Unusual presentation of large B cell lymphoma: a case report and review of literature

Abstract

Diffuse large B cell lymphoma (DLBCL) is the largest subtype of non-Hodgkin's lymphomas (NHLs) and is characterized by relatively frequent extranodal presentation. In these cases, the most common extranodal localizations are stomach, CNS, bone, testis and liver. Simultaneous detection of multiple extranodal involvement at presentation is quite uncommon, with the majority of these cases characterized by gastric or intestinal disease localization. Retrospective analysis concerning multifocal extranodal NHLs never pointed out disease features such as those described here. We report a patient with an unusual presentation of DLBCL, characterized by adrenal and renal involvement, associated with symptoms and signs of the cold agglutinin disease and a hypercoagulable state. Subsequently, computed tomography (CT) and fluorodeoxyglucose-positron emission tomography (FDG-PET) scanning disclosed a rapidly extensive spread to nodes and bones. Cytofluorimetric analysis of a renal specimen showed medium-to-large lympho-monocytoid elements positive for CD20 with monoclonal expression of immunoglobulin kappa light chain. Histopathological examination confirmed a renal CD20 positive DLBCL localization.

Primary Renal Lymphoma: A Case Report and Literature Review

“…This form accounts for one-third of all NHL cases (1). Diffuse large B-cell lymphoma (DLBCL) is the predominant type of NHL, accounting for approximately 40% of all lymphomas (2,3).…”

“…Diffuse large B-cell lymphoma (DLBCL) is the predominant type of NHL, accounting for approximately 40% of all lymphomas (2,3). It has also been reported that 30-50% of NHL cases have extranodal manifestations in various organs, such as the gastric tract, skin, bone, central nervous system, breast, heart, liver, or adrenal glands (1).…”

Multifocal primary extranodal B-cell non-Hodgkin’s lymphoma involving six extranodal sites: Figure 1

“…Other sites commonly involved include the skin, CNS, thyroid and lung,7 but disease is usually restricted to a single anatomical site, indicating organ-specific lymphoid proliferation or migration. A small proportion of patients may show multifocal extranodal lymphoma at diagnosis, but, to our knowledge, simultaneous involvement of no more than three extranodal sites has previously been described 7 – 9.…”

“…Other sites commonly involved include the skin, CNS, thyroid and lung,7 but disease is usually restricted to a single anatomical site, indicating organ-specific lymphoid proliferation or migration. A small proportion of patients may show multifocal extranodal lymphoma at diagnosis, but, to our knowledge, simultaneous involvement of no more than three extranodal sites has previously been described 7 – 9. This report on the occurrence of likely diffuse large B-cell lymphoma in six extranodal sites including kidneys, adrenals, lungs, liver and pancreas, with a possible low-grade lymphomatous infiltrate in the bone marrow, without significant nodal disease is therefore unusual.…”

Diffuse large B-cell lymphoma of tonsil and testis: unexpected metastatic sequence

“…Frequently, the origin of primary extranodal NHL can be ascribed to one given organ system or site, with most common extranodal sites being the stomach, skin, and small intestine. The breast, thyroid, lung, heart, liver, genitourinary tract, adrenal glands and bone could also be primarily affected [1].…”