Lymphoma and the Urinary Tract

THE PREMORTEM diagnosis of involvement of the urinary tract by lymphoma is difficult and depends greatly upon roentgen technics (12). In an attempt to add to our knowledge of this subject, a review was made of the necropsies on patients with lymphoma who died during the past five years at the University of Michigan Medical Center. There had been 2,898 necropsies. Of these, 96 had been in cases of lymphoma (leukemia was not included in this study), and 50 of these had pathological evidence of involvement of the urinary tract. A careful study of these cases has been carried out and the data are included in this report. A consideration of the fact that an average of 10 patients yearly die with this aspect of lymphoma in a large medical center such as ours indicates the relative infrequency of the phenomenon. However, the radiologist is often called upon when hematuria and renal failure occur in the patient with lymphoma. Since the hematuria may be related to treatment, hemorrhagic cystitis, or clotting mechanism disorder and the renal failure may be the result of uric acid nephritis complicating the disease and resulting from its therapy, the prospect of unusual and diagnosable involvement by lymphoma must be maintained (13). Material Of the 50 patients with urinary tract involvement, 25 had undergone excretory urography within four months of death. These films were reviewed and compared with the development of the disease and its manifestations during life and at necropsy in each individual. The intent was to secure information which would reveal the reliability of present radiographic technics and the directions which might be pursued in the future. An angiogram of an involved kidney was obtained in only 1 case. The indications for the examinations are displayed in TABLE 1. A problem which always arises in lymphoma concerns the nomenclature. A variety of terms were employed during life in several cases and evolution from lymphoblastoma to reticulum-cell sarcoma, for example, has been previously described. However, the diagnosis by the pathologist at necropsy was the one used here, and this is reflected in TABLE II. In TABLE III the varieties of involvement of the urinary tract by lymphoma are given in detail. Discussion In our material, as in that of others, reticulum-cell sarcoma and lymphosarcoma were much more responsible for roentgen detectable urinary tract involvement than was Hodgkin's disease(9, 11). In all of our site of onset, duration, or clinical course which could be used to anticipate this problem. Evidence of involvement of the retroperitoneal space, however, was frequently correlated with eventual involvement of the kidneys or ureters (4). The only clinical signs of value were the presence of palpable kidneys or hematuria. The last was confusing in that it might be the result of complicating hemorrhagic cystitis (3 of our patients) or treatment with drugs such as Cytoxan.