Hospital: HUVV.
Ciudad:
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Aut@r o Autores: A. Merchán Páez, R. Ruiz Salas, G. Müller Bravo, I. Salas Coronado, A. Castaño Ramírez.,
Presentación:
A 53-year-old man with a history of repeating renal colic (RC), presenting in Emergency Room (ER) with left lumbar pain with irradiation to the abdominal area, along with a loss of appetite and weight, nausea without vomiting and polaquiuria. The physical examination highlights the abdominal pain and the palpation of a hard consistency mass in the lower left flank, not dependent on spleen, and adhered to deep planes. The suspicion is complicated RC, so an emergency ultrasound is performed and the study is completed with CT enhanced with iodinated contrast material. These tests are conclusive for the diagnosis of Primary Renal Lymphoma (PRL) as a first possibility or Renal Cell Carcinoma (RCC) as an alternative, with significant adenopathic involvement, without evidence of pulmonary and bone metastatic involvement. The patient underwent a left renal mass biopsy that offered a diagnosis of Non-Hodgkin type B lymphoma (specifically diffuse large B cell lymphoma, of a centrogerminal origin).
Discusión:
Primary renal lymphomas (PRL) are defined as lymphomas arising in the renal parenchyma and not invasion from an adjacent lymphomatous mass. PRL usually affects adults and the clinical presentations include flank pain, hematuria, renal failure, abdominal mass, fever and weight loss. Clinically and radiologically it may mimic renal cell carcinoma. The most commonly encountered pattern on imaging is that of multiple soft tissue masses, with minimal enhancement after contrast, compared to surrounding renal parenchyma. Most of the patients also have adjacent retroperitoneal adenopathy that can cause some obstruction in the renal sinus and collecting system. Preoperative biopsy is worthwhile in patients with atypical radiological features, since it may avoid nephrectomy. The most common histological subtype encountered is diffuse large B cell lymphoma (DLBCL) and the prognosis is very poor with median survival less than a year. Its treatment has been revolutionized with addition of Rituximab to the standard chemotherapy (CHOP), hence, this may overcome the poor outlook of this rare presentation of lymphoma.
Conclusión:
Primary renal lymphomas (PRL) are defined as lymphomas arising in the renal parenchyma and not invasion from an adjacent lymphomatous mass. PRL usually affects adults and the clinical presentations include flank pain, hematuria, renal failure, abdominal mass, fever and weight loss. Clinically and radiologically it may mimic renal cell carcinoma. The most commonly encountered pattern on imaging is that of multiple soft tissue masses, with minimal enhancement after contrast, compared to surrounding renal parenchyma. Most of the patients also have adjacent retroperitoneal adenopathy that can cause some obstruction in the renal sinus and collecting system. Preoperative biopsy is worthwhile in patients with atypical radiological features, since it may avoid nephrectomy. The most common histological subtype encountered is diffuse large B cell lymphoma (DLBCL) and the prognosis is very poor with median survival less than a year. Its treatment has been revolutionized with addition of Rituximab to the standard chemotherapy (CHOP), hence, this may overcome the poor outlook of this rare presentation of lymphoma.
Bibliografía:
– Sanju C., Rajendranath R., Sundersingh S., Gnana T. S. Primary renal lymphoma mimicking renal cell carcinoma. Indian J Urol. 2010 Jul-Sep, 26(3): 441–443. – Sheth S., Ali S., Fishman E. Imaging of Renal Lymphoma: Patterns of Disease with Pathologic Cor