Intravascular Large B-Cell Lymphoma and Renal Clear Cell Carcinoma as Collision Tumor: A Case Report and Review of the Literature

Abstract

Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal large B-cell lymphoma characterized by the selective growth of lymphoma cells within the lumina of vessels. The patient usually presents with nonspecific symptoms and a remarkable deterioration in performance status. The occurrence of synchronous IVLBCL and renal cell carcinoma (RCC) is extremely rare. A right kidney tumor was found in a 72-year-old man with a history of low back pain. The kidney was enlarged, with a tumor mass measuring 4.5 × 4 × 4 cm. Sections exhibited a RCC (clear cell type, nuclear grade I). Also an extensive tumor affecting capillaries and small veins was present, positive for CD45, CD20, BCL-2, and MUM1/IRF-4, consistent with IVLBCL. The lymphoma was circumscribed to the RCC. The final diagnosis was IVLBCL with a RCC as collision tumor. After that, with neurological findings, central nervous system compromise by lymphoma was made. The patient started a first cycle of chemotherapy, progressive deterioration of the sensorium, and positive blood cultures for Klebsiella pneumoniae and Escherichia coli. The patient died 8 days later of acute respiratory failure. No autopsy was done. IVLBCL is an aggressive and systemic disease characterized by massive proliferation of tumor cells without a known primary site. Clinical identification and histopathologic diagnosis are relevant issues in the therapeutic management of these lymphomas. Until now, only one case of IVLBCL coexisting with RCC has been reported. In this article, we report a second case of IVLBCL with RCC simultaneous, as an unusual collision tumor.

Random Skin Biopsy for Diagnosis of Intravascular Large B-Cell Lymphoma: A Case Report and Literature Review

“…9 Positive intravascular markers CD20, CD5, BCL-2, and BCL-6 are in support of the diagnosis of IVLBCL. 1,6,[13][14][15][16] Numerous studies reported that regarding patients with unexplained fever suspected of IVLBCL, RSB is suggested to be performed before other invasive tests because of its high sensitivity, less trauma, and operation being relatively simple. 8,17 For patients suspected of having IVLBCL, RSB is recommended before brain biopsy regardless of the involvement of central nervous system.…”

Positive FDG‐PET/CT uptake guiding diagnosis in a patient with microscopic polyangiitis: A case report

“…Both findings suggested abnormal DRU rather than physiologic renal activity 6 (Figure 2). The pattern of diffuse renal uptake was not only reported in MPA and other ANCA‐associated vasculitis (AAV), 7 but also in acute kidney injury 8 and intravascular B cell lymphoma 9,10 . All of the possible causes should be included in the differential diagnosis for DRU.…”

Intravascular large B‐cell lymphoma in renal cell carcinoma incidentally detected by robot‐assisted partial nephrectomy

“…There have been only four cases of IVLBCL involving the microvasculature of RCC. [3][4][5][6] We present the case of a 69-year-old female who underwent RAPN for a clear cell RCC sized 1.7 cm, in which IVLBCL was incidentally detected. To our knowledge, this is the first case of synchronous IVLBCL with RCC detected by RAPN.…”

“…Furthermore, the synchronous occurrence of intravascular lymphoma with RCC is extremely rare. There have been only four cases of IVLBCL involving the microvasculature of RCC 3–6 …”