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A Rare Case of Massive Bilateral Renomegaly due to Primary Involvement by Mantle Cell Lymphoma on 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography
Address for correspondence: Dr. Rajender Kumar, Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail: drrajender2010@gmail.com
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Received: ,
Accepted: ,
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This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Mantle cell lymphoma (MCL) is a rare subtype of B-cell non-Hodgkin's lymphoma with an annual incidence of 5%, common in men with a median age of 60–70 years. Renal involvement is seen in about 0.7% of the extranodal lymphomas. The bilateral presentation is seen in 10%–20% of cases. There have been many case reports of MCL with renal involvement; however, primary renal involvement by MCL is extremely rare. We hereby describe the 18F-fluorodeoxyglucose positron emission tomography/computed tomographic findings in primary MCL involving the bilateral kidneys.
Keywords
18F-Fluorodeoxyglucose positron emission tomography/computed tomography
Mantle cell lymphoma
renal involvement
A 62-year-old man was found to have raised serum urea and creatinine levels on a routine check-up. On further clinical examination, he had enlarged cervical and inguinal lymph nodes. In view of raised serum urea and creatine levels, ultrasonography (USG) of the abdomen was done, which demonstrated grossly enlarged bilateral kidneys. A USG-guided core needle biopsy from the kidney revealed Mantle cell lymphoma (MCL), which was diffusely positive for CD20, SOX11, cyclin D1, and Ki67 (5%–10%) and correlated with (11;14) translocation CCND1 expression.
He underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging workup. The maximum intensity projection image [Figure 1a], coronal fused PET/CT image [Figure 1b], and coronal CT image [Figure 1c] revealed FDG avid lymph nodes on both sides of the diaphragm [dashed arrows in Figure 1a] and FDG avid bilateral grossly enlarged kidneys [solid arrows in Figure 1a] showing FDG uptake in the massively enlarged kidneys (right kidney ~21.5 cm × 11.9 cm, maximum standard uptake value [SUV max] 5.5 and left kidney ~20.5 cm × 12.0 cm, SUV max 5.9).
MCL is a rare subtype of B-cell non-Hodgkin's lymphoma, having an incidence of 5% with renal involvement of 0.7% and the bilateral presentation of 10%–20% of the cases.[1] MCL is a rare disease arising from mature B-lymphocytes and generally involves lymph nodes with common extranodal involvement, bone marrow, spleen, gastrointestinal tract, and Waldeyer ring.[2] Renal involvement of MCL is very rare and usually presents as acute kidney injury due to proliferative glomerulonephritis, focal segmental glomerulosclerosis, or tubulointerstitial nephritis with mildly enlarged kidneys.[3456] The usefulness of FDG/PET in MCL was well established in the literature, with pretreatment PET scans being positive in 94%–100%.[78] The positivity for SOX11, a specific MCL marker, correlates with (11;14) translocation, CCND1 expression, and an adverse prognosis.[9] Primary MCL involving bilateral kidneys is extremely rare. The present case highlights the 18F-FDG-PET/CT findings in a rare case of primary MCL involvement of bilateral kidneys.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- Cutaneous presentation of Mantle cell lymphoma. Acta Derm Venereol. 2010;90:548-50.
- [Google Scholar]
- CD10-positive blastoid Mantle cell lymphoma with secondary cutaneous involvement. J Cutan Pathol. 2013;40:765-7.
- [Google Scholar]
- Membranoproliferative glomerulonephritis, Mantle cell lymphoma infiltration, and acute kidney injury. Int Urol Nephrol. 2013;45:1489-94.
- [Google Scholar]
- Successful treatment of focal segmental glomerulosclerosis in association with Mantle cell lymphoma. Ren Fail. 2007;29:363-6.
- [Google Scholar]
- Acute renal failure due to Mantle cell lymphoma – A case report and discussion of the literature. Clin Nephrol. 2007;67:394-6.
- [Google Scholar]
- Acute tubulo-interstitial nephritis associated with Mantle cell lymphoma presented as acute renal failure. Nephrology (Carlton). 2007;12:107-8.
- [Google Scholar]
- Positron emission tomography in Mantle cell lymphoma. Leuk Lymphoma. 2008;49:1693-701.
- [Google Scholar]
- Utility of positron emission tomography scans in Mantle cell lymphoma. Am J Hematol. 2011;86:841-5.
- [Google Scholar]
- SOX11 overexpression is a specific marker for Mantle cell lymphoma and correlates with t (11;14) translocation, CCND1 expression and an adverse prognosis. Leukemia. 2013;27:2388-91.
- [Google Scholar]