Renal lymphoma

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.

Associations
Fluoroscopy - IVU

It is the most sensitive imaging for involvement of renal collecting system and ureters, as well as provides functional information.

Ultrasound

Hypoechoic lesions (single/multiple) within renal parenchyma with very little internal vascularity.

CT

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
MRI

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:

Lymphoma
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Article information

rID: 16653
Section: Pathology
Tag: cases
Synonyms or Alternate Spellings:
  • Lymphoma of kidney

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Cases and figures

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    Case 1: multifocal visceral lymphoma
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