Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2010  |  Volume : 21  |  Issue : 3  |  Page : 544--545

Primary renal lymphoma: A differential diagnosis of renal mass in a young male


Ankur Gupta1, Anil Bhatt1, Ambar Khaira1, Ashwini Gupta2, Devender S Ran2,  
1 Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India

Correspondence Address:
Ankur Gupta
Department of Nephrology, All India Institute of Medical Sciences, New Delhi
India




How to cite this article:
Gupta A, Bhatt A, Khaira A, Gupta A, Ran DS. Primary renal lymphoma: A differential diagnosis of renal mass in a young male.Saudi J Kidney Dis Transpl 2010;21:544-545


How to cite this URL:
Gupta A, Bhatt A, Khaira A, Gupta A, Ran DS. Primary renal lymphoma: A differential diagnosis of renal mass in a young male. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2020 Jul 15 ];21:544-545
Available from: http://www.sjkdt.org/text.asp?2010/21/3/544/62721


Full Text

To the Editor,

Primary renal lymphoma (PRL) is replete in world literature and its existence has been ques­tioned as the kidney does not normally contain lymphoid tissue. [1] Here we present case of 32 year-old male who came to our tertiary centre for evaluation of symptoms of heaviness in epi­gastric region, dull ache in left flank and loss of appetite and weight for three months. There was no fever or macroscopic hematuria. There was no hepatosplenomegaly, lymphadenopathy, as­cites or pleural effusion. Blood chemistry showed hemoglobin 8 g/dL, ESR 79 mm/1 st hr, blood urea 22 mg/dL, serum creatinine 1.0 mg/dL, se­rum bilirubin 0.6 mg/dL, AST/ALT 13/17. Urine routine/microscopy revealed no proteins, RBC 0-1and WBC 1-3/hpf. Chest X-ray was normal. A contrast computerized tomogram of abdomen revealed a 19 cm Χ 15.5 cm Χ 8.2 cm soft tissue mass involving upper and middle pole of left kidney. Retroperitoneal or mesenteric lymph nodes were not enlarged. There was no metas­tasis on bone scan. He underwent left radical nephrectomy for the presumed diagnosis of renal cell carcinoma. Microscopic examination of specimen revealed sheets of lymphoid cells with few scattered glomeruli within the tumor [Figure 1]. On immunochemistry, the tumor cell stained positive for leukocyte common antigen and negative for cytokeratin. Most of the cells were positive for CD 20 making it compatible with non Hodgkin's lymphoma of B cell type. Bone marrow was free of malignant lymphoid cells. He received combination chemotherapy with cyclophosphamide, doxorubicin hydro­chloride, vincristine and prednisolone (CHOP) regime but died after two months because of septicemia and disseminated intravascular coa­gulation.

PRL is a distinct pathological and clinical en­tity which is extremely rare. It usually affects adults with an average age of 60 years and has slight male predominance. [2] In our case it oc­curred at a relatively younger age, where the suspicion of PRL was not even kept. Etiology of PRL is still unknown and many classes of non-Hodgkin lymphoma including large, small, intermediate and mixed cell types with high, intermediate or low grade histologies has been described. [1] The neoplastic lymphoid cells may express both B and T immunoblastic phenol­types. Up to now, there is no standard treatment modality for this entity because of the small number of cases reported. Survival is extremely poor since 75% of patients die less than one year after operation. Prognosis may be improved by early detection of disease and by performing systemic chemotherapy.

We conclude that although PRL is a rare entity but it should be kept in differential diagnosis of isolated renal mass, even in young to ensure early and proper chemotherapy after histologi­cal examination.

References

1Torrecilla Garcia-Ripoll JR, Pascual Samaniego M, Martin Blanco S, Rivera Ferro J, Peral Martinez JI, Fernandez del Busto E. Primary renal lymphoma. Actas Urol Esp 2003;27:555­-8.
2Gellrich J, Hakenberg OW, Naumann R, Manseck A, Lossnitzer A, Wirth MP. Primary renal non­Hodgkin's lymphoma: a difficult differential diagnosis. Onkologie 2002;25:273-7.