The patient is a 54-year-old male who presented with a 2-month history of fever, fatigue, weight loss, and reduced appetite. Ultrasound revealed lesions in the pancreas and bilateral kidney tissues. A biopsy was consistent with diffuse large B cell lymphoma. Renal lymphoma can involve the kidneys primarily (primary renal lymphoma) or secondarily with widespread disease elsewhere (secondary renal lymphoma). It most commonly appears on imaging as multiple small masses but can also appear as a single large mass, retroperitoneal nodal invasion, diffuse infiltration, or perirenal involvement. Treatment involves chemotherapy such as R-CHOP which may improve renal function and survival rates.

1. MORNING CASE
Nhóm 8
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2. LÂM SÀNG
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 Bệnh nhân nam 54 tuổi
 Vào viện vì sốt kéo dài 2 tháng nay, mệt mỏi, ăn uống
kém, sút 5kg/ 2 tháng
 Khám, siêu âm phát hiện các tổn thương ở tụy và nhu mô
thận hai bên.

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very little internal vascularity

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8. KQ GPB
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9. Renal Lymphoma
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10. RENAL LYMPHOMA
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Renal involvement in lymphoma
commonly occurs in the presence of
widespread nodal or extranodal
lymphoma and is classified as
secondary renal lymphoma (SRL).
However, lymphoma may rarely involve
the kidneys alone without evidence of
disease elsewhere; then, it is termed
“primary renal lymphoma” (PRL)

11. Epidemiology
 While renal lymphoma has an autopsy incidence of ~45%
(range 30-60%) in lymphoma patients, the incidence by
CT evaluation is ~5%.
 The kidneys are the most common abdominal organ
affected by lymphoma. Most instances are B-cell non
Hodgkin lymhoma ; primary renal lymphoma is rare
(<1%).
 Involvement of kidneys in Hodgkin lypmphoma is rare
(<1%).
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Pathology
- On gross examination, lesions
are fleshy or firm yellow, tan, or
grey tumors of 1-20 cm size.
- Renal lymphoma occurs
commonly with non-Hodgkin
lymphoma. The majority have
intermediate or high-grade
lymphomas including Burkitt and
histiocytic varieties. Most are B-
cell lymphoma.

13. Clinical Presentation
- Patients present with flank pain, weight loss, hematuria, or
a palpable mass.
- Acute renal failure may be seen in infiltrative disease also
been described but is quite rare.
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14. Hypoechoic lesions
(single/multiple) within
renal parenchyma with
very little internal
vascularity.
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Radiographic features: Ultrasound

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16. Radiographic features: CT- Scaner
 multiple masses (up to 60%:
most common pattern)
 typically 1-3 cm in size
 associated with enlarged
retroperitoneal nodes (≥50%)
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17. Radiographic features: CT- Scaner
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 single mass (over 20% of cases)
 up to 15 cm
 homogeneous, hypodense without cystic
change
 calcium, bleed, or necrosis

18. Radiographic features: CT- Scaner
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 invasion from retroperitoneal
nodal mass (over 30% of
cases)
 usually >10 cm
 encasement of vessels without
thrombosis, +/- hydronephrosis
 diffuse infiltration (up to 20%
of cases)
 no discrete mass
 usually bilateral
 Seen with Burkitt lymphoma

19. Radiographic features: CT- Scaner
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 perirenal mass (less than 10% of cases)
 perirenal stranding
 thickening of Gerota fascia
 perirenal nodules
 atypical patterns:
 spontaneous hemorrhage
 necrosis
 heterogenous lesion
 cystic changes
 calcification

20. Biopsy was
consistent
with diffuse large
B cell lymphoma.
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u lympho
xâm nhập

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30. MRI
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Features include:
T1: hypointense to renal parenchyma
T2: iso or hyperintense to renal parenchyma
Renal lymphoma tends to show restricted diffusion
Gad (C+):
poor enhancement compared to renal parenchyma
delayed enhancement is seen in some lesions

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34. Treatment and prognosis
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 Traditionally, PRL was reported to be associated with a poor prognosis
 SRL can result in acute renal failure in 6–16% or impaired renal function
in nearly one fourth of patients.
 Tumor size larger than 10 cm, involvement of the renal hilum, and diffuse
renal infiltration may be associated with a poorer prognosis
 Early diagnosis and chemotherapy involving rituximab,
cyclophosphamide, doxorubicin, vincristine, and prednisolone (“R-
CHOP”) may improve renal function within 2–4 weeks of initiating therapy
and may improve 5-year survival rates

35. Conclusion
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- Renal lymphomas are associated with various imaging
appearances on CT and MRI.
- The disease may be unilateral or bilateral and may present as
focal masses (solitary or multiple) or diffuse infiltrative lesions or
may manifest as enlarged kidneys without focal lesions.
- Knowledge of the imaging spectrum of PRL and SRL and the
potential confounding diagnoses will enable the radiologist to
suggest a renal biopsy when necessary, prevent an unnecessary
nephrectomy, and also avoid a delay in initiating the appropriate
therapy.

36. THANK YOU…
FOR YOUR
LISTENING AND
ATTENSION
36