Light chain cast nephropathy caused by plasmablastic lymphoma of the bladder

Abstract

Introduction: Plasmablastic lymphoma (PBL) is a rare form of B-cell lymphoma typically seen in patients with underlying immunosuppression such as HIV, autoimmune disease, and organ transplantation. PBL in HIV-positive patients usually originates from the gastrointestinal tract, with a predilection for the oral cavity. Bladder involvement by PBL is exceedingly rare, and cast nephropathy due to κ light chain-secreting PBL has not been reported previously. Case report: We report a patient who presented with acute kidney injury (AKI) in the setting of HIV, and was found to have a bladder tumor. Bladder pathology revealed a high-grade PBL with κ light chain restriction. Renal biopsy showed κ light chain cast nephropathy, presumably secondary to κ light chain-secreting PBL. Conclusion: Although the prognosis of PBL is poor, our patient recovered from AKI, achieved complete hematologic remission with chemotherapy, and underwent successful autologous stem cell transplant.

Plasmablastic Lymphoma Presenting as Extensive Peritoneal and Retroperitoneal Nodules in an HIV-Positive Patient

“… 26 To our knowledge, there has only been 1 case where PBL presented in the bladder similar to how it presented in our case with hydronephrosis and acute kidney injury (AKI). 27 …”

“…26 To our knowledge, there has only been 1 case where PBL presented in the bladder similar to how it presented in our case with hydronephrosis and acute kidney injury (AKI). 27 Etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (EPOCH) are used to treat PBL rather than cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) based on the results of a meta-analysis. Other regimens include cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate (CODOX-M) alternating with ifosfamide, hyperfractionated cyclophosphamide, vincristine, methotrexate, and cytarabine (hyper-CVAD).…”

VIH y cáncer de vejiga. Revisión de una asociación patológica poco estudiada

“…El CV ocurre mayoritariamente en hombres, y cuando se trata de hombres con VIH su aparición suele ser a una edad más temprana, alrededor de los 55 años en promedio, mientras que en la población general es sobre los 72 años. En esta revisión, los tumores de vejiga urinaria descritos en la serie de 300 pacientes VIH positivos corresponden tanto a TDS (tipo linfomas no Hodgkin, linfoma de células T de vejiga 15 , linfoma anaplásico de células grandes 24 , linfoma de Burkitt 22,29,46 y linfoma plasmablástico de células B 51 ) como a TNDS o TAS, cuya histopatología corresponde la mayoría de las veces a carcinomas de células transicionales 16,39,40 , en raras ocasiones a carcinomas escamosos (epidermoides) 13,33,35,40 y mucho menos a otras variantes como el carcinoma sarcomatoide 40 o el carcinoma neuroendocrino, del que solo hay publicado un caso en un paciente VIH positivo 4 .…”

“…Solo tres revisiones disponen de estudio anatomopatológico en todos sus pacientes: la de Gaughan et al 26 , de 2009, que revisa 11 casos; la de Chawki et al 40 , de 2015, que revisa 28 casos (15 propios y 13 de otros autores), y la de Trickey et al 50 , de 2020, que revisa 57 casos. Entre los tumores estudiados hay dos infrecuentes: uno es la variante de TNDS carcinoma neuroendocrino de vejiga, un tumor muy agresivo de evolución fulminante y fatal, con un único caso publicado de esta estirpe histopatológica en un paciente VIH positivo 4 , y el otro es la variante de TDS linfoma plasmablástico de células B de vejiga, de mejor pronóstico 51 .…”

Primary Diffuse Large B-Cell Lymphoma of the Urinary Bladder: Update on a Rare Disease and Potential Diagnostic Pitfalls

“…PBL has been initially reported in the oral cavity in HIV-positive individuals, but GIT and skin are other sites commonly involved. PBL arising in the UT in general or in the UB is very unusual [ 60 , 61 ]. Histologically, PBL consists of sheets of IBs and plasmablasts (PBs) usually expressing plasma cell-associated markers such as CD138, CD38, and MUM1/IRF4; unlike in DLBCL, NOS, CD20 is often not expressed in PBL.…”