Diagnostic Ultrasound - Abdomen and Pelvis

Renal Lymphoma
Diagnoses: Urinary Tract
Transitional Cell Carcinoma
• Centered in collecting system; may be infiltrative and
extend into renal cortex; more likely to cause collecting
system obstruction
Metastases
• Lung, breast, gastric cancer, and melanoma
Other Malignant Lymphoproliferative Diseases
• Myeloma:Diffuse infiltration, solitary or multiple masses
• Leukemia: Enlarged kidney from diffuse infiltration
Renal Infection
• Pyelonephritis, renal abscess, septic emboli
• May present as single or multiple lesions; differentiated by
clinical history and urinalysis
Perirenal Hematoma,Extramedullary
Hematopoiesis,Retroperitoneal Sarcoma
• May simulate perirenal lymphoma
PATHOLOGY
General Features
• GU system commonly affected by extranodal spread of
lymphoma; kidney is most commonly involved
• Usually non-Hodgkin lymphoma, typically B-cell or Burkitt
type; involvement by Hodgkin disease very rare
• Renal tissue is devoid of lymphoid tissue; lymphatics within
renal capsule, perinephric fat, or lymphocytes in areas of
chronic inflammation may account for renal involvement
• Modes of renal spread include hematogenous and direct
contiguous extension
Gross Pathologic & Surgical Features
• Enlarged kidney ± distortion of renal contour
• Expansion of fat caused by homogeneous yellowish tumor
infiltration
CLINICAL ISSUES
Presentation
• Most common signs/symptoms
○ Majority are asymptomatic and renal function
unaffected
○ Rarely present with acute renal failure; rapid
improvement in renal function post treatment
○ Hematuria, flank pain, palpable mass, or renal
insufficiency
• Other signs/symptoms
○ Fever, weight loss,↑ serum lactate dehydrogenase,
lymphopenia
Demographics
• Age
○ Any (middle-aged to elderly more common)
• Gender
○ Prevalence equal in both sexes
• Epidemiology
○ SRL: 30-60% silent renal disease in case of widespread
lymphoma based on autopsy series; imaging
manifestation occurs only in 1-8%
○ PRL: More common in middle-aged men; may present
with renal failure in absence of other causes of renal
impairment
• Predisposing factors
○ Immunocompromised (post organ transplantation, HIV),
prior treatment for malignancy,autoimmune disorders,
viruses such as Epstein-Barr virus
Natural History & Prognosis
• Complications
○ Renal or perinephric hemorrhage, renal obstruction,
renovascular hypertension, acute renal failure
• Prognosis
○ Good prognosis with early diagnosis and chemotherapy
○ Tumor size > 10 cm, involvement of renal hilum and
diffuse infiltration associated with poorer prognosis
○ Involvement of kidneys at time of initial presentation of
B-cell lymphoma may be associated with high incidence
of CNS relapse; diagnosis may alter treatment regimen
Treatment
• Chemotherapy ± radiation therapy
DIAGNOSTIC CHECKLIST
Consider
• Clinical history, any other malignancy, extent of disease
• Overlapping features of renal metastases, renal lymphoma,
and primary renal carcinoma
• Ultrasound-guided renal biopsy for definitive diagnosis
Image Interpretation Pearls
• Always look for evidence of multisystem involvement in
liver, lung, CNS, bone marrow and gastrointestinal tract
SELECTED REFERENCES
1. Ganeshan D et al: Imaging of primary and secondary renal lymphoma. AJR
Am J Roentgenol. 201(5):W712-9, 2013
2. Kostakoglu L et al: State-of-the-Art Research on "Lymphomas: Role of
Molecular Imaging for Staging, Prognostic Evaluation, and Treatment
Response". Front Oncol. 3:212, 2013
3. Bach AG et al: Prevalence and patterns of renal involvement in imaging of
malignant lymphoproliferative diseases. Acta Radiol. 53(3):343-8, 2012
4. Ye XH et al: 18F-FDG PET/CT evaluation of lymphoma with renal
involvement: comparison with renal carcinoma. South Med J. 103(7):642-9,
2010
5. El-Sharkawy MS et al: Renal involvement in lymphoma: prevalence and
various patterns of involvement on abdominal CT. Int Urol Nephrol.
39(3):929-33, 2007
6. Sheth S et al: Imaging of renal lymphoma: patterns of disease with
pathologic correlation. Radiographics. 26(4):1151-68, 2006
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