Indian Journal of Cancer Medknow Publications on behalf of Indian Cancer Society ISSN: 0019-509X EISSN: 1998-4774 Vol. 48, Num. 2, 2011, pp. 255-256

Indian Journal of Cancer, Vol. 48, No. 2, April-June, 2011, pp. 255-256

Letter to Editor

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

Rhizlane Belbaraka, Meriem Benameur Elyoubi, Saber Boutayeb, Hassan Errihani

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

Correspondence Address: Rhizlane Belbaraka Department of Medical Oncology, National Institute of Oncology, Rabat Morocco r_belbaraka@yahoo.fr

Code Number: cn11061

DOI: 10.4103/0019-509X.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).

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.

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

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