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Kidney Week

Abstract: SA-PO140

Clinching the Diagnosis: A Case of Marginal Zone Lymphoma Diagnosed on Kidney Biopsy

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Gertze, Chelsea, Loyola University Health System, Maywood, Illinois, United States
  • Vellanki, Kavitha, Loyola University Health System, Maywood, Illinois, United States
  • Picken, Maria M., Loyola University Health System, Maywood, Illinois, United States
Introduction

Marginal zone lymphomas are low-grade non-Hodgkin B-cell lymphomas that rarely has renal involvement. We describe a case of lymphmatous involevement of the kidneys.

Case Description

A 73-year-old female with h/o breast cancer, HTN, HLD, hypothyroidism, monoclonal gammopathy was transferred from an outside hospital for evaluation as extensive work up (as shown in table 1) for diffuse lymphadenopathy, hypercalcemia, acute kidney injury, was inconclusive despite high clinical suspicion for metastasis. Labs were significant for Cr 2.29 (baseline 1.3) calcium 11.3 and ionized calcium 1.8. In the setting of worsening renal function and no unifying diagnosis, the decision was made to pursue kidney biopsy. Biopsy results were consistent with low grade B-Cell Lymphoma with plasmacytic differentiation most consistent with marginal zone lymphoma (Figure 1). The patient underwent guideline directed therapy with normalization in her serum calcium and return of renal function near her baseline.

Discussion

This case illustrates the rarity of low grade b cell lymphoma involvement of the kidneys and the role of kidney biopsy in establishing a diagnosis despite multiple an ehaustive work up. At a time where there is a huge debate regarding the necessity of biopsy as a requirement for nephrology training graduation, our case emphasizes that kidney biopsy as diagnostic tool still reigns supreme.

Completed Work Up During 8 Months Prior to Presentation
EndocrineACE: 59 nmol/ml/min
PTH: 4 pg/ml
PTHrP: negative X 2
Vit-D: wnl
LDH: wnl
HematologyParaprotein studies
Serum:
IgG: 2206; IgA: 170; IgM: 147
Kappa: 122.1; Lambda: 55.4; Ratio: 2.20
Immunofixation: IgG-K
SPEP: 1.3 g/dL
Urine: 24H
Infectious DiseaseEBV: neg
HHV8: neg
HIV: neg
CMV: neg
HHV6: eg
Quant Gold: neg
ImagingMammogram: neg
CT C/A/P: diffuse intrathoracic, intra-abdominal, intrapelvic lymphadenopathy, pulmonary nodules,enhancing hepatic lesions
PET-CT: multiple solid and part solid pulmonary nodules,
left greater than right, with hypermetabolic activity.
Supradiaphragmatic, subdiaphragmatic hypermetabolic lymph nodes
RheumatologyANA: negative
Anti CCP: neg
RF: neg
DsDNA:371
VEGF: wnl
PathologyParotid Gland FNA: negative for malignancy
Left Lower Lobe Lung Wedge Resection:negative for malignancy
Mediastinal Lymph Node Biopsy x2: negative for malignancy
Bone Marrow Biopsy:
Normocellular at 30%
Plasma cells < 1%
Cytology: normal karyotype
Negative myeloma FISH panel

Kidney Biopsy with CD20 positivity