Selective renal arteriography in Hodgkin's disease of the kidney. A case report.

Abstract

Selective renal arteriography has been utilized in the differential diagnosis of renal masses with great success. Different tumors have been studied arteriographically and their characteristics described in the literature (1, 2). Recently the arteriographic findings of lymphoma of the kidneys were described (4). Since that time we have had the opportunity to perform selective renal arteriography in a patient with Hodgkin's disease of the kidney, and the findings are described in this report. To our knowledge, selective renal arteriography has not been previously described in Hodgkin's disease of the kidney. Case Report B.W., a 28-year-old male, noted left cervical adenopathy in July 1963, and subsequent lymph node biopsy disclosed Hodgkin's disease, nodular sclerosing type. Radiotherapy was given to the supradia-phragmatic node-bearing regions in 1963 and 1964. In 1965, the patient experienced weight loss and hepatomegaly, and lymphangiography demonstrated abnormal periaortic lymph nodes. Chlorambucil produced a complete remission. Hepatosplenomegaly with fever was again present in January 1967 and disappeared after nitrogen mustard therapy. Fever and hepatomegaly recurred in April 1968, and the lower border of a firm, smooth right upper quadrant mass was palpable 9 cm below the costal margin. Moderate pitting edema was present in both lower extremities. At this point intravenous urography, infusion nephrotomography, retrograde pyelography, and renal arteriography were performed. Open right renal biopsy demonstrated marked infiltration of the renal parenchyma by a large tumor with dilated superficial veins. No attempt was made to remove it. Microscopic examination showed sclerotic tissue infiltrated with atypical reticulum cells, lymphocytes, and eosinophils, interpreted as Hodgkin's disease. The most striking aspect was the intense fibrous reaction in the tissue. The patient received vincristine, 1.5 mg per m2, and nitrogen mustard, 6mg per m2, weekly for two weeks; and prednisone, 40 mg per m2, and procarbazine (NSC (7213), 100 mg per m2, orally daily for two weeks. The erythrocyte sedimentation rate decreased from (54 to 19 mm in one hour, and periodic fevers ceased. Two months later, the mass in the right abdomen was not palpable. Radiographic Findings The intravenous urogram at time of admission demonstrated poor excretory function of the right kidney with several hydronephrotic calyces, and a renal outline was not demonstrable. The left kidney measured 17 cm and had a normal calyceal system. The intravenous nephrotomogram showed a large mass filling the right renal area and measuring 25 cm in length. This mass was homogeneous throughout, without evidence of localized increase or decrease in concentration of contrast medium in any area.