Renal lymphoma is usually seen as a part of spectrum of multi-systemic lymphoma, however, rarely may be seen as a primary disease.
While renal lymphoma has autopsy incidence of 30-60% in lymphoma patients, actual CT diagnosis incidence is ~ 5%1.
The kidneys are the most common abdominal organ affected by lymphoma. Most instances are are B-cell non-Hodgkin lymphoma and primary renal lymphoma are rare (<1%).
Involvement of kidneys in Hodgkin lymphoma is rare (<1%).
Flank pain, weight loss, hematuria or palpable mass. Acute renal failure may be seen in infiltrative disease.
Renal lymphoma occurs commonly with non-Hodgkin lymphoma. Majority have intermediate or high-grade lymphomas including Burkitt and histiocytic varieties 2. Most are B-cell lymphoma. Gross macroscopy reveals fleshy or firm yellow, tan or gray tumours of 1-20 cm size.
Fluoroscopy - IVU
It is the most sensitive imaging for involvement of renal collecting system and ureters, as well as provides functional information.
Hypoechoic lesions (single/multiple) within renal parenchyma with very little internal vascularity.
Six patterns are recognised:
- multiple masses: most common (up to 60%), 1-3 cm in size, associated with enlarged retroperitoneal nodes (≥50%)
- single mass: second most common (≥20%), Up to 15 cm, homogeneous, hypodense without cystic change, calcium, bleed or necrosis
- invasion from retroperitoneal nodal mass: seen in ≥30%, usually > 10 cm, encasement of vessels without thrombosis, +/- hydronephrosis
- diffuse infiltration = enlarged kidney(s): seen in up to 20%, no discrete mass, usually bilateral, seen with Burkitt’s
- perirenal mass: seen in <10%, perirenal stranding, thickening of Gerota’s fascia, perirenal nodules
- atypical patterns: spontaneous haemorrhage, necrosis, heterogenous lesion, cystic changes, calcification
Features include 3:
- T1: hypointense to renal parenchyma
- T2: iso or hyperintense to renal parenchyma
- Gad (C+): poor enhancement compared to renal parenchyma; delayed enhancement is seen in some lesions
Imaging differential considerations include:
- renal cell carcinoma: usually heterogenous, with vascular invasion
- metastases to kidney
- transitional cell carcinoma
- acute pyelonephritis
- xanthogranulomatous pyelonephritis
- retroperitoneal fibrosis
- metastatic adenocarcinoma
- overview of lymphoma
WHO classification of tumours of haematopoietic and lymphoid tissues
- Hodgkin lymphoma
mature B-cell lymphoma
- Burkitt lymphoma
- follicular lymphoma
- lymphoplasmacytic lymphoma (Waldenström's macroglobulinaemia)
- lymphomatoid granulomatosis
- mantle cell lymphoma
- mature T-cell and NK-cell lymphoma
- post-transplant lymphoproliferative/lymphoproliferation disorders
- mature B-cell lymphoma
- location-specific lymphomas
- central nervous system
- head and neck lymphoma
- thoracic lymphoma
- gastrointestinal lymphoma
- hepatobiliary lymphoma
- genitourinary lymphoma
- musculoskeletal lymphoma
- cutaneous lymphoma
- lymphoma staging
- 1. Urban BA, Fishman EK. Renal lymphoma: CT patterns with emphasis on helical CT. Radiographics. 20 (1): 197-212. Radiographics (full text) - Pubmed citation
- 2. Hartman DS, David CJ, Goldman SM et-al. Renal lymphoma: radiologic-pathologic correlation of 21 cases. Radiology. 1982;144 (4): 759-66. Radiology (abstract) - Pubmed citation
- 3. Sheth S, Ali S, Fishman E. Imaging of renal lymphoma: patterns of disease with pathologic correlation. Radiographics. 2006;26 (4): 1151-68. doi:10.1148/rg.264055125 - Pubmed citation