You are here: Urology Textbook > Kidneys > Renal lymphoma

Diagnosis and Treatment of Renal Lymphoma

Definition

Renal lymphoma is a rare manifestation of non-Hodgkin's lymphoma or Hodgkin's lymphoma in the kidney (Okuno et al., 1995) (Sheth et al., 2006).

Etiology and Pathology of Renal Lymphoma

Origin and growth:

Renal lymphoma begins in 90% via hematogenous spread; primary renal lymphoma is rare. Most commonly, multiple smaller masses grow and become radiologically visible.

Risk factors for renal lymphoma:

• existing lymphoma
• iatrogenic immunosuppression
• AIDS
• autoimmune diseases
• radiotherapy or chemotherapy

Ann Arbor Staging of Lymphomas:

Stage I:

Manifestation of a single lymph node region or a single extranodal organ

Stage II:

Manifestation of several lymph node regions or organs on one side of the diaphragm, either above or below

Stage III:

Manifestation of several lymph node regions or organs on both sides of the diaphragm

Stage IV:

Diffuse or disseminated involvement of visceral organs or lymph node regions.

Modifiers:

The following letters are used for further description of the disease and are apppended after above mentioned roman numbers of appropriate stage:

• A – absence of constitutional symptoms
• B – presence of constitutional symptoms
• E – extranodal manifestation (such as testes or kidneys)
• S – splenic manifestation
• X – large tumor mass with >10 cm maximum diameter in adults

Signs and Symptoms of Renal Lymphoma

• Flank pain or hematuria
• Constitutional symptoms: fatigue, fever, weight loss, or night sweats
• Kidney failure with hypercalcemia or hyperuricemia

Diagnostic Workup

Laboratory tests:

Complete blood count (may be normal), elevated erythrocyte sedimentation rate (ESR), liver and kidney tests.

Bone marrow biopsy:

Essential staging procedure

Computed tomography (CT) scans of abdomen and thorax:

Lymphoma may present with different morphology: singular mass, multiple masses, diffuse kidney infiltration with organ enlargement, or direct invasion from hilar lymph nodes. Typical signs of a renal lymphoma besides the renal mass include splenomegaly, retroperitoneal lymphadenopathy, or marked lymphadenopathy in another area.

Renal Biopsy:

Renal biopsy is crucial for the diagnosis of renal lymphoma and the prevention of unnecessary nephrectomy.

Therapy of Renal Lymphoma

The treatment depends on histology (lymphoma subtype) and the Ann Arbor staging, see textbooks of internal medicine. Therapy consists of combination chemotherapy (e.g., COPP, BEACOPP or ABVD) optionally in combination with radiotherapy of the involved areas. The central task for the urologist is to avoid unnecessary radical nephrectomy.

References

  Deutsche Version: Nierenlymphom