Proliferative glomerulonephritis and mantle cell lymphoma: a rare association

Abstract

Renal involvement in mantle cell lymphoma (MCL) is rare. We present the case of a man followed for MCL presented with acute kidney injury and positive antineutrophil cytoplasmic antibody (ANCA) type anti proteinase 3 (PR3). He was treated as for a rapidly progressing glomerulonephritis with cyclophosphamide and methylprednisolone followed by oral prednisone. Renal biopsy revealed diffuse endocapillary proliferation and segmental extracapillary proliferation in four glomeruli. Immunohistochemistry confirmed the renal invasion of lymphomatous cells. He started improving his renal function shortly after starting treatment. The coexistence of renal MCL infiltration, extracapillary proliferation and ANCA positive is exceptional.

A Diverse Spectrum of Immune Complex– and Complement-Mediated Kidney Diseases Is Associated With Mantle Cell Lymphoma

“…The overall findings of this clinicopathologic cohort are well-supported by previous case reports of patients with MCL and kidney biopsies (summarized in Table 3 ). Of 15 previously reported cases of MCL-associated kidney injury, 9 had a polyclonal IC mediated GN, 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 usually with deposition of IgG, IgM, C3, and C1q. Two had C3GN, 24 , 25 1 had a pauci-IC crescentic GN, 26 9 had direct parenchymal infiltration by MCL, 17 , 18 , 19 , 21 , 22 , 23 , 24 , 26 , 27 and 2 had a proliferative GN without further available description of IC findings.…”

“…Of 15 previously reported cases of MCL-associated kidney injury, 9 had a polyclonal IC mediated GN, 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 usually with deposition of IgG, IgM, C3, and C1q. Two had C3GN, 24 , 25 1 had a pauci-IC crescentic GN, 26 9 had direct parenchymal infiltration by MCL, 17 , 18 , 19 , 21 , 22 , 23 , 24 , 26 , 27 and 2 had a proliferative GN without further available description of IC findings. 31 , 32 These case reports span 20 years and include a variety of lymphoma treatment approaches.…”

“… 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 Less has been published about MCL which is an aggressive subtype of B-cell non-Hodgkin lymphoma that is characterized by a recurrent genetic translocation, t(11;14), involving the gene encoding cyclin D1 in approximately 85% of cases. 14 MCL-associated kidney dysfunction has been documented only in case reports, with authors reporting polyclonal IC mediated GN, 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 C3GN, 24 , 25 and pauci-immune crescentic GN, 26 as well as frequent renal infiltration by lymphoma. 17 , 18 , 19 , 21 , 22 , 23 , 24 , 26 , 27 In this study, we initiated a multi-institutional retrospective review to describe the clinicopathologic spectrum of MCL-associated kidney injury, treatment, and outcomes.…”

“…14 MCL-associated kidney dysfunction has been documented only in case reports, with authors reporting polyclonal IC mediated GN, 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 C3GN, 24 , 25 and pauci-immune crescentic GN, 26 as well as frequent renal infiltration by lymphoma. 17 , 18 , 19 , 21 , 22 , 23 , 24 , 26 , 27 In this study, we initiated a multi-institutional retrospective review to describe the clinicopathologic spectrum of MCL-associated kidney injury, treatment, and outcomes.…”

Case Report: A Rare Case of Lupus Nephritis Associated With Mantle Cell Lymphoma

“…Several case reports have been published on the glomerular involvement of MCL. Some of the histopathological findings include minimal change disease (MCD) ( 9 ), membranoproliferative glomerulonephritis (MPGN) ( 10 ), proliferative glomerulonephritis ( 11 ), and ANCA-associated pauci-immune crescentic glomerulonephritis ( 12 ).…”