Clinicopathological features of Chinese patients with B‐cell lymphoproliferative disorders and kidney infiltration

Abstract

AimDirect kidney involvement in B‐cell lymphoproliferative disease is a rare disorder with only a few studies reported in Caucasian patients. The clinicopathological characteristics and outcome of this entity remain poorly described.MethodsWe retrospectively studied all adult Chinese patients who had histology‐proven renal parenchymal infiltration by malignant B‐cells between 1 January 2000 and 31 December 2018 at two tertiary hospitals in Hong Kong. Clinical, pathological and radiological data were collected from 20 patients. Follow‐up data were analysed until 31 December 2019.ResultsMedian follow‐up duration was 22 (1–171) months. Only seven patients (35%) had established diagnosis of haematological cancer before kidney biopsy.Diffuse large B‐cell lymphoma (DLBCL) was the most common subtype in our cohort (n = 5, 25%). Others included low‐grade B‐cell lymphoma (n = 11), intravascular large B‐cell lymphoma (n = 1), mantle cell lymphoma (n = 1) and multiple myeloma (n = 2). Fourteen patients (70%) presented with AKI while 12 patients (60%) had proteinuria. Seven patients (35%) had unilateral renal mass, one had bilateral renal masses and one had bilateral diffuse nephromegaly in computed tomography. Lymphomatous tubulointerstitial infiltration was the prevalent histological finding. Nine patients (45%) had coexisting renal lesions other than direct tumour infiltration. All but one patient received chemotherapy. Ten patients died and renal responders had a significantly better survival than non‐renal responders (p = .03).ConclusionDirect tumour infiltration can occur in a wide variety of B‐cell lymphoproliferative disorders. Coexisting immunoglobulin‐related nephropathy is frequently found. Renal biopsy is required for early diagnosis which allows timely and appropriate treatment.

Mantle Cell Lymphoma Presenting as Cholecystitis and Nephromegaly

“…While cholecystitis isn't an uncommon presenting symptom for GI involvement of lymphoma, it is rare for MCL to be the underlying lymphoma subtype [7]. Additionally, renal lymphomatous involvement presenting as nephromegaly is rare in all subtypes of lymphoma, including MCL [8,9].…”

“…Similar to gallbladder involvement of lymphoma, direct kidney involvement of lymphoma is extremely rare. A retrospective review over an 18-year time period at two tertiary hospitals identified 20 total cases of patients with renal parenchymal infiltration of lymphoma [8]. Of the 20 cases identified, only one was found to be MCL, with diffuse large B-cell lymphoma, follicular lymphoma, and marginal zone lymphoma being more commonly associated with parenchymal involvement of the kidneys [8].…”

“…A retrospective review over an 18-year time period at two tertiary hospitals identified 20 total cases of patients with renal parenchymal infiltration of lymphoma [8]. Of the 20 cases identified, only one was found to be MCL, with diffuse large B-cell lymphoma, follicular lymphoma, and marginal zone lymphoma being more commonly associated with parenchymal involvement of the kidneys [8]. Of the 20 cases, 14 patients (70%) presented with acute kidney injury and one patient (5%) presented with bilateral nephromegaly [8].…”

“…Of the 20 cases identified, only one was found to be MCL, with diffuse large B-cell lymphoma, follicular lymphoma, and marginal zone lymphoma being more commonly associated with parenchymal involvement of the kidneys [8]. Of the 20 cases, 14 patients (70%) presented with acute kidney injury and one patient (5%) presented with bilateral nephromegaly [8]. In patients presenting with lymphomatous involvement of the kidneys, an elevated serum creatinine has been reported in up to 56% of patients [9].…”