Lymphoproliferative Disorders of the Kidney on Fine Needle Aspiration: A Study of 34 Cases
Andrea P Subhawong, Ty K Subhawong, Momin T Siddiqui, Syed Z Ali. Johns Hopkins, Baltimore, MD; Emory, Atlanta, GA
Background: While extranodal spread of non-Hodgkin lymphoma (NHL) frequently affects the kidneys, primary renal lymphoma is rare. Making the diagnosis can be challenging in limited cytologic specimens. We review our experience with lymphoproliferative disorders in the kidney diagnosed by fine needle aspiration (FNA), with a focus on clinico-pathologic and radiographic features.
Design: All cases of NHLs diagnosed on renal FNA at two large academic institutions from 1989 until 2011 were reviewed. Demographics, clinical history, radiographic and cytomorphologic features, and follow-up were assessed.
Results: 34 cases were identified, 32 of which had available cytologic material for review. There were 16 primary tumors, 15 recurrences/secondary tumors, 2 post-transplant lymphoproliferative disorders, and 1 acute lymphoblastic lymphoma (ALL). There were 24 males and 10 females with an age range of 4.6 to 86.4 years (average 54.4 years). All lesions were of B-cell origin; the majority were aggressive/high grade (26/34). 25 of 34 cases were substantiated by positive flow cytometry results. The most common presenting symptom was pain, although the majority of lesions were detected at follow-up/incidentally. 21 cases presented as a solitary renal mass; the remaining cases showed multiple renal and or retroperitoneal masses. Salient radiologic features included hypodense, infiltrative, and ill-defined masses. Cytomorphologic characteristics included a monotonous population of large and atypical lymphoid cells, often with lymphoglandular bodies. Flow cytometry either displayed an abnormal population with clonal light chain expression or expression of blast markers (ALL case). Follow-up was available for 27 cases; 15 patients died of disease with a mean survival of 3.0 years (range 1 month to 8 years).
Conclusions: Renal lymphoma is an aggressive disease of older adults that is usually high grade. Although recurrences and/or systemic spread of lymphoma to the kidneys is far more common that primary tumors, involvement in these cases may not be documented by biopsy. Cytologic diagnosis of renal lymphoma requires analysis of morphological, clinical and immunophenotypic information. Certain helpful features for diagnosis include: flank pain and/or acute renal failure in an older patient, prior history of lymphoma, multiple homogeneous renal masses on CT, a monotonous population of large abnormal cells in a background of lymphoglandular bodies, and immunophenotyping demonstrating light chain restriction.
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 92, Wednesday Afternoon