Klinik und Poliklinik für Innere Medizin II, and Institut für Pathologie, Klinikum der Universität Regensburg, Regensburg, Germany
Correspondence and offprint requests to: Dr Bernhard K. Krämer, Klinik und Poliklinik für Innere Medizin II, Klinikum der Universität Regensburg, D-93042 Regensburg, Germany.
A 39-year-old man presented in March 1998 with a high-grade malignant non-Hodgkin lymphoma (T-cell type) manifesting only in the nose (Figure 1) and in submandibular lymph nodes. Between March and June 1998 he received five cycles of CHOP chemotherapy (cyclophosphamide 1535 mg, vincristine 2 mg, adriamycine 100 mg and prednisolone 100 mg daily for 5 days). However in July 1998 the lymphoma was judged to be locally progressive and radiation therapy with up to 36 Gy for the nose and cervical glands and up to 50 Gy for nasal sinuses was given. Despite an initial local remission, in November 1998 a cervical recurrence was diagnosed. Furthermore, on ultrasound of the abdomen, multiple hypodense lesions in both kidneys were found. A CT-scan of the abdomen showed that the lesions appeared hyperdense before radiocontrast and hypodense after radiocontrast, however no lymph node enlargement or other organ involvement was seen (Figure 2
). An ultrasound-guided biopsy of a hypodense lesion at the lower pole of the right kidney was performed, and showed infiltration of the kidney with the lymphoma (Figure 3
). Serum creatinine and serum urea at the time of biopsy were normal (79 µmol/l and 7.2 mmol/l, respectively), but urinary protein excretion was increased to 260 mg/day. After renal biopsy a combination chemotherapy according to the VIP-E regimen (etoposide 890 mg, ifosfamide 7120 mg, cisplatin 89 mg, epirubicin 89 mg in total) was started.
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