Enormous primary renal diffuse large B-cell lymphoma: A case report and literature review

Abstract

Introduction Primary renal lymphoma is a rare malignant lymphoma that is difficult to differentiate from renal cell carcinoma. Positron emission tomography/computed tomography and image-guided percutaneous biopsy are valuable tools for diagnosis. Case report A 64-year-old woman presented with a 2-year history of repeated right waist pain and a 1-month history of nausea, vomiting, and frequent and urgent urination. A computed tomography scan showed a huge mass that was initially considered to be renal cell carcinoma at the upper pole of the right kidney. The mass had invaded the renal pelvis, narrowed the right renal artery, and constricted the inferior vena cava and liver. Postoperative examination of the tumor confirmed lymphoma. We herein present this case and its multidisciplinary team management. Conclusion Multidisciplinary team management is efficient for preoperative assessment and surgery in difficult and high-risk cases. Based on our literature review, we suggest biopsy before chemotherapy whenever possible. Chemotherapy can be implemented after surgery for better survival outcomes.

The Differential Diagnosis of Medullary-Based Renal Masses

“…14,192 However, primary renal lymphoma (PRL), although exceedingly rare, exists and accounts for less than 1% of extranodal lymphomas in North America, with fewer than 100 cases reported in the literature. [195][196][197][198] The mean age is 60 years and it more commonly arises in patients with immunodeficiency states. 195,199,200 Bilateral involvement is more common in patients younger than 30 years, while unilateral disease is more frequent in older patients.…”

“…195,199,200 Bilateral involvement is more common in patients younger than 30 years, while unilateral disease is more frequent in older patients. 197 Regardless of primary or secondary etiology, lymphomas and other LPDs may occasionally manifest as a solitary mass and lead to an initial erroneous diagnosis of RCC because RCC is much more common. 14,195,198 The initial symptoms may be flank pain, fever, or renal insufficiency; however, commonly renal involvement is asymptomatic and only discovered after a definitive diagnosis of lymphoma is already established.…”

“…14 There are no conclusive numbers on prognosis owing to the limited number of cases, limited follow-up, variable histologic subtypes, and differences in treatment approach. 14,197,202 Earlier reports showed a poor prognosis for PRL, with a median survival of less than 1 year. 202,203 In addition, bilateral disease and younger age seem to be associated with a shorter survival time, albeit with limited follow-up data.…”

“…202,203 In addition, bilateral disease and younger age seem to be associated with a shorter survival time, albeit with limited follow-up data. 197 One would expect that the prognosis largely hinges on the biological potential of the underlying lymphoma. However, a recent review showed no significant relationship between pathologic type and survival.…”

“…However, a recent review showed no significant relationship between pathologic type and survival. 197 More recently, reports have suggested longer survival. 202 Patients with unilateral disease whose mass was removed completely by surgical resection followed by combination chemotherapy experience longer disease-free survival and overall survival.…”