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LETTER TO EDITOR
Year : 2011  |  Volume : 48  |  Issue : 2  |  Page : 255-256
 

Primary renal non-Hodgkin lymphoma: An unusual diagnosis for a renal mass


Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco

Date of Web Publication11-Jul-2011

Correspondence Address:
Rhizlane Belbaraka
Department of Medical Oncology, National Institute of Oncology, Rabat
Morocco
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.82880

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How to cite this article:
Belbaraka R, Elyoubi MB, Boutayeb S, Errihani H. Primary renal non-Hodgkin lymphoma: An unusual diagnosis for a renal mass. Indian J Cancer 2011;48:255-6

How to cite this URL:
Belbaraka R, Elyoubi MB, Boutayeb S, Errihani H. Primary renal non-Hodgkin lymphoma: An unusual diagnosis for a renal mass. Indian J Cancer [serial online] 2011 [cited 2019 Dec 14];48:255-6. Available from: http://www.indianjcancer.com/text.asp?2011/48/2/255/82880


Sir,

Although secondary renal involvement from systemic lymphoma is very frequent, primary renal lymphoma (PRL) is a rare entity. [1] Recognition of PRL is essential, so that patients could receive appropriate therapy.

A 72-year-old man was admitted in our institution with a 4-month history of left flank pain, weakness, and weight loss. He had no relevant past medical history. At first presentation, the performance status was equal to 2.0. Physical examination showed a painful resistance on the left flank. Initial laboratory testing showed high erythrocyte sedimentation rate (50 mm/h) and high serum creatinine (25 mg/l). An abdominal computed tomography (CT) scan revealed large left renal mass of 8 cm in the lower pole with infiltration of psoas muscle [Figure 1]. A CT-guided renal biopsy was performed. Histological and immunohistochemical studies [Figure 2] showed diffuse large B-cell lymphoma (DLBCL) according to the Revised European-American Classification of Lymphoid Neoplasms/World Health Organization classification of lymphoid neoplasms (REAL/WHO).
Figure 1: Abdominal CT-scan image showing hypodense renal mass involving the left kidney

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Figure 2: Primary renal lymphoma: histopathology

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Most of the neoplastic cells were positive for cluster of differentiation-20 (CD-20). No evidence of distant metastasis was shown by the CT scan. A bone marrow biopsy was normal. The patient was staged IEBb according to the Ann Arbor classification. He was managed with eight cycles of R-CHOP regimen: Rituximab 375 mg/m 2 on day 1, Cyclophosphamide 750 mg/m 2 on day 1, Doxorubicin 50 mg/m 2 on day 1, Vincristine 1.4 mg/m 2 on day 1, and Prednisone 50 mg/m 2 on day 1−5. After three cycles, renal function was returned to normal, and abdominal CT scan showed partial radiological response of the renal mass. The second abdominal CT scan performed after the end of the eight cycles of treatment showed complete [Figure 3] radiological response. The patient remained disease-free, until now, 15 months after the end of the chemotherapy.
Figure 3: Abdominal CT-scan image showing regression of left renal mass after eight cycles. R-CHOP regimens

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Involvement of the kidney by lymphoma is a quite common late manifestation of advanced nodal disease. [2] However, PRL is extremely rare and constitutes 0.7% of extra nodal lymphomas and 0.1% of all malignant lymphomas. [3] It is estimated that less than 70 cases have been described in the worldwide literature.

The term PRL is attributed, when the disease is localized to the kidney without any sign of other organ involvement or in which renal involvement is the presenting manifestation. [4] General agreement exists about the criteria needed to define the diagnosis of PRL as follows: (i) acute renal failure at the presentation in the absence of other causes of renal impairment; (ii) rapid improvement of renal function after treatment; (iii) increase of the kidneys' size without any urinary tract obstruction; and (iv) absence of other nodal or extra-nodal involvement. Our case achieved all the diagnostic criteria for identification of a PRL.

Because standard management of a renal mass is nephrectomy, differentiating renal lymphoma from carcinoma remains a diagnostic challenge. Renal lymphoma, is important to include in the differential diagnosis of renal masses, because generally, it is a systemic disease and treatment is nonsurgical.

Little is known of its optimal management. [5] To our knowledge, the present case is the third case [6],[7] of early primary lymphoma of the kidney, which was managed successfully with RCHOP chemotherapy.

 
 » References Top

1.Ahmad AH, Maclennan GT, Listinsky C. Primary renal lymphoma: A rare neoplasm that may present as a primary renal mass. J Urol 2005;173:239.  Back to cited text no. 1
    
2.Levendoglu-Tugal O, Kroop S, Rozenblit GN, Weiss R. Primary renal lymphoma and hypercalcemia in a child. Leuk Lymphoma 2002;43:1141-6.  Back to cited text no. 2
    
3.Tefekli A, Baykal M, Binbay M, Barut M, Muslumanoglu AY. Lymphoma of the kidney: Primary or initial manifestation of rapidly progressive systemic disease? Int Urol Nephrol 2006;38:775-8.  Back to cited text no. 3
    
4.Okuno SH, Hoyer JD, Ristow K, Witzig TE. Primary renal non-Hodgkin's lymphoma: An unusual extra nodal site. Cancer 1995;75:2258-61.  Back to cited text no. 4
    
5.O'Riordan E, Reeve R, Houghton JB, O'Donoghue DJ, Waldek S. Primary bilateral T-cell renal lymphoma presenting with sudden loss of renal function. Nephrol Dial Transplant 2001;16:1487-9.  Back to cited text no. 5
    
6.Vázquez Alonso F, Sánchez Ramos C, Vicente Prados FJ, Pascual Geler M, Ruiz Carazo E, Becerra Massare P, et al. Primary renal lymphoma: Report of new three cases and literature review. Arch Esp Urol 2009;62:461-5.  Back to cited text no. 6
    
7.Diskin CJ, Stokes TJ, Dansby LM, Radcliff L, Carter TB, Graves E, et al. Acute renal failure due to a primary renal B-cell lymphoma. Am J Kidney Dis 2007;50:885-9.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]

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