Letters to Editor Departments of Medical Oncology, Centre Oncology-Hematology, Cadi Ayad University, Marrakech, 1National Institute of Oncology, Rabat, Morocco, 2Centre Leon Berard, Lyon, France Correspondence to: Dr. Rhizlane Belbaraka, E‑mail: [email protected]

References 1. 2. 3. 4. 5. Figure 3: CT scan showing multiple metastatic lesions in the obturator and gluteal muscles

recipient for tumors, which may be related to lactic acid metabolism. [5] These different factors that inhibit the growth of metastases in the skeletal muscle did not prevent the growth of metastases in our case. Belbarka R, Fadoukheir Z1, Delafouchardiere C2, Desseigne F2, Errihani H2

Primary renal lymphoma: An unusual presentation of non‑Hodgkin’s lymphoma

Sir, Primary renal non‑Hodgkin’s lymphoma (NHL) is a rare disease. Less than 100 of cases of primary renal Lymphoma are described.[1]

Wafflart E, Gibaud H, Lerat F, de Kersaint‑Gilly A, Leborgne J. Muscular metastasis of cancer of the pancreas. A propos of a case. J Chir (Paris) 1996;133:167‑70. Garcia OA, Fernandez FA, Satue EG, Buelta L, Val‑Bernal JF. Metastasis of malignant neoplasms of skeletal muscle. Rev Esp Oncol 1984;31:57‑67. Belloir A, Pujol J, Bruel JM, Rouanet JP, Lamarque JL. Muscular metastases: Uncommon manifestation of cystadenocarcinoma of the pancreas. J Radiol 1986;67:209‑11. Perrin AE, Goichot B, Greget M, Lioure B, Dufour P, Marcellin L, et al. Muscular metastasis as the first manifestation of an adenocarcinoma. Rev Med Interne 1997;18:328‑31. Bar‑Yehuda S, Barer F, Volfsson L, Fishman P. Resistance of muscle to tumor metastases: A role for A3 adenosine receptor agonists. Neoplasia 2001;3:125‑31. Access this article online Quick Response Code:

Website: www.indianjcancer.com DOI: 10.4103/0019-509X.146714 PMID: *****

with the compressed kidney at the periphery. Sections from the tumor show round cells having hyper‑chromatic nuclei, coarse chromatin, and scant–moderate amount of cytoplasm [Figure 2]. Some of the cells display a plasmacytoid appearance. The tumor cells are arranged in sheets and they tend to fall out from each other and have no definite architecture. Immunohistochemistry revealed CD20 positivity [Figure 3]. A staging bone marrow

It is defined as an NHL arising primarily in the renal parenchyma, not resulting from invasion of an adjacent lymphomatous mass and without evidence of systemic involvement.[1,2] We report a case of a 49‑year‑old male who presented with a history of pain and mass per abdomen since 20 days. General physical examination revealed no lymphadenopathy. Local examination revealed a mass occupying the right hypochondriac, lumbar, and iliac regions, and measuring 13 × 10 cm. Investigations revealed normal peripheral smear and negativity for HIV, hepatitis C virus (HCV), and hepatitis B surface antigen (HBsAg). Ultrasonography revealed a complex mass of mixed echogenicity at the posterior border of the right kidney measuring 14 × 12 cm [Figure 1]. With provisional diagnosis of sarcoma, laparotomy was undertaken and nephrectomy was done. We received a large single nodular, grey‑white soft tissue mass measuring 17 × 13 × 11cm. The external surface was nodular and glistening. The cut section shows a solid, grey‑white, lobular, and well‑circumscribed tumor 370

Figure 1: Pre‑operative radiologic image

Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3

Letters to Editor

Figure 3: CD20‑positive

Figure 2: Small round blue cells with scattered larger cells

biopsy did not show evidence of involvement with a B‑cell lymphoproliferative disorder. Head, chest, and pelvic computerized tomographic (CT) scans were unremarkable. Diagnosis of primary renal lymphoma‑ B cell type was made. The patient is followed up every 3 months and is doing well at the end of 1 year, without any adjuvant therapy. The pathogenesis of primary renal lymphoma is poorly understood, as the renal parenchyma is not a lymphoid organ. [2] However, HCV syndrome (HCV‑related extra‑hepatic autoimmune lymphoproliferative disorder[3]) needs to be ruled out. Histopathologically there are three patterns of renal involvement. The most common is diffuse infiltration by lymphoma cells, resulting in marked organ enlargement. The second pattern is formation of one or more tumor masses. The least common pattern is the intravascular form where lymphoma cells fill all vascular components.[1] Renal lesions that do not have the typical radiologic features of renal cell carcinoma are the main indications for fine‑needle biopsy with CT guidance. [2] Diagnostic percutaneous biopsy of a renal mass is generally unnecessary, because common non‑malignant lesions have characteristic radiographic findings and/or clinical history. Renal lymphoma, however, is important to include in the differential diagnosis of renal masses, because generally it is a systemic disease and treatment is non‑surgical. Most primary renal lymphomas disseminate rapidly from their renal origin, and mean survival is reportedly less than a year after diagnosis.[2] Our case is unique because of the nodular pattern of the tumor. In addition, a primary renal lymphoma is extremely rare and existence of primary renal lymphoma

Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3

has been a subject of debate due to the rarity of cases and the inability to rule out absolutely the presence of microscopic foci of tumor elsewhere![4‑6] The rarity of cases reported and the poor prognosis, with dissemination of disease usually resulting in death, has added weight to this argument.[4] Naveen Kumar BJ, Barman P, Chowdhury N, Bora M1 Departments of Pathology and 1Radiology, Aarupadai Veedu Medical College, Kirumampakkam, Cuddalore Road, Pondicherry, India Correspondence to: Dr. Naveen BJ, E‑mail: [email protected]

References 1. Marx A, Bonsib SM. Lymphomas. In: Eble JN, Sauter G, Epstein JI, Sesterhenn IA, editors. World Health Organization Classification of Tumors: Pathology and Genetics of Tumors of the Urinary System and Male Genital Organs. Lyon: IARC Press; 2004. p. 85. 2. Pervez H, Shaikh M, Potti A, Mehdi SA. Primary renal lymphoma. J Clin Oncol 2003;21:567‑9. 3. K h a t t a b   M A , E s l a m   M , A l a v i a n   S M . H e p a t i t i s C v i r u s a s a multifaceted disease: A simple and updated approach for extrahepatic manifestations of hepatitis C virus infection. Hepat Mon 2010;10:258‑69. 4. Eble JN, Young RH. Tumors of the urinary tract. In: Fletcher CD, editor. Diagnostic Histopathology of Tumors. 3rd ed. China: Elsevier; 2007. p. 509. 5. O’ Riordan E, Reeve R, Houghton JB, O’ Donoghue DJ, Waldek S. Primary bilateral T‑cell renal lymphoma presenting with a sudden loss of renal function. Nephrol Dial Transplant 2001;16:1487‑9. 6. O’Sullivan AW, Lee G, Fitzgerald E, O’Sullivan GC. Bilateral primary renal lymphoma. Ir J Med Sci 2003;172:44‑5.

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Primary renal lymphoma: An unusual presentation of non-Hodgkin's lymphoma.

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