Renal lymphoma

Renal lymphoma is usually a part component of multi-systemic lymphoma - primary renal lymphoma is unusual.

Typical imaging findings are multiple bilateral hypodense or infiltrative renal masses.

While renal lymphoma has an autopsy incidence of ~45% (range 30-60%) in lymphoma patients, the incidence by CT evaluation is ~5% 1.

The kidneys are the most common abdominal organ affected by lymphoma. Most instances are B-cell non-Hodgkin lymphoma; primary renal lymphoma is rare (<1%).

Involvement of kidneys in Hodgkin lymphoma is rare (<1%).

Patients present with flank pain, weight loss, hematuria, or a palpable mass. Acute renal failure may be seen in infiltrative disease.

Renal lymphoma occurs commonly with non-Hodgkin lymphoma. The majority have intermediate or high-grade lymphomas including Burkitt and histiocytic varieties 2. Most are B-cell lymphoma.

On gross examination, lesions are fleshy or firm yellow, tan, or grey tumors of 1-20 cm size.

It is the most sensitive imaging for the involvement of the renal collecting system and ureters, as well as provides functional information.

Hypoechoic lesions (single/multiple) within renal parenchyma with very little internal vascularity.

The following patterns of disease may be seen on CT:

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

Features include 3:

  • T1: hypointense to renal parenchyma
  • T2: iso or hyperintense to renal parenchyma
  • Gad (C+):
    • poor enhancement compared to renal parenchyma
    • delayed enhancement is seen in some lesions

Imaging differential considerations include:

Lymphoma
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Article information

rID: 16653
Synonyms or Alternate Spellings:
  • Lymphoma of kidney

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Cases and figures

  • Case 1: multifocal visceral lymphoma
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  • Case 2
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  • Case 3
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