Renal Lymphoma : Macroscopic Pathology

Renal Lymphomas - Macroscopic Features: Renal lymphomas are unilateral in about 75% of cases. Bilateral involvement is more common in patients with systemic lymphoma with secondary renal involvement. Massive bilateral renal infiltration by lymphoma can cause acute renal failure. The gross appearance consists of single or multiple pink-tan or gray-white nodules (shown here), a diffusely infiltrative process, or mainly perirenal plaques (see next image). The tumor consistency ranges from soft, fleshy and friable to firm to rock hard. Areas of hemorrhage and necrosis may be present. The tumor can reach massive size and efface renal architecture (size range <5 cm to >20 cm). Adjacent structures are frequently involved, including adrenals, perinephric fat, renal pelvis, renal vessels, ureters, psoas muscle, duodenum and pancreas. Hilar lymphadenopathy may be present. Extension into inferior vena cava or renal vein can mimic renal cell carcinoma.