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Year : 2022  |  Volume : 37  |  Issue : 3  |  Page : 299-300  

A rare case of massive bilateral renomegaly due to primary involvement by mantle cell lymphoma on 18F-fluorodeoxyglucose positron emission tomography/computed tomography


1 Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission04-Mar-2022
Date of Acceptance04-Apr-2022
Date of Web Publication02-Nov-2022

Correspondence Address:
Dr. Rajender Kumar
Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.ijnm_44_22

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   Abstract 


Mantle cell lymphoma (MCL) is a rare subtype of B-cell non-Hodgkin's lymphoma with an annual incidence of 5%, common in men with a median age of 60–70 years. Renal involvement is seen in about 0.7% of the extranodal lymphomas. The bilateral presentation is seen in 10%–20% of cases. There have been many case reports of MCL with renal involvement; however, primary renal involvement by MCL is extremely rare. We hereby describe the 18F-fluorodeoxyglucose positron emission tomography/computed tomographic findings in primary MCL involving the bilateral kidneys.

Keywords: 18F-Fluorodeoxyglucose positron emission tomography/computed tomography, Mantle cell lymphoma, renal involvement


How to cite this article:
Solanki R, Kavanal AJ, Singh H, Kumar R, Prakash G. A rare case of massive bilateral renomegaly due to primary involvement by mantle cell lymphoma on 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Nucl Med 2022;37:299-300

How to cite this URL:
Solanki R, Kavanal AJ, Singh H, Kumar R, Prakash G. A rare case of massive bilateral renomegaly due to primary involvement by mantle cell lymphoma on 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Nucl Med [serial online] 2022 [cited 2022 Nov 29];37:299-300. Available from: https://www.ijnm.in/text.asp?2022/37/3/299/360262



A 62-year-old man was found to have raised serum urea and creatinine levels on a routine check-up. On further clinical examination, he had enlarged cervical and inguinal lymph nodes. In view of raised serum urea and creatine levels, ultrasonography (USG) of the abdomen was done, which demonstrated grossly enlarged bilateral kidneys. A USG-guided core needle biopsy from the kidney revealed Mantle cell lymphoma (MCL), which was diffusely positive for CD20, SOX11, cyclin D1, and Ki67 (5%–10%) and correlated with (11;14) translocation CCND1 expression.

He underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging workup. The maximum intensity projection image [Figure 1]a, coronal fused PET/CT image [Figure 1]b, and coronal CT image [Figure 1]c revealed FDG avid lymph nodes on both sides of the diaphragm [dashed arrows in [Figure 1]a] and FDG avid bilateral grossly enlarged kidneys [solid arrows in [Figure 1]a] showing FDG uptake in the massively enlarged kidneys (right kidney ~21.5 cm × 11.9 cm, maximum standard uptake value [SUV max] 5.5 and left kidney ~20.5 cm × 12.0 cm, SUV max 5.9).
Figure 1: The maximum intensity projection image of FDG PET/CT (a), coronal fused PET/CT image (b) and coronal CT image (c) revealed FDG avid lymph nodes on both sides of the diaphragm (dashed arrows in [Figure 1]a) and FDG avid bilateral grossly enlarged kidneys (solid arrows in [Figure 1]a) showing FDG uptake in the massively enlarged kidneys (right kidney ~21.5 x 11.9 cm, SUV max 5.5 and left kidney~20.5 x 12.0 cm, SUV max 5.9)

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MCL is a rare subtype of B-cell non-Hodgkin's lymphoma, having an incidence of 5% with renal involvement of 0.7% and the bilateral presentation of 10%–20% of the cases.[1] MCL is a rare disease arising from mature B-lymphocytes and generally involves lymph nodes with common extranodal involvement, bone marrow, spleen, gastrointestinal tract, and Waldeyer ring.[2] Renal involvement of MCL is very rare and usually presents as acute kidney injury due to proliferative glomerulonephritis, focal segmental glomerulosclerosis, or tubulointerstitial nephritis with mildly enlarged kidneys.[3],[4],[5],[6] The usefulness of FDG/PET in MCL was well established in the literature, with pretreatment PET scans being positive in 94%–100%.[7],[8] The positivity for SOX11, a specific MCL marker, correlates with (11;14) translocation, CCND1 expression, and an adverse prognosis.[9] Primary MCL involving bilateral kidneys is extremely rare. The present case highlights the 18F-FDG-PET/CT findings in a rare case of primary MCL involvement of bilateral kidneys.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Canpolat F, Taş E, Albayrak Sönmez A, Oktay M, Eskioğlu F, Alper M. Cutaneous presentation of Mantle cell lymphoma. Acta Derm Venereol 2010;90:548-50.  Back to cited text no. 1
    
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Phelps A, Gorgan M, Elaba Z, Pennington M, Norwood C, Rezuke W, et al. CD10-positive blastoid Mantle cell lymphoma with secondary cutaneous involvement. J Cutan Pathol 2013;40:765-7.  Back to cited text no. 2
    
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Lubas A, Mróz A, Smoszna J, Niemczyk S. Membranoproliferative glomerulonephritis, Mantle cell lymphoma infiltration, and acute kidney injury. Int Urol Nephrol 2013;45:1489-94.  Back to cited text no. 3
    
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Wong CF, Mohteshamzadeh M, Arsalanizadeh B, Dutt T, Shawki H, Khine MM, et al. Successful treatment of focal segmental glomerulosclerosis in association with Mantle cell lymphoma. Ren Fail 2007;29:363-6.  Back to cited text no. 4
    
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Davies J, Healey DA, Wood KM, Jones K, Kanagasundaram NS. Acute renal failure due to Mantle cell lymphoma – A case report and discussion of the literature. Clin Nephrol 2007;67:394-6.  Back to cited text no. 5
    
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Colak N, Dede F, Canbakan B, Odabaş AR, Akyürek N. Acute tubulo-interstitial nephritis associated with Mantle cell lymphoma presented as acute renal failure. Nephrology (Carlton) 2007;12:107-8.  Back to cited text no. 6
    
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Brepoels L, Stroobants S, De Wever W, Dierickx D, Vandenberghe P, Thomas J, et al. Positron emission tomography in Mantle cell lymphoma. Leuk Lymphoma 2008;49:1693-701.  Back to cited text no. 7
    
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Hosein PJ, Pastorini VH, Paes FM, Eber D, Chapman JR, Serafini AN, et al. Utility of positron emission tomography scans in Mantle cell lymphoma. Am J Hematol 2011;86:841-5.  Back to cited text no. 8
    
9.
Meggendorfer M, Kern W, Haferlach C, Haferlach T, Schnittger S. SOX11 overexpression is a specific marker for Mantle cell lymphoma and correlates with t (11;14) translocation, CCND1 expression and an adverse prognosis. Leukemia 2013;27:2388-91.  Back to cited text no. 9
    


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