Multiple, rapidly evolving hypodense lesions in both kidneys

(Section Editor: G.H. Neild)

Bernhard K. Krämer, Martin Kammerl, Matthias Schreiber and Ferdinand Hofstädter

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 1Go) 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 2Go). 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 3Go). 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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Fig. 1. Histology from the nose showing high-grade T-cell non-Hodgkin's lymphoma (CD3-staining).

 


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Fig. 2. CT-scan of the middle and lower pole of the kidneys without radiocontrast (A) and after 180 ml of iopromide (B). Multiple hyperdense or hypodense lesions are visible in both kidneys on native or contrast-enhanced CT-scans.

 


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Fig. 3. Histology of the renal biopsy showing dense infiltration of the kidney with the known malignant lymphoma. HE staining with a obj. magnification of x10.

 
Kidney infiltration with T-cell lymphoblastic lymphoma had recently already been discussed in this journal [1] with renal involvement occurring in 15–50% of patients with more advanced disease [2,3].

References

  1. Jose MD, Bannister KM, Clarkson AR, Faull RJ. Diffuse kidney infiltration with T-cell lyphoblastic lymphoma. Nephrol Dial Transplant 1998; 13: 1877–1878[ISI][Medline]
  2. Morel P, Dupriez B, Herbrecht R et al. Aggressive lymphomas with renal involvement: A study of 48 patients treated with the LNH-84 and LNH-87 regimens. Br J Cancer 1994; 70: 154–159[ISI][Medline]
  3. Richards MA, Mootoosamy I, Reznek RH et al. Renal involvement in patients with non-Hodgkin's lymphoma: Clinical and pathological features in 23 cases. Haematol Oncol 1990; 8: 105–110[ISI][Medline]




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