Large cell non-Hodgkin's lymphoma masquerading as renal carcinoma with ...
IntroductionMany cancers are associated with inferior vena cava (IVC) obstruction, but very few cancers have the ability to propagate within the lumen of the renal vein or the IVC. Renal cell carcinoma is the most common of these cancers.Renal cancer with IVC extension has a high rate of recurrence and a low five year survival rate.Case presentationA 62-year-old Caucasian woman previously in good health developed the sudden onset of severe reflux symptoms and right-sided abdominal pain that radiated around the right flank. A subsequent ultrasound and CT scan revealed a right upper pole renal mass with invasion of the right adrenal gland, liver, left renal vein and IVC.
This appeared to be consistent with stage III renal cancer with IVC extension. Metastatic nodules were believed to be present in the right pericardial region; the superficial anterior abdominal wall; the left perirenal, abdominal and pelvic regions; and the left adrenal gland.
The pattern of these metastases, as well as the invasion of the liver by the tumor, was thought to be atypical of renal cancer. A needle biopsy of a superficial abdominal wall mass revealed a surprising finding: The malignant cells were diagnostic of large-cell, B-cell non-Hodgkin's lymphoma.
The lymphoma responded dramatically to systemic chemotherapy, which avoided the need for nephrectomy.
Conclusion: Lymphomas only rarely progress via intraluminal vascular extension. We have been able to identify only one other case report of renal lymphoma with renal vein and IVC extension.
While renal cancer would have been treated with radical nephrectomy and tumor embolectomy, large-cell B-cell lymphomas are treated primarily with chemotherapy, and nephrectomy would have been detrimental. It is important to remember that, rarely, other types of cancer arise from the kidney which are not derived from the renal tubular epithelium.
These may be suspected if an atypical pattern of metastases or unusual invasion of surrounding organs is present. A pre-operative or intraoperative biopsy may be helpful in these cases.
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A needle biopsy of a superficial abdominal wall mass revealed a surprising finding: The malignant cells were diagnostic of large-cell, B-cell non-Hodgkin's lymphoma. The lymphoma responded dramatically to systemic chemotherapy, which avoided the need
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NICE Recommends Treatment Option For Non-Hodgkin's Lymphoma – New ...
The National Institute for Health and Clinical Excellence (NICE) has recommended a new maintenance treatment that can help delay the growth and spread of follicular non-Hodgkin’s lymphoma. The final guidance issued today states that rituximab (Mabthera, Roche Products) can be used as a first-line maintenance treatment in people with follicular non-Hodgkin’s lymphoma that has responded to first-line induction therapy with rituximab in combination with chemotherapy.
Professor Peter Littlejohns, Clinical and Public Health Director at NICE, said: “We are pleased to be able to recommend that the NHS in England and Wales fund this treatment option which could help improve the lives of hundreds of patients. Current NHS practice is for doctors to wait until the cancer begins to grow again before giving patients more treatment. However, the independent Appraisal Committee concluded that the evidence demonstrates that this drug works well as a maintenance treatment for patients, and offers value for money for the NHS.”
Notes
About this guidance
1. The final guidance is available to view from Wednesday 22 June 2011.
2. The final guidance recommends rituximab maintenance therapy as an option for the treatment of people with follicular non-Hodgkin’s lymphoma that has responded to first-line induction therapy with rituximab in combination with chemotherapy.
3. A maintenance treatment is used to stop a cancer from growing following initial chemotherapy. Induction therapy is a type of treatment that is first given to a patient to reduce the size of the cancer or stop the cancer from progressing.
4. Standard clinical practice for these patients, around 1600 in the UK (according to the manufacturer’s submission) is for doctors to wait for the cancer to grow again following successful induction therapy, before giving them further treatment. However the evidence presented to NICE’s independent committee by the manufacturer, and advice from clinical specialists suggest that treating patients with rituximab maintenance after induction therapy may prevent the spread and growth of this cancer for at least 3-4 years.
The manufacturer’s economic modelling also convinced the committee that first-line rituximab maintenance treatment for patients with follicular non-Hodgkin’s lymphoma could be a cost-effective use of NHS resources compared with current clinical practice (observation).
Non Hodgekins Lymphoma - Bookshelf
Non-Hodgkin Lymphomas
This edition is the first text using the new World Health Organization classification of non-Hodgkin lymphomas.Hodgkin's and non-hodgkin's lymphoma
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Non-Hodgkin Lymphoma Home Page - National Cancer Institute
Information about non-Hodgkin lymphoma treatment, clinical trials, research, statistics, and other topics from the National Cancer Institute.
Non-Hodgkin Lymphoma
Non-Hodgkin lymphoma is a disease in which cancer cells form in a person's lymphatic system and start to grow uncontrollably.
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