Isolated renal intravascular lymphoma: a case report and review of the literature

Figures & data

Figure 1. (a, b) FDG-PET-CT images depicting diffuse FDG accumulation in both kidneys with a SUVmax of 13.80.

Figure 2. Renal biopsy revealed lymphoma cells in arterioles, venules and capillaries (H&E).

Figure 3. Renal biopsy revealed CD20 (+) lymphoma cells in renal arterioles, venules and capillaries.

Table 1. Baseline biochemical data of the patient (BUN: blood urea nitrogen, LDH: lactate dehydrogenase, GGT: gamma-glutamyltransferase, ALT: alanine aminotransferase, AST: aspartate aminotransferase, WBC: white blood cell, PMNL: polymorphonuclear cells, LYM: lymphocytes, PLT: platelets, ESR: erythrocyte sedimentation rate, hs-CRP: high-sensitive C-reactive protein).

Laboratory findings	Values	Reference values
BUN (mg/dL)	190	0–40
Creatinine (mg/dL)	3.9	0.7–1.4
LDH (U/L)	2430	240–480
Albumin (g/dL)	2.1	3.2–5.4
Total protein (g\dL)	6.9	6.0–8.0
β2-microglobulin (mg/dL)	90	0.7–1.8
Calcium (mg\dL)	7.9	8.4–9.7
Alkaline phosphatase (U\L)	94	40–129
GGT (U\L)	23	5–85
ALT (U\L)	26	10–40
AST (U\L)	32	5–42
Hemoglobin (g/dL)	6.1	13.6–17.2
WBC (/µl)	19,700	4.3–10.3 × 10^3
PMNL (/µl)	17,300	2.8–10 × 10^3
LYM (/µl)	1080	1.2–3.6 × 10^3
PLT (/µl)	225.000	155–375 × 10^3
ESR (mm\h)	127	0–20
hs-CRP (mg\L)	215	0.00–5.00

Table 2. Summary of the clinical features, treatments and outcomes of the IVLBCL cases involving the kidneys (CAVP: cyclophosphamide, doxorubicin, vincristine, prednisone, R-CHOP: rituximab, cyclophosphamide, Adriamycin, vincristine and prednisolone, AKI: acute kidney injury, VACOP-B: etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, bleomycin, LAP: lymphadenopathy).

Case – Reference	Age-gender	Presenting symptoms	Type of renal involvement	Other organ involvement	Treatment	Outcome
D'Agati et al.7	62, F	Fever, nausea	Nephrotic syndrome	None	Prednisolone	Death
Axelsen et al.8	60, F	Fever	Nephrotic syndrome	CNS	CAVP	Remission
Zhu et al.9	55, M	Fever	Mild proteinuria	None	R-CHOP	Remission
Sawa et al.10	35, F	Fever	AKI, bilateral enlarged kidneys	None	R-CHOP	Complete remission
Niitsu et al.11	52, M	Edema	AKI	None	R-CHOP	Complete remission
Bai et al.12	41, F	Fever, lower limb fatigue	Nephrotic syndrome, AKI	Spleen, multiple vertebrae	CHOP + radiotherapy	Remission
Yoo et al.13	74, F	Fever	Nephrotic syndrome, AKI	None	Drugs not defined	Unknown
Kusaba et al.14	48, M	No complaint	Mild proteinuria, hematuria	None	R-CHOP	Complete remission
Nishikawa et al.15	52, F	Fever	Nephrotic syndrome	None	CHOP	Complete remission
Bilgili et al.16	56, F	Edema, erythematous diffuse skin plaques	AKI	Skin, inguinal LAP	R-CHOP	Remission
Agar et al.17	60, M	Fever	Macrohematuria, proteinuria	CNS	VACOP-B	Unknown
Kakumitsu et al.18	58, M	Fever, edema	Nephrotic syndrome	Lungs, hemophagocytosis	CHOP + etoposide, mitoxantrone, ranimustine, vindesine	Complete remission
Shaknovich et al.19	85, F	Weight loss, edema	Nephrotic syndrome, AKI	None	No treatment	Unknown
Tornroth et al.20	69, M	Fever, fatigue	AKI, proteinuria	None	No treatment	Death
Tornroth et al.20	63, M	Indurated skin lesions	AKI	Skin	CHOP	Death
Cossu et al.21	56, F	Fever , weakness	Nephrotic syndrome	None	CHOP + radiotherapy	Unknown
Akpinar et al.  (present report)	59, M	Fever, weight loss, edema	Nephrotic syndrome, AKI	None	R-CHOP	Complete remission

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