Acute Lymphocytic Leukemia with Bilateral Renal Masses Masquerading as Nephroblastomatosis

Abstract

Acute lymphoblastic leukemia (ALL) is the most common malignancy in the pediatric patient population. However, renal involvement as the primary manifestation of ALL is rare. We report a case of a 4-year-old boy with bilateral renal lesions resembling nephroblastic rests as the first finding of early stage ALL preceding hematological changes and subsequent classic clinical findings by two weeks. These renal hypodensities completely resolved after one week of induction chemotherapy. This case demonstrates that renal involvement can be the only initial presenting finding of leukemia. Children with lesions resembling nephroblastic rests need appropriate surveillance due to the risk of malignant disease.

Renal lesions mimicking acute focal bacterial nephritis in pediatric leukemia

“…Renal imaging in childhood leukemia seems variable according to age, type of leukemia, and the presence of extramedullary complications 2 . Renal involvement in the absence of blasts in the peripheral blood is rare, and as far as we are aware only three pediatric cases with anormal kidney imaging without blasts in the peripheral blood have been reported in the relevant literature 3–5 . The characteristic common findings are as follows: early B‐cell lineage ALL with mild leukocytosis, age at onset as young as 2–5 years, no abnormal biochemical data or urinalysis findings at the onset, and abdominal pain as a clinical complaint (Table ).…”

“…2 Renal involvement in the absence of blasts in the peripheral blood is rare, and as far as we are aware only three pediatric cases with anormal kidney imaging without blasts in the peripheral blood have been reported in the relevant literature. [3][4][5] The characteristic common findings are as follows: early B-cell lineage ALL with mild leukocytosis, age at onset as young as 2-5 years, no abnormal biochemical data or urinalysis findings at the onset, and abdominal pain as a clinical complaint (Table S1). The pathological findings of the infiltrated kidneys in the previous report demonstrated lymphocytic infiltration of the renal interstitium and urinary space of the glomerulus, causing tubular separation, compression, and focal atrophy.…”