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Abstract: PO2205

A Rare Case of Composite Lymphoma with Kidney Infiltration of Nodal Marginal Zone B Cell Lymphoma and Three Different Types of Cast Nephropathy

Session Information

  • Onco-Nephrology - 2
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Guan, Tianjun, Division of Nephrology, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
  • Li, Yu, Division of Nephrology, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
  • Chen, Anqun, Division of Nephrology, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
Introduction

We present an interesting case of composite lymphoma (nodal marginal zone B-cell lymphoma and multiple myeloma) characterized by the rare kidney invasion of the nodal marginal zone B-cell lymphoma and three different types of cast nephropathy present simultaneously in patient with multiple myeloma.

Case Description

A 57-year-old Chinese male was admitted to hospital for proteinuria. He reported foam urine, abdominal distension, fatigue, and weight loss of 5 kg within one month. Laboratory tests demonstrated hemoglobin 108 g/L, blood urea nitrogen 27.1 mmol/L, serum creatinine 639.1 umol/L and urine acid 547 umol/L. The 24-hour urinary protein and microalbumin was 3193.3mg and 42.3mg, respectively. Immunofixation electrophoresis (IFE) showed IgD-Lambda+Lambda monoclonal protein. MRI identified diffuse osseous lesions. Bone marrow aspirate and biopsy demonstrated a hypercellular marrow with extensive plasma cell infiltration. Besides, multiple lymphadenopathies in both axillary and bilateral Inguinal lymph nodes were noticed. Lymph node biopsy suggested a nodal marginal zone B-cell lymphoma. To explore the involvement of kidney injury, we performed a kidney biopsy. Surprisingly, we found three types of nephropathy (myeloma casts, light chain crystal structure and light chain amyloidosis). At the same time, we also found focal lymphocyte infiltration, which are confirmed of nodal marginal zone B-cell lymphoma by immunohistochemistry with various molecule markers. To further explore the relationship between the two tumors, we performed the whole genome exon sequencing of the bone marrow and lymph nodes, surprisingly we found the similar mutation sites (V1982I of ARID1A gene) in both tissues, suggesting that the two tumors might originated from the same mutation. After BCT chemotherapy and PAD-T chemotherapy, urea nitrogen and blood creatinine decreased, the patients get rid of hemodialysis.

Discussion

nodal marginal zone B-cell lymphoma infiltrate kidney only is very rare. Also three kinds of nephropathy (myeloma casts, light chain crystal structure and light chain amyloidosis). present simultaneously is also very rare. And the sequencing of the genome exon suggested that nodal marginal zone B-cell lymphoma might developed in to multiple myeloma in bone marrow micro-environment.