Lymphoblastoma of the Kidney

Abstract

The generalized character of the lymphoblastoma group of diseases is well known. Involvement of the lymphatic system is most common, whereas invasion of the lungs, bones, nervous system, gastro-intestinal tract, and skin also is found frequently, particularly in the later stages of the diseases. Renal lesions of this type are recognized clinically less often than the others, although they are observed fairly frequently at autopsy. In a clinical analysis of 196 proved cases of lymphosarcoma, Sugarbaker and Craver made no mention of kidney involvement, either as a primary focus or secondary invasion, although twenty-one other organs were listed as being secondarily involved. Barney, Hunter, and Mintz pointed out the paucity of references to the urologie aspects of the “radiosensitive tumors of the blood-forming organs” and described, among others, a case of lymphosarcoma with a grapefruit-sized mass in each loin which was the result of extensive infiltrations in the kidneys. According to these writers, such infiltrations can produce oliguria and uremia. Price described a case of unilateral lymphosarcoma of the kidney in a child with hematuria for four days at the onset of his illness; the involved kidney was removed and found to weigh 600 gm. In a case of acute lymphatic leukemia in a three-week-old infant, White and Burns found enlargement of the kidneys to four times their normal size. The nature of the enlargement presented a problem in diagnosis until the leukemic blood picture was discovered. Another report of a case of lymphatic leukemia which presented bilateral infiltrations of the kidneys with leukemic tissue is described in the Case Records of the Massachusetts General Hospital. Among 125 cases of Hodgkin's disease and lymphosarcoma, Locke and Minot observed paroxysms of abdominal pain and hematuria in three cases, which they attributed to a urological manifestation of the disease. In these cases the external manifestations of the condition were not prominent. Chute discussed involvement of the urinary tract by “malignant lymphoma” and stressed the importance of diagnosis to avoid mistreatment. He stated that the signs and symptoms may simulate one of the more usual forms of kidney disease, or may be only of a general nature, but held that the diagnosis probably would be made if the condition were kept in mind. According to Ewing, the kidney is a favorite site for metastases from lymphosarcoma, which may take the form of minute foci, diffuse infiltrations, or bulky masses. Baldridge and Awe found microscopic evidence of kidney involvement in 20 out of 39 cases of lymphoma, the highest incidence occurring in lymphocytic lymphoma with leukemia. On the other hand, Griffin and Brindley discovered 6 cases of lymphosarcoma among 3,865 cases at autopsy, none of which showed renal infiltration. In 4 out of 18 cases of leukemia, Merrill and Jackson found extensive gross and microscopic involvement of the kidneys.