Abstract: SA-PO140
Clinching the Diagnosis: A Case of Marginal Zone Lymphoma Diagnosed on Kidney Biopsy
Session Information
- Onconephrology: Clinical and Research Advances - II
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
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
| Endocrine | ACE: 59 nmol/ml/min PTH: 4 pg/ml PTHrP: negative X 2 Vit-D: wnl LDH: wnl |
| Hematology | Paraprotein 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 Disease | EBV: neg HHV8: neg HIV: neg CMV: neg HHV6: eg Quant Gold: neg |
| Imaging | Mammogram: 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 |
| Rheumatology | ANA: negative Anti CCP: neg RF: neg DsDNA:371 VEGF: wnl |
| Pathology | Parotid 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