Kidney tumor - adult malignancies

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Kidney tumor - adult malignancies

Other neoplasms – adult or adult/child

Lymphoma

Reviewers: Sean Williamson, M.D. (see Reviewers page)
Revised: 3 July 2012, last major update July 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Less than 1% of renal tumors

Clinical description
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● More often secondary involvement than primary; usually bilateral, usually B cell
● Diffuse large cell lymphoma is most common subtype
● High rate of CNS relapse in patients with kidney involvement by diffuse large B-cell lymphoma (Haematologica 2011;96:1002)
● FNA usually conclusive, but high index of suspicion is important for a correct interpretation (Am J Clin Pathol 2001;115:18)
● May occur in transplanted kidney (Clin Transplant 2008;22:512)

Case reports
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Diffuse large B cell lymphoma/intravascular lymphoma:
● 72 year old man (Arch Pathol Lab Med 2003;127:1380)
● 77 year old woman with coexisting renal cell carcinoma (Arch Pathol Lab Med 2001;125:1239)
● With minimal change disease (Hum Pathol 1989;20:263), post-transplant tumor of donor origin (Mod Pathol 1998;11:99)
● HIV+ patient (Arch Pathol Lab Med 1993;117:541)
● Limited to kidney (Int J Hematol 2009;89:533)

Intravascular T cell lymphoma:
● AIDS patient (Hum Pathol 2003;34:950)
● Long term renal allograft recipient (Mod Pathol 1996;9:671)

MALT lymphoma:
● 9 year old boy (Arch Pathol Lab Med 2000;124:1520)
● Other cases (Arch Pathol Lab Med 2000;124:919, Arch Pathol Lab Med 1993;117:780, Arch Pathol Lab Med 2006;130:86)

Other:
● 19 year old man with B-ALL (Case of the Week #126)
● SLL/CLL in renal cyst (Arch Pathol Lab Med 2005;129:111)

Radiologic images
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PET/CT showing bilateral kidneys involved by intravascular diffuse large B-cell lymphoma

CT showing large B-cell lymphoma mimicking vena cava extension of RCC

Gross images
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Massive tumor engulfs both kidneys and adrenal glands

Main tumor mass is in hilar region

Diffuse large B cell lymphoma

Micro description
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● Glomeruli and other structures are usually intact

Micro images
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Burkitt like-’s lymphoma #1 - biopsy; #2 - CD20+;


Diffuse large B cell

MALT images

SLL/CLL in cyst

Intravascular diffuse large B-cell lymphoma

Angiocentric T cell lymphoma:

Massive lymphoid infiltrate with angiocentric distribution

Mixed inflammatory cell population with scattered, large, atypical lymphoid cells,
angiocentricity of infiltrate with destruction of vessel wall

Case reports - 77 year old woman:

Figure 1B: renal cell carcinoma (large arrows); intravascular lymphoma (small arrows);
Fig. 1C: intravascular lymphoma, Fig. 1D: CD20+ (B cell)

72 year old man:

Figure 1: hypercellular glomeruli due to atypical mononuclear cells;
fig 2: cells have irregular nuclei, occasional multiple nucleoli, mitotic figures (arrow)
fig 3A: CD20+; fig 3B: CD3 negative; fig 3C: bcl2+; fig 3D: CD68 negative;
fig 4: EM shows focal foot process fusion (arrowheads) and microvillous transformation, also abundant endoplasmic reticulum (arrow)

Case of the Week - B-ALL:

Image #1; #2; #3 - bone marrow

CD10

CD34

CD79a

TdT

Positive stains
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● PAX2 weak positivity may be seen in lymphoblastic lymphoma, possibly due to cross reaction/sequence homology with PAX5 (Am J Surg Pathol 2011;35:1186)

Cytology images
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Burkitt’s lymphoma

HIV+ patient with high grade B cell lymphoma

Additional references
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● Am J Surg Pathol 1995;19:134, eMedicine

End of Kidney tumor - adult malignancies > Adult renal cell carcinoma > Lymphoma

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