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Diagnosis: Small lymphocytic lymphoma (SLL) Involving the Renal Parenchyma

The monotonous appearance of the lymphocytic infiltrate led us to think about the possibility of a lymphoma. Our coleague hematopathologist diagnosed small lymphocytic lymphoma (SLL). Abdominal nodes were also involved.

Kidney diseases are frequently associated with hematologic malignancies. Depending on the type and stage of the malignancy, the spectrum of kidney pathology can be particularly wide, including immune-mediated glomerulonephritis, interstitial monoclonal infiltration and tubular obstruction. Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) are two different presentations of the most frequent B-cell neoplasm in adults in Western countries, with an annual incidence of 4–30 cases per 100,000 persons per year. Although most patients remain asymptomatic, the clinical features of CLL/SLL are highly variable, including presentation, course and outcome (Poitou-Verkinder AL, et al. The spectrum of kidney pathology in B-cell chronic lymphocytic leukemia / small lymphocytic lymphoma: a 25-year multicenter experience. PLoS One. 2015;10(3):e0119156. [PubMed link]).

Renal interstitial infiltration is a frequent finding in autopsy series of CLL patients, estimated between 44 and 90% of patients. The B-cell infiltrate can either be nodular or diffuse, and its localization classically begins in the subcapsular cortex, at the corticomedullar junction, and along the vasa recta. In many cases, the lymphocytes are monotypic and presented a monomorphic, regular, and mature aspect, separating and directly infiltrating the tubular epithelium, surrounded by local accumulation of extracellular matrix. Usually, the infiltration of the kidneys by monoclonal B cells is bilateral, asymptomatic, and is diagnosed or suspected in late stages of the disease. Even a massive infiltration of both kidneys can remain totally asymptomatic. Urine sediment is usually normal, and proteinuria < 1 g/d. On the other hand, kidney infiltration can present as acute kidney failure or moderate chronic kidney disease (Poitou-Verkinder AL, et al. The spectrum of kidney pathology in B-cell chronic lymphocytic leukemia / small lymphocytic lymphoma: a 25-year multicenter experience. PLoS One. 2015;10(3):e0119156. [PubMed link]).

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References

• Tees MT, Flinn IW. Chronic lymphocytic leukemia and small lymphocytic lymphoma: two faces of the same disease. Expert Rev Hematol. 2017;10(2):137-146. [PubMed link]
• Poitou-Verkinder AL, Francois A, Drieux F, Lepretre S, Legallicier B, Moulin B, Godin M, Guerrot D. The spectrum of kidney pathology in B-cell chronic lymphocytic leukemia / small lymphocytic lymphoma: a 25-year multicenter experience. PLoS One. 2015;10(3):e0119156. [PubMed link]
• Nasr SH, Shanafelt TD, Hanson CA, Fidler ME, Cornell LD, Sethi S, Chaffee KG, Morris J, Leung N. Granulomatous interstitial nephritis secondary to chronic lymphocytic leukemia/small lymphocytic lymphoma. Ann Diagn Pathol. 2015;19(3):130-6. [PubMed link]
• Santos FP, O'Brien S. Small lymphocytic lymphoma and chronic lymphocytic leukemia: are they the same disease? Cancer J. 2012;18(5):396-403. [PubMed link]

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