A case of primary renal lymphoma that was difficult to differentiate from invasive urothelial carcinoma, lymphoma-like/plasmacytoid variant

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  • リンパ腫様型/形質細胞腫型尿路上皮癌との鑑別に苦慮した腎門部発生悪性リンパ腫の 1 例

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Abstract

<p>Background : We report a case of diffuse large B-cell lymphoma (DLBCL) arising in the renal pelvis, that was misdiagnosed by preoperative urinary cytology as invasive urothelial carcinoma, lymphoma-like/plasmacytoid variant (PUC).</p><p>Case : The patient was a man in his 60 s who was suspected as having a left renal tumor and referred to the urology department of our hospital. Urinary cytology showed scattered small tumor cells with round nuclei in an inflammatory background. The tumor cells showed a high N/C ratio and the nuclei contained fine granular chromatin. A few atypical cells were also seen, with irregular nuclei and prominent nucleoli. Based on these cytological findings, we diagnosed the tumor as PUC.</p><p>Histopathological examination of the excised kidney specimen revealed a diffuse proliferation of tumor cells with round nuclei in the subepithelium of the renal pelvis. The tumor cells were round and mononuclear, had a high N/C ratio and irregular nuclei containing prominent nucleoli, and lymphocytes and plasma cells were admixed with the tumor cells. Based on the above histological findings and results of immunostaining, we diagnosed the tumor as a DLBCL.</p><p>Conclusion : Primary renal lymphoma is a very rare tumor, and it is difficult to distinguish DLBCL from PUC by urinary cytology alone. However, this tumor should be borne in mind in cases showing atypical cells in clusters, with irregular and constricted nuclei, and polymorphic cell diameters.</p>

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