Lymphoproliferative Disorders of the Kidney on Fine-Needle Aspiration: Cytomorphology and Radiographic Correlates in 33 Cases

Abstract

Background: Unless renal lesions present in the setting of widespread lymphoma, biopsy can be indicated to differentiate from metastases, hypovascular renal cell carcinoma, urothelial carcinoma or infection. We review our experience with lymphoproliferative disorders in the kidney diagnosed by fine-needle aspiration (FNA), and focus on clinicopathologic and radiographic features. Design: All cases of non-Hodgkin lymphoma diagnosed on renal FNA at 2 academic institutions between 1989 and 2011 were reviewed. Clinical history, radiographic and cytomorphologic features, and follow-up were assessed. Results: 33 cases were identified, with 15 primary tumors and 18 recurrences/secondary tumors including 1 acute lymphoblastic lymphoma. The majority were aggressive/high-grade lesions (25/33). 25 cases were substantiated by positive flow cytometry results. Most were detected at follow-up/incidentally. 22 cases showed multiple renal and/or retroperitoneal masses or a significant component of adenopathy; others showed a solitary renal mass. Salient radiologic features included hypodense, infiltrative and ill-defined masses. Cytomorphology showed a monotonous population of large atypical lymphoid cells, often with lymphoglandular bodies. Conclusion: Cytologic diagnosis of renal lymphoma requires analysis of morphological, clinical and immunophenotypic information. Helpful features for diagnosis include: multiple masses on computed tomography, a monotonous population of abnormal cells in a background of lymphoglandular bodies and immunophenotyping demonstrating light chain restriction.

Acute kidney injury as initial presentation of renal lymphoma: Diagnostic and therapeutic challenges in a resource-limited setting

“…Kidney FNAC in our patient demonstrated lymphoglandular bodies and a monomorphic population of atypical lymphoid cells suggesting a lymphoma. 5,14 This was substantiated with bone marrow cytology. Cytomorphology suggested lymphoblastic or Burkitt’s lymphoma/leukaemia, both of which are known to have overlapping features.…”

“…However, conditions like transitional cell, collecting duct or medullary carcinoma and pyelonephritis can equally cause nephromegaly without a mass and require adequate imaging to exclude. 5,8,9…”

“…Renal involvement in non-Hodgkin’s lymphoma is usually clinically silent and discovered incidentally on routine imaging. 5 When kidney impairment occurs (usually not at presentation), it results from one or a combination of several mechanisms, notably; parenchymal infiltration, uric acid nephropathy, glomerulopathy, obstruction, cytotoxic drugs, nephrotic syndrome, sepsis, amyloidosis and hypotension. 7 Parenchymal infiltration usually takes the form of a mass and less commonly diffuse infiltration.…”

“…Kidney involvement in non-Hodgkin’s lymphoma documented in the literature across the globe 1–3 is often asymptomatic and rarely presents with renal failure. 2,4,5 We present a case of aggressive non-Hodgkin lymphoma, with renal failure, nephromegaly and bone marrow involvement, normal white cell counts and no lymph node enlargement. We equally discuss diagnostic challenges in a resource poor setting in Cameroon.…”

Importance of Flow Cytometry in the Cytopathologic Evaluation of Lymphoid Lesions Involving the Kidney

“…Clinical findings and imaging are often suggestive of lymphoma in these patients, with flank pain or acute renal failure and multiple hypovascular renal masses on computed tomography [31]; however, even when cytomorphology is indicative of lymphoma (fig. 2), the diagnosis is not always straightforward.…”