Canelhas A, Compérat E, Le Tourneau A, Molina T, Ramos M, Ribeiro P, Pimenta A, Diebold J, Audouin J
Hospital de Santo Antonio, Porto, Portugal.
Int Urol Nephrol. 2006;38(3-4):431-7. doi: 10.1007/s11255-006-6658-3.
We report a case of simultaneous involvement of the spleen and the left kidney in a marginal zone lymphoma with a monotypic lymphoplasmacytic cell component, which transformed into a diffuse large B-cell lymphoma of the immunoblastic type. PCR showed that the small and large B-cell populations carried the same type of immunoglobulin heavy chain gene rearrangement. This type of rearrangement was detected in the spleen, the latero-aortic lymphadenopathy and the kidney demonstrating that it is the same lymphoma that affected both organs and the lymph nodes. Primary renal lymphoma is very rare and only a few cases of renal marginal zone lymphoma, MALT type, have been reported. Involvement of simultaneous multiple sites has been described in MALT type lymphoma, but splenic involvement secondary to renal MALT lymphoma seems to have never been observed. Nevertheless, in our case the huge size of the spleen associated with splenic hilar node involvement is consistent with primary splenic marginal zone lymphoma. The extension into latero-aortic lymph nodes of this lymphoma can explain secondary kidney involvement. The nodal Kaposi's sarcoma observed in this patient of Mediterranean origin was probably coincidental.
我们报告了一例边缘区淋巴瘤同时累及脾脏和左肾的病例，该淋巴瘤具有单型淋巴浆细胞成分，并转化为免疫母细胞型弥漫性大B细胞淋巴瘤。聚合酶链反应（PCR）显示，小B细胞群体和大B细胞群体携带相同类型的免疫球蛋白重链基因重排。在脾脏、主动脉旁淋巴结和肾脏中均检测到这种重排类型，表明累及两个器官和淋巴结的是同一淋巴瘤。原发性肾淋巴瘤非常罕见，仅报道过少数几例MALT型肾边缘区淋巴瘤。MALT型淋巴瘤曾有同时累及多个部位的描述，但肾MALT淋巴瘤继发脾脏受累似乎从未被观察到。然而，在我们的病例中，脾脏巨大且脾门淋巴结受累，符合原发性脾边缘区淋巴瘤。该淋巴瘤延伸至主动脉旁淋巴结可解释继发性肾受累。在这位地中海血统患者中观察到的淋巴结卡波西肉瘤可能是巧合。
