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(Peri)renal diffuse large B-cell lymphoma: report of two cases

Perirenal involvement in lymphoma usually occurs due to contiguous spread from retroperitoneal or renal lymphoma. The occurrence of isolated lymphoma in the perirenal space is very unusual (<10% of cases of perirenal lymphoma). Renal involvement in lymphoma is much more common in non-Hodgkin's disease, with the majority of patients having intermediate or high-grade lymphomas of B- cell origin. A 72-year-old male presented with pain in his left upper abdomen, as well as swelling and feeling of fullness. CT scan of the abdomen revealed a left perirenal tumor mass and peritoneal fluid excess. Radical left nephrectomy was performed. Grossly, the kidney with perirenal fat tissue measured up to 12 cm. A poorly circumscribed, whitish tumor, measuring 6 cm in diameter was found, located on one pole of the kidney and in the surrounding fat tissue. In the second case, a 53-year-old patient was hospitalized because of the explorative abdominal surgery. Abdominal CT scan revealed a tumor mass measuring up to 3.5 cm in diameter, located in the left side of the pelvis, with infiltration of the left kidney. Histologically, both tumors were composed of sheets of atypical, medium to large lymphoid cells showing abundant mitotic activity. Tumor cells showed diffusely positive immunohistochemical reaction for CD 20 and focally positive for bcl-2. Proliferative activity measured immunohistochemically with Ki-67 was around 90% to 50%, respectively. Clinical data, histological appearance and immunohistochemical profile suggested the diagnosis of diffuse large B-cell non-Hodgkin's lymphoma in both cases. Patients were treated with combination chemotherapy. Additional CT scan of the thorax in both patients revealed mediastinal lymphadenopathy (first case) and a tumor mass in hilus of the right lung (second case). In conclusion, renal involvement in non-Hodgkin's lymphoma is usually seen as part of disseminated disease. The reported incidence is as high as 47% in autopsy series of lymphomas but clinically recognized in only up to 15% of patients. It is 11 critical for pathologists, urologists and oncologists to be aware of the possibility of lymphoma arising in these sites.

lymphoma

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