymphoma, patients usually recover their kidney function. However, in the case we describe here, the patient's kidney function recovered greatly after an open renal biopsy. Here, we review and discuss this unique case.
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Affiliation(s)
- Taku Mitome
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Kazuhiro Furuya
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Masashi Imano
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Kimito Osaka
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Yumiko Yokomizo
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Narihiko Hayashi
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Noboru Nakaigawa
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
| | - Shoji Yamanaka
- Department of Pathology Yokohama City University Hospital Yokohama Kanagawa Japan
| | - Masahiro Yao
- Department of Urology Yokohama City University Graduate School of Medicine Yokohama Kanagawa Japan
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18
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Asgari SA, Aval HB, Asgari SA, Kheradmand K. A unique case of kidney's collecting system MALT lymphoma. Can Urol Assoc J 2014; 8:E172-5. [PMID: 24678358 DOI: 10.5489/cuaj.1452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Low-grade B cell lymphomas of mucosa-associated lymphoid tissue (MALT lymphomas) are mostly seen in the gastrointestinal tract. MALT lymphomas involving kidney are extremely rare. We report on a case of MALT lymphomas of the kidney. A 74-year-old woman presented with an episode of gross hematuria and right flank pain. In renal sonography, we found a hypoecho lesion measuring 61 × 58 × 44 mm in the lower pole of right kidney. A computed tomography scan revealed an enlarged hypodense soft tissue measuring 62 × 42 × 37 mm within the pelvic brim of the right kidney, with extension to the proximal portion of the ipsilateral ureter and engulfed it. The patient underwent a right radical nephrectomy. The pathology specimen indicated a lymphoprolifrative disorder involving the kidney and ureter. To obtain a definitive diagnosis, we used an immunohistochemistry, which confirmed the diagnosis of a MALT lymphoma.
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Affiliation(s)
- Seyed Alaeddin Asgari
- Urology Research Center, School of Medical, Guilan University of Medical Sciences, Razi Hospital, Rasht, Iran
| | - Hamidreza Baghani Aval
- Urology Research Center, School of Medical, Guilan University of Medical Sciences, Razi Hospital, Rasht, Iran
| | - Seyed Ali Asgari
- Urology Research Center, School of Medical, Guilan University of Medical Sciences, Razi Hospital, Rasht, Iran
| | - Keyvan Kheradmand
- Urology Research Center, School of Medical, Guilan University of Medical Sciences, Razi Hospital, Rasht, Iran
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19
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Khalil MAM, Latif H, Rehman A, Kashif WU, Awan S, Khalil Z, Mushtaq U, Ahmad M, Khalil MAU, Ranga Sami M, Tan J. Acute kidney injury in lymphoma: a single centre experience. Int J Nephrol 2014; 2014:272961. [PMID: 24639896 PMCID: PMC3930139 DOI: 10.1155/2014/272961] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/20/2013] [Accepted: 12/25/2013] [Indexed: 12/13/2022] Open
Abstract
Background. Acute kidney injury (AKI) is a common but least studied complication of lymphoma. Objective. To determine the frequency and predictors of AKI in lymphoma and to study the impact of AKI on hospital stay and mortality. Methods. Retrospective review of medical records of hospitalized lymphoma patients aged ≥14 years between January 2008 and December 2011 was done. Results. Out of 365 patients, AKI was present in 31.8% (116/365). Multivariate logistic regression analysis showed that independent predictors for AKI included sepsis (odds ratio (OR) 3.76; 95% CI 1.83-7.72), aminoglycosides (OR 4.75; 95% CI 1.15-19.52), diuretics (OR 2.96; 95% CI 1.31-6.69), tumor lysis syndrome (OR 3.85; 95% CI 1.54-9.59), and R-CVP regimen (OR 4.70; 95% CI 1.20-18.36). AKI stages 2 and 3 was associated with increased hospital stay (OR 2.01; 95% CI 1.19-3.40). Conclusion. AKI was significantly associated with sepsis, aminoglycoside, diuretics, presence of tumor lysis syndrome, and use of R-CVP regimen. Presence of AKIN (Acute Kidney Injury Network) stages 2 and 3 AKI had increased hospital stay. AKI was also associated with increased mortality.
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Affiliation(s)
| | - Hira Latif
- Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Abdur Rehman
- Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Waqar Uddin Kashif
- Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Safia Awan
- Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Zarghona Khalil
- Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Uziar Mushtaq
- Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Maria Ahmad
- Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | | | - Manickam Ranga Sami
- Department of Nephrology, SSB Hospital, Kuala Belait KA1131, Brunei Darussalam
| | - Jackson Tan
- Department of Nephrology, RIPAS Hospital, Bandar Seri Begawan BA1710, Brunei Darussalam
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20
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On W, Udberg M. Acute kidney injury as first presentation of lymphoma: the role of renal biopsy. BMJ Case Rep 2013; 2013:bcr-2013-202196. [PMID: 24293542 DOI: 10.1136/bcr-2013-202196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A 65-year-old man with an insidious history of being generally unwell with weight loss, a poor appetite and night sweats was transferred to a tertiary nephrology unit after being found to be in acute kidney injury (AKI). A renal biopsy was performed on the same day which revealed lymphomatous infiltration of the renal parenchyma. He required temporary haemodialysis as he was oliguric and was started on chemotherapy. His renal function improved to baseline 3 weeks after treatment. This case illustrates the uncommon presentation of direct lymphomatous infiltration as a cause of AKI and the integral role of renal biopsy in ascertaining the diagnosis.
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Affiliation(s)
- Wei On
- Department of Medicine, Countess of Chester NHS Foundation Trust, Chester, UK
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21
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Ganeshan D, Iyer R, Devine C, Bhosale P, Paulson E. Imaging of primary and secondary renal lymphoma. AJR Am J Roentgenol 2013; 201:W712-W719. [PMID: 24147501 DOI: 10.2214/ajr.13.10669] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Dhakshinamoorthy Ganeshan
- 1 All authors: Department of Diagnostic Radiology, Division of Diagnostic Imaging, Body Imaging Section, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX 77030-4009
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22
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Hart S, Ellimoottil C, Shafer D, Mehta V, Turk TM. A Case of Primary Renal Lymphoma. Urology 2012; 80:763-5. [DOI: 10.1016/j.urology.2012.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 04/28/2012] [Accepted: 05/14/2012] [Indexed: 10/28/2022]
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