Dr. med. Dirk Manski



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Renal Lymphoma

Definition

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:

Ann Arbor classification of lymphomas:

Stage I:

Manifestation of a single lymph node region or a single extranodal organ

Stage II:

Manifestation of several lymph node regions or organs on one side of the diaphragm, either above or below

Stage III:

Manifestation of several lymph node regions or organs on both sides of the diaphragm

Stage IV:

Diffuse or disseminated involvement of visceral organs or lymph node regions

Modifiers:

The following letters are used for further description of the disease, they are apppended after above mentioned roman number:

Signs and Symptoms of Renal Lymphoma

Diagnostic Work-Up

Laboratory tests:

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:

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





References

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.
In: Cancer
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.


  Deutsche Version: Nierenlymphom