J Pathol Transl Med.  2020 Sep;54(5):426-431. 10.4132/jptm.2020.06.18.

Renal intravascular large B cell lymphoma: the first case report in Korea and a review of the literature

• Kim M
• Chung H
• Yang WI
• Jeong HJ

• KMID: 2506276
• DOI: http://doi.org/10.4132/jptm.2020.06.18

Abstract

Herein, we describe the first case of renal intravascular large B cell lymphoma in Korea occurring in a 66-year-old female. She presented with mild fever and dyspnea. On physical and laboratory evaluations, hemophagocytic lymphohistiocytosis was suspected, but the bone marrow biopsy results were unremarkable. During the work-up, massive proteinuria developed, which led to a renal biopsy. The renal architecture was relatively well-preserved, but the glomeruli were hypercellular with the infiltration of atypical, large lymphoid cells with increased nucleus-cytoplasm ratio and clumped chromatin. Similar cells were also present in the peritubular capillaries. The tumor cells exhibited membranous staining for CD20 and CD79a. After the diagnosis of intravascular large B cell lymphoma, the patient received rituximab-based chemotherapy under close follow-up.

Keyword

Intravascular large B cell lymphoma; Kidney glomerulus; Peritubular capillary

Figure

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  Fig. 1. Positron emission tomography (PET) images (18F-Fluorodeoxyglucose PET). (A) Maximal intensity projection image. PET–computed tomography image of the lung (B), liver (C), and axial bones (D).

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  Fig. 2. Histopathologic findings and immunohistochemical staining results of renal intravascular large B cell lymphoma. (A) Atypical large lymphoid cells are confined to the lumina of the glomerular capillaries. (B) On higher magnification, malignant lymphoid cells exhibited nuclear size variation, chromatin clumping, and scant cytoplasm. (C) Some atypical lymphoid cells are scattered in the peritubular capillaries. On immunohistochemical staining, these atypical lymphoid cells demonstrated strong membranous positivity for CD20 (D) and CD79a (E). (F) The Ki-67 proliferation index was 80%.

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  Fig. 3. Representative electron microscopy of the kidney. (A) Atypical large lymphoid cells are present in the glomerular capillary lumen, and the podocytes exhibit diffuse foot process effacement (× 1,500). (B) On high power magnification, the atypical large lymphoid cell (arrow) shows prominent nucleoli and chromatin clumping (×3,000).

Reference

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