Dr Gemma Scholes1, Dr Bridget Strasser1, Dr Alan Pham1, Associate Professor Gopal Basu1,2, Dr Peggy Teh1
1Alfred Health, 2Monash University Central Clinical School
Background: Mantle cell lymphoma (MCL) is an aggressive but rare form of B cell lymphoma. Most extra-nodal disease involves the bone marrow, skin or gastrointestinal tract. Renal involvement is rare and occurs in the context of extensive aggressive or relapsed disease associated with systemic symptoms.
Case report: A 62-year-old male was referred with stage 3 acute kidney injury (AKI) (serum creatinine 506 µmol/L) on routine three-monthly blood testing, in the absence of urinary symptoms, hypovolaemia, recent medication changes or systemic symptoms. He had underlying low-risk indolent MCL diagnosed from a lymph node biopsy two years earlier and was being managed with surveillance only. Notably, previous serial surveillance scans and a staging bone marrow biopsy performed just one month prior to the AKI episode showed ongoing indolent disease with stable cellularity.
Investigations revealed urinary red cell casts, without proteinuria or malignant cells. Ultrasound showed slightly enlarged kidneys without obstruction. A renal biopsy was performed, which revealed heavy interstitial infiltration of plasma cells and lymphocytes that were CD20 and Cyclin D1 positive by immunohistochemistry, consistent with MCL infiltration. This prompted initiation of chemotherapy with resultant remission and partial recovery of renal function, with a serum creatinine stable at 150-200umol/L on last follow up (two years later).
Conclusion: We report potentially the first case of seemingly indolent MCL presenting with extensive tumour infiltration of the kidney and associated AKI in an otherwise systemically well patient. The discordance between indolence of cellularity and the aggressive renal infiltration underscores the importance of pursuing a high index of suspicion for renal involvement in patients with new renal impairment and indolent hematological malignancies, as timely diagnosis and treatment significantly improves patient outcomes.
Biography:
Bio to come