Primary renal lymphoma

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A 55-year-old woman presented with low grade fever and frequent night sweating of one month’s duration. Laboratory data showed severe anaemia (haemoglobin: 74 g/l) with low reticulocyte count 67AE54 · 10/l (2AE2%) and elevated lactate dehydrogenase (1174 U/l) without leukocytosis (white blood cell count: 6AE56 · 10/l). There was no history or evidence of recent blood loss. Microbiological studies and immunological profiles were unremarkable. Abdominal computed tomography with contrast enhancement (left figure) demonstrated a heterogenous hypodense renal tumour occupying the right renal sinus. In addition, right renal vein encasement and inferior vena cava invasion (arrow) were noted, accompanied by multiple enlarged para-aortic lymph nodes (arrow heads). Doppler sonography (right figure) showed a hypovascular mass (arrow heads) with surrounding hydrocalyces (arrows). Tissue sampling was achieved by open laparotomy. Histopathology with immunochemical staining revealed a diffuse large B-cell lymphoma with positive CD20 expression, confirming the diagnosis of primary renal lymphoma. One month after rituximab-based chemotherapy, the patient became apyrexial with concurrent regression of the renal tumour. Primary renal lymphoma is rare and may present with acute renal failure of flank pain or as an incidental renal mass. Typical image findings on a colour Doppler ultrasound consist of a hypoechoic mass with hypovascularity, in contrast to the hypervascular pattern of most renal cell carcinomas. Most primary renal lymphomas are highly chemo-sensitive as demonstrated in this case.