Case 60
With discussion
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CASE 60 (February 2011)

Clinical information

A 23-year-old man was hospitalized for acute renal failure, severe hypercalcemia and dehydration. On physical examination was found with multiple lymphadenopathy and hepatosplenomegaly. He also had signs of metabolic encephalopathy. Lymph node biopsy documented peripheral high grade T-cell lymphoma. The patient required hemodialysis.

Serum creatinine: 3.5 mg/dL, BUN: 110 mg/dL; serum calcium: 18.9 mg/dL; Mg: 2.3 mg/dL, K: 4.6 meq/L; paratohormone: 5.3 ng/L.

The patient developed severe multisystem organ failure and died before any treatment for the neoplasm. Th autopsy showed diffuse pulmonary interstitial involvement by lymphoma.

The following images correspond to histologic sections of the kidneys.

What is the most relevant finding?

Figure 1. H&E, X100.

Figure 2. H&E, X100.

Figure 3. H&E, X200.

Figure 4. H&E, X100.

Figure 5. H&E, X200.

Figure 6. H&E, X200.

Figure 7. H&E, X200..

What is your diagnosis?

See diagnosis and discussion