PMC6138943_01
(A) Staging (at diagnosis) 18FDG-PET/CT demonstrated extensive cervical, thoracic and abdominal lymph nodes, spleen and bone involvement characterized by a high 18FDG uptake. The left renal mass also presented a high diffusely increased 18FDG uptake suggesting renal lymphoma involvement. (B) Post-treatment 18FDG-PET/CT demonstrating remission of previous lesions and a symmetrical 18FDG uptake by the kidneys. Late images showed reduction of both renal uptakes, suggesting physiological urinary clearance of the radiotracer.
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PET/CT demonstrated highly diffuse increased 18F-FDG uptake of the left renal mass (Fig. 1A). Pleural thickening with increased 18F-FDG uptake was also demonstrated and is possibly related to the thoracic duct obstruction due to HL (Fig. 1A). After two weeks of treatment, the patient had total recovery of renal function reaching a creatinine of 0.87 mg/dl. After two cycles of chemotherapy, a new 18F-FDG PET/CT showed regression of the renal left mass with symmetrical 18F-FDG uptake by the kidneys and both measured normal at CT-scan (Fig. 1B).
Histopathology of kidneys - (A) Lymphoid infiltrate consisting of large and small cells with associated fibrosis and scattered Reed-Sternberg cells (arrow). Immunostaining for CD30 (B) and Ki-67 (high-index) (C), respectively.
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There were also lymphoepithelial damage and coagulative necrotic tubules with obliteration of the lumens by cellular debris.  Some arteries showed intimal lymphohistiocitic infiltration narrowing the lumens.  Immunohistochemical stains were performed and resulted positive to CD30 and CD15, but negative to adenovirus on atypical cells, consistent with HL infiltrating the kidney parenchyma (Fig. 2).