Large cell non-Hodgkin's lymphoma masquerading as renal carcinoma with inferior vena cava thrombosis: a case report

Abstract

IntroductionMany cancers are associated with inferior vena cava (IVC) obstruction, but very few cancers have the ability to propagate within the lumen of the renal vein or the IVC. Renal cell carcinoma is the most common of these cancers. Renal cancer with IVC extension has a high rate of recurrence and a low five year survival rate.Case presentationA 62-year-old Caucasian woman previously in good health developed the sudden onset of severe reflux symptoms and right-sided abdominal pain that radiated around the right flank. A subsequent ultrasound and CT scan revealed a right upper pole renal mass with invasion of the right adrenal gland, liver, left renal vein and IVC. This appeared to be consistent with stage III renal cancer with IVC extension. Metastatic nodules were believed to be present in the right pericardial region; the superficial anterior abdominal wall; the left perirenal, abdominal and pelvic regions; and the left adrenal gland. The pattern of these metastases, as well as the invasion of the liver by the tumor, was thought to be atypical of renal cancer. A needle biopsy of a superficial abdominal wall mass revealed a surprising finding: The malignant cells were diagnostic of large-cell, B-cell non-Hodgkin's lymphoma. The lymphoma responded dramatically to systemic chemotherapy, which avoided the need for nephrectomy.ConclusionLymphomas only rarely progress via intraluminal vascular extension. We have been able to identify only one other case report of renal lymphoma with renal vein and IVC extension. While renal cancer would have been treated with radical nephrectomy and tumor embolectomy, large-cell B-cell lymphomas are treated primarily with chemotherapy, and nephrectomy would have been detrimental. It is important to remember that, rarely, other types of cancer arise from the kidney which are not derived from the renal tubular epithelium. These may be suspected if an atypical pattern of metastases or unusual invasion of surrounding organs is present. A preoperative or intraoperative biopsy may be helpful in these cases.

Unusual complication and successful high-dose chemotherapy treatment of advanced Burkitt’s lymphoma in an adult HIV-positive patient

“…Bilateral renal vein tumour thrombosis is an uncommon complication, not typically seen in lymphoma, necessitating anticoagulation (Figure 4). 5,6 CT confirmed resolution, allowing a return to thromboprophylaxis alone.…”

Lymphoma Masquerading as Lung Cancer

“…Lymphomatous tumor thrombus, either from a primary nodal mass 4,5 or from a primary extranodal mass, 6 is rare and can present a diagnostic dilemma in extranodal disease involving a solid organ. This has been more commonly described in the liver 7,8 and kidney, 9,10 and to our knowledge, tumor thrombus from a lymphomatous lung mass has not been described before. Awareness of this unusual presentation of lymphoma is helpful for the differential diagnosis of lung masses with tumor thrombus.…”

A primary retroperitoneal anaplastic lymphoma kinase-positive anaplastic large cell lymphoma with tumor thrombosis

“…Tumor thrombosis is an extremely rare manifestation in lymphoma. As far as we know, only 29 cases of extravascular lymphoma with tumor thrombosis formation have been reported in English literatures 3,7–10. The most common pathology is diffuse large B cell lymphoma (DLBCL).…”