Mantle Cell Lymphoma associated with Membranoproliferative and Membranous Glomerulonephritis: Report of Two Cases

Abstract

pathology patterns, reported in the literature, are represented by interstitial or glomerular specific infiltration and paraneoplastic glomerulonephritis (GN)-mainly Membranous Nephropathy (MN) and Membranoproliferative Glomerulonephritis (MPGN), and rarely Minimal Change Disease (MCD), Focal Segmental Glomerulosclerosis (FSGS) and Crescentic Glomerulonephritis (CGN) [1-10]. Mantle Cell Lymphoma (MCL) is an aggressive lymphoid neoplasm, representing 5-10% of all B-cell NHL and characterized by the proliferation of mature B-lymphocytes, that infiltrate lymphoid tissues, bone marrow, peripheral blood, and extranodal sites. The hallmark of this lymphoma is translocation t(11;14) (q13; q32), which results in overexpression of Cyclin D1 [11]. Kidney involvement in MCL, reported rarely in living patients, is caused either by direct lymphoid infiltration or by multiple mechanisms (cytokines, immune complexes etc.) triggering paraneoplastic GN. Data retrieval allowed us to find 17 biopsyproven cases, have been described in the literature so far: 3 cases of renal MCL infiltration, 1 case of interstitial nephritis without lymphoid infiltration, 5 cases of proliferative GN, 1 case of MCD, 1 case of FSGS, 1 case of MPGN, 1 case of CGN, and 4 cases with the combination of MCL infiltration and GN (3 with MPGN and 1 with CGN) [12-26]. We didn't find any data, reporting membranous nephropathy in MCL. Here we present two cases of MCL with GN, diagnosed on the basis of renal biopsy findings, one case of MPGN and another with MN, and discuss the diagnostics difficulties and treatment results.

Lymphomatous interstitial nephritis coexistent with paraneoplastic crescentic membranoproliferative glomerulonephritis in a case of mantle cell lymphoma

“…12 cases of p-GN in the setting of MCL have been described. [ 3 4 5 6 7 8 9 10 11 12 ] LIN due to MCL has been observed in 4 cases. [ 13 14 15 16 ] The coexistence of LIN and p-GN due to MCL is extremely rare.…”

“…Very few reports have noted renal disease as the first manifestation of MCL, with the observed latency between renal disease and MCL diagnosis of up to 6 years. [ 9 ] A few others described primary renal MCL limited to kidneys alone. [ 16 ]…”