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Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
Published on: June 8, 2022
Intravascular large cell lymphoma: diagnosis on renal biopsy
R A Axelsen1, P P Laird, M Horn
1Department of Pathology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Insights
This case report details a 60-year-old woman diagnosed with intravascular large cell lymphoma via renal biopsy. Chemotherapy led to remission, highlighting the kidney as a diagnostic site for this rare lymphoma.
Area of Science:
- Oncology
- Nephrology
- Hematology
Background:
- Intravascular large cell lymphoma (ILCL) is a rare extranodal non-Hodgkin lymphoma characterized by proliferation of malignant lymphocytes within the lumina of small blood vessels.
- Diagnosis can be challenging due to its varied clinical presentations and potential to mimic other conditions.
- Renal involvement is uncommon, but can manifest as proteinuria and systemic symptoms.
Observation:
- A 60-year-old woman presented with systemic symptoms and significant proteinuria (3.5 g/day).
- Renal biopsy revealed numerous neoplastic cells obstructing glomerular capillaries.
- Immunoperoxidase staining confirmed a B-cell lineage (LCA+, L26+, MB2+).
Findings:
- The patient was diagnosed with intravascular large cell lymphoma based on renal biopsy findings.
- Initial chemotherapy with cyclophosphamide, adriamycin, vincristine, and prednisone (CAVP) induced remission.
- A subsequent relapse was successfully treated with cyclophosphamide, etoposide (VP16), and prednisone.
Implications:
- This case highlights the renal biopsy as a crucial diagnostic tool for intravascular large cell lymphoma, particularly when other sites are not initially informative.
- The successful treatment with standard chemotherapy regimens suggests that ILCL may respond to protocols used for other large cell lymphomas.
- Further research into optimal diagnostic and therapeutic strategies for ILCL, especially with renal involvement, is warranted.
Abstract:
The case is reported of a woman aged 60 yrs who presented with systemic symptoms and who was found to have proteinuria of 3.5 g per day. A renal biopsy revealed numerous neoplastic cells filling many of the glomerular capillary lumina. Immunoperoxidase stains revealed that the phenotype of the malignant cells was LCA+, L26+, MB2+, UCHL1-, CD43-, CAM5.2- and S100-, indicating that they were of lymphoid origin and B-cell lineage. The diagnosis of intravascular large cell lymphoma was therefore made. Remission was induced by chemotherapy with CAVP (cyclophosphamide, adriamycin, vincristine and prednisone). A subsequent relapse was treated with cyclophosphamide, VP16 and prednisone, and again remission occurred. This is the first case known to the authors in which the diagnosis of intravascular large cell lymphoma was made on renal biopsy. We confirm the experience of others that chemotherapy with regimens utilized in other varieties of large cell lymphoma may also be appropriate for this unusual neoplasm.
