Renal lymphoma is a rare manifestation of non-Hodgkin's lymphoma or Hodgkin's lymphoma in the kidney (Okuno et al, 1995) (Sheth et al, 2006).
Etiology and Pathology of Renal Lymphoma
Origin and growth:
Renal lymphoma begins in 90% via hematogenous spread, a primary renal lymphoma is very rare. Most common, multiple smaller masses confluate to a radiologically visible lesion.
Risk factors for renal lymphoma:
- existing lymphoma
- iatrogenic immunosuppression
- autoimmune diseases
- radiotherapy or chemotherapy
Ann Arbor classification of lymphomas:
Manifestation of a single lymph node region or a single extranodal organ
Manifestation of several lymph node regions or organs on one side of the diaphragm, either above or below
Manifestation of several lymph node regions or organs on both sides of the diaphragm
Diffuse or disseminated involvement of visceral organs or lymph node regions
The following letters are used for further description of the disease, they are apppended after above mentioned roman number:
- A – absence of constitutional symptoms
- B – presence of constitutional symptoms
- E – extranodal involvement (such as testes or kidneys)
- S – splenal involvement
- X – large tumor mass with >10 cm maximum diameter in adults
Signs and Symptoms of Renal Lymphoma
Complete blood count (may be normal), elevated erythrocyte sedimentation rate (ESR), liver and kidney tests.
Bone marrow puncture:
Essential staging procedure
Computed tomography (CT) scans of abdomen and thorax:
Lymphoma may present with different morphology: singular mass, multiple masses, diffuse infiltration of the kidney with organ enlargement or direct invasion from hilar lymph nodes. Typical signs of a renal lymphoma beside the renal mass include splenomegaly, retroperitoneal lymphadenopathy or a marked lymphadenopathy in another area.
Fine needle biopsy of the kidney:
Renal biopsy is crucial for the diagnosis or renal lymphoma and the prevention of unnecessary nephrectomy.
Angiography is not indicated any more for the evaluation of renal masses. Lymphoma presents as a hypovascular mass.
Therapy of Renal Lymphoma
The treatment depends on histology (lymphoma subtype) and the disease stage (Ann Arbor classification), see textbooks of internal medicine. Therapy consists of chemotherapy (e.g. COPP, BEACOPP or ABVD), optionally in combination with radiotherapy of the involved areas. The central task for the urologist is to avoid unnecessary radical nephrectomy.
Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
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Okuno u.a. 1995 OKUNO, S. H. ; HOYER, J. D. ;
RISTOW, K. ; WITZIG, T. E.:
- Primary renal non-Hodgkin’s lymphoma. An unusual extranodal site.
75 (1995), Nr. 9, S. 2258–61
- Sheth, S.; Ali, S. & Fishman, E.
- Imaging of renal lymphoma: patterns of disease with pathologic correlation. Radiographics 2006, 26, 1151-1168.