Lymphomatous involvement of the kidney is produced in three different clinical scenarios. The most common is the advanced stage lymphoma affects the kidney in second place. Posttrans plantation lymphoproliferative disease (PTLD) may also involve the kidney secondary to iatrogenic immunosuppression. Primary renal lymphoma (PRL) is the least common. The incidence of PTLD arising in kidney transplants has increased over the past two decades due to the increasing frequency of transplants. Secondary renal involvement tends to be bilateral and is seen with a high incidence (37-47%) in advanced disease. If there really PRL remains a controversial issue because of its rarity, about 60 cases have been reported, and only about 30 cases really useful for filling the diagnostic criteria as PRL.
Pathology of Lymphoma in kidney tumors
PRL nephrectomy specimens can have a company uniform, pale appearance with occasional thrombus or renal vein involvement. The most common pattern of involvement is a diffuse involvement with lymphoma cells that permeates from the nephrons, the "interstitial pattern." However, the involvement of discrete nodular masses with intravascular lymphoma has also been described. diffuse large B cell is the most common histologic type, although Burkitt, lymphoblastic lymphoma, and other histologies have been described. The origin of these tumors remains controversial, since the renal parenchyma does not contain lymphoid tissue. PTLD in kidney transplants are related to the degree of immunosuppression and infection with EBV (Epstein Barr Virus) and can present the process as monoclonal or polyclonal.
Clinical Presentation of Lymphoma in kidney tumors
Patients may present with back pain / abdominal pain, fever, cachexia, renal failure or hematuria. Acute renal failure is a common complication. The TAC is the most sensitive diagnostic modality and effective renal lymphoma. In a review of Urban et al., Typical patterns of participation of the masses are simple and multiple invasion of renal disease, retroperitoneal, perirenal disease, and diffuse renal infiltration. PRL patients are usually treated by nephrectomy, because PRL is considered clinically as a renal epithelial tumor. Once the renal involvement of lymphoma is confirmed, a thorough search for extrarenal disease and staging studies such as CT scan and bone marrow biopsy, are warranted to rule out a secondary lymphoma, since it is much more common (30 times more common). Stallone et al. have proposed that the diagnosis of PRL is done only when the following conditions: 1) renal lymphomatous infiltration, 2) the expansion of non-obstructive kidney and 3) without extrarenal location at the time of diagnosis.
Treatment and Prognosis of Lymphoma in kidney tumors
Although there have been reports of modest disease-free survival after nephrectomy for PRL, the prognosis is generally poor, due to the spread of secondary sites. Early detection and systemic combination chemotherapy can reverse kidney failure and improve survival by preventing the spread. Secondary renal lymphomas are usually seen in the context of advanced lymphoma have a poor prognosis. PTLD is treated by reducing immunosuppression, if possible, although recent reports with anti-CD20 monoclonal antibody rituximab have been encouraging and is used as first-line therapy in appropriate settings.
Pathology of Lymphoma in kidney tumors
PRL nephrectomy specimens can have a company uniform, pale appearance with occasional thrombus or renal vein involvement. The most common pattern of involvement is a diffuse involvement with lymphoma cells that permeates from the nephrons, the "interstitial pattern." However, the involvement of discrete nodular masses with intravascular lymphoma has also been described. diffuse large B cell is the most common histologic type, although Burkitt, lymphoblastic lymphoma, and other histologies have been described. The origin of these tumors remains controversial, since the renal parenchyma does not contain lymphoid tissue. PTLD in kidney transplants are related to the degree of immunosuppression and infection with EBV (Epstein Barr Virus) and can present the process as monoclonal or polyclonal.
Clinical Presentation of Lymphoma in kidney tumors
Patients may present with back pain / abdominal pain, fever, cachexia, renal failure or hematuria. Acute renal failure is a common complication. The TAC is the most sensitive diagnostic modality and effective renal lymphoma. In a review of Urban et al., Typical patterns of participation of the masses are simple and multiple invasion of renal disease, retroperitoneal, perirenal disease, and diffuse renal infiltration. PRL patients are usually treated by nephrectomy, because PRL is considered clinically as a renal epithelial tumor. Once the renal involvement of lymphoma is confirmed, a thorough search for extrarenal disease and staging studies such as CT scan and bone marrow biopsy, are warranted to rule out a secondary lymphoma, since it is much more common (30 times more common). Stallone et al. have proposed that the diagnosis of PRL is done only when the following conditions: 1) renal lymphomatous infiltration, 2) the expansion of non-obstructive kidney and 3) without extrarenal location at the time of diagnosis.
Treatment and Prognosis of Lymphoma in kidney tumors
Although there have been reports of modest disease-free survival after nephrectomy for PRL, the prognosis is generally poor, due to the spread of secondary sites. Early detection and systemic combination chemotherapy can reverse kidney failure and improve survival by preventing the spread. Secondary renal lymphomas are usually seen in the context of advanced lymphoma have a poor prognosis. PTLD is treated by reducing immunosuppression, if possible, although recent reports with anti-CD20 monoclonal antibody rituximab have been encouraging and is used as first-line therapy in appropriate settings.