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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2000  |  Volume : 11  |  Issue : 2  |  Page : 201-204
Perirenal Mass: An Unusual Presentation of Malignant Lymphoma

Department of Radiology, Salmaniya Medical Complex, Bahrain

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Perirenal masses are an uncommon manifestation of malignant lymphoma. We report a 73-year-old patient who had this very unusual pattern of renal involvement in non-Hodgkin's lymphoma. Diagnosis was made on the basis of characteristic ultrasound and computed tomography findings and confirmed by histology from a specimen obtained by ultrasound guided biopsy.

Keywords: Non Hodgkin′s lymphoma (NHL), Perirenal masses, Ultrasound.

How to cite this article:
Jamsheer NS, Malik N. Perirenal Mass: An Unusual Presentation of Malignant Lymphoma. Saudi J Kidney Dis Transpl 2000;11:201-4

How to cite this URL:
Jamsheer NS, Malik N. Perirenal Mass: An Unusual Presentation of Malignant Lymphoma. Saudi J Kidney Dis Transpl [serial online] 2000 [cited 2020 Sep 30];11:201-4. Available from: http://www.sjkdt.org/text.asp?2000/11/2/201/36679

   Introduction Top

Renal involvement is not rare in malignant lymphoma. [1] However, perirenal involvement in the absence of renal parenchymal infil­tration and contiguous abdominal adeno­pathy is extremely unusual. [2] We describe a case of non-Hodgkin's lymphoma (NHL) with perirenal masses having characteristic ultrasound and computed tomography (CT) findings and histological proof of perirenal involvement by biopsy.

   Case Report Top

A 73-year-old man was admitted to hospital with low-grade fever of 20 days duration, malaise and abdominal fullness. There was no history of cough, dysuria or hematuria. Except for mild hepatomegaly, his physical examination was unremar­kable. Relevant laboratory data included a hemoglobin level of 90 g/L, serum urea 12.8 mmol/L, serum creatinine 116 tmol/L and serum protein 72 g/L. Urine examination was normal. Bence-Jones proteins in the urine were not detected.

Because of the clinical finding of mild hepatomegaly, the attending physician ordered an ultrasound scan of the abdomen. No focal abnormality was seen in the liver parenchyma. Gallbladder, pancreas and spleen were normal. The kidneys were also normal in size, contour and echogenecity but were completely surrounded by a hypoechoic band of tissue [Figure - 1]. There were no focal masses. The CT scan confirmed the solid character of the perirenal abnormality [Figure - 2]. No intra or retroperitoneal lymphadenopathy was noted. Biopsy of the left perirenal mass using local anesthesia was performed under ultrasound guidance. The histopathological report was compatible with non-Hodgkin's lymphoma.

The patient was started on a combination of chemotherapy for lymphoma. A repeat ultrasound performed after six months showed no significant change in the appearance of perirenal mass. His renal functions remained normal. At this time, bone marrow infiltration was detected.

   Discussion Top

Involvement of the kidneys in lymphoma is frequently manifested by multiple focal masses, a solitary mass or diffuse parenchymal infiltration. [3] Isolated perirenal involvement in the absence of renal parenchymal infiltration is extremely unusual. Obstruction of, as well as tumor infiltration, into the lymphatics around the kidney accounts for this pattern of spread. Ultrasonographically, a hypoechoic band, which surrounds the kidney and separated from renal parenchyma by the hyperechoic renal capsule, characterizes the perirenal infiltration. The width of this band may vary from few millimeters to large masses producing palpable kidneys. [4]

Color doppler ultrasound and CT scan are helpful in confirming the solid nature of the perirenal abnormality. Clear separation between the lymphomatous tissue and the renal parenchyma is difficult to appreciate on unenhanced scan. Following intravenous contrast injection however, the mean attenuation value of the lymphomatous mass increases but to a lesser extent than that of the normal renal parenchyma and is seen as a hypodense zone around the kidneys.

Decrease in the tumor thickness or complete resolution of the mass has been reported after chemotherapy.

Perirenal involvement is an important pattern of renal lymphoma. It should be included in the differential diagnosis of any soft tissue mass surrounding the kidney even in the absence of renal parenchymal abnormality or abdominal adenopathy.

Ultrasound is more useful than CT in distinguishing perirenal from renal involve­ment. Furthermore, ultrasound is an easier imaging method for guidance for renal biopsy and for follow-up of tumor response during chemotherapy.

   References Top

1.Hartman DS, David CJ Jr, Goldman SM, Friedman AC, Fritzsche P. Renal lymphoma: radiologic-pathologic correlation of 21 cases. Radiology 1982;144:759-66.  Back to cited text no. 1    
2.Castagnone D, Mandelli C, Rivolta R, Bonelli N, Baldini L. An unusual case of renal involvement in non-Hodgkin lymphoma. Eur J Radiol 1992;15:146-8.  Back to cited text no. 2    
3.Heiken JP, McClennan BL, Gold RP. Renal lymphoma. Seminars in US, CT & MRI 1986;7:58-66.  Back to cited text no. 3    
4.Gorg C, Weide R, Schwerk WB. Unusual perirenal sonographic pattern in malignant lymphoma of the kidney. Clin Radiol 1995;50:720-4.  Back to cited text no. 4    

Correspondence Address:
Najeeb S Jamsheer
Department of Radiology, Salmaniya Medical Complex, P.O. Box 12
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PMID: 18209315

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