A 61-Year-Old Man with a Concomitant Chronic Lymphocytic Leukemia and Renal Cell Carcinoma

Case Report

Austin J Clin Case Rep. 2020; 7(2): 1170.

A 61-Year-Old Man with a Concomitant Chronic Lymphocytic Leukemia and Renal Cell Carcinoma

Lujain Hamdan*, Kinda Mohammad and Firas Hussein

Department of Clinical Hematology, Tishreen University Hospital, Lattakia, Syria

*Corresponding author: Lujain Hamdan, Department of Clinical Hematology, Tishreen University Hospital, Lattakia, Syria

Received: July 28, 2020; Accepted: August 25, 2020; Published: September 01, 2020


The association between Renal Cell Carcinoma (RCC) and Non-Hodgkin's Lymphomas (NHL) has been reported in the past years more than expected. In this case, a 61-year-old- patient was diagnosed with Chronic Lymphocytic Leukemia (CLL) and during his work up, RCC was found out at the same time. Previous studies have attributed this association to specific genetic mutations, previous chemotherapy/radiotherapy, hormonal-environmental factors or immunomodulation. However, the accurate mechanism of this connection remains unclear. Through this case we aim to draw the attention of clinicians for further investigations on this unexplained connection.

Keywords: Non-Hodgkin's Lymphoma; Renal Cell Carcinoma; Simultaneous Association 


NHL: Non-Hodgkin’s Lymphoma; RCC: Renal Cell Carcinoma; CLL: Chronic Lymphocytic Leukemia; HM: Hematologic Malignancies


Chronic Lymphocytic Leukemia is a monoclonal disorder characterized by a progressive accumulation of functionally incompetent lymphocytes. CLL is the most common form of leukemia found in adults in Western countries. The overall survival rate ranges between 5 to 10 years, although some patients have a lower life expectancy [1].

Renal Cell Carcinoma (RCC) is a result of malignant proliferation of the epithelial cells of proximal convoluted tubule of the nephron, and it accounts for 95% of the malignant neoplasm of kidney [2].

The authors described a possible association of RCC and lymphoid malignancies. The co-existence of both malignancies in the same individual has been reported more than expected in the general population over the past 20 years [3,4]. Several epidemiological studies have revealed that the observed-to-expected ratio for occurrence of RCC in NHL patients was 1,86-fold greater than the expected rates in the general population, while the risk of NHL in the RCC patients was 2.67 times higher [5,6]. This article discusses a case of simultaneous occurrence of CLL and RCC in the same patient.

Case Report

A 61-year-old, light alcoholic, non-smoker male with no past medical history, except for his mother who had breast cancer, visited the hematology clinic with right lower quadrant pain for the past month, accompanied by anorexia, polyuria and dry cough. He also mentioned mild weight loss in the past two months. At administration, his blood pressure was 120/70 mm Hg, his body temperature was 37°, his heart rate was 81 bpm and his oxygen saturation was 98%.

His blood count parameters were as follows: Hemoglobin (Hb): 10.3 g/dl, MCV: 73 FL, Leukocyte: 21×103/mm3, Lymphocyte: 15.5×103/mm3, Platelet Count (PLT): 210×103/mm3. Erythrocyte Sedimentation Rate (ESR) was 103 mm/h, C - reactive protein (CRP) was 68 mg/L (normal range: 0-5).

Creatinine and urea values were 1.5 mg/dl and 36 mg/dl respectively, uric acid was 7.2 mg/dl and there were 15-20 red blood cells in urine sample. All other laboratory tests including serum electrolytes, liver function tests and coagulation profile were normal. Direct and indirect antiglobulins tests were negative, reticulocyte correction index was 0.08 and detailed laboratory investigations including protein electrophoresis and tumour markers were unremarkable.

On peripheral blood smear there was an increase in white blood cells with a majority of matured lymphocytes, red blood cells were hypochromic with variation in size and shape, and platelets were normal.

Immunophenotyping demonstrated the presence of CD5, CD19, CD20, CD22, CD23, CD45, HLA-DR, and Kappa light chain expression, confirming the diagnosis of B-cell chronic lymphocytic leukemia. Then, a complete computed tomography CT was made to determine the clinical stage. It showed several axillary and mediastinal lymphatic nodes measuring between 1 and 2.2 cm. The liver was normal with a few small low-density foci, which were likely to be biliary cysts. The spleen was enlarged (around 17 cm) with a small splenunculus. And finally, a large right infrarenal mass, measuring 7*6*7 cm with an increased uptake, invades the right psoas muscle (Figure 1, Figure 2).

The previous data classified the patient as a stage (A) on Binet classification. Accordingly, he was put on ‘watch and wait’ strategy.

The patient then was elected for surgery to investigate the kidney mass. The mass was removed alongside the right kidney. The kidney was dissected from neighboring organs and the ureter was ligated (Figure 3).

Histopathology of the resected mass was consistent with RCC (Clear cell Renal Cell Carcinoma). It measured 8 cm with an infiltration to the fibrous renal capsule and the perirenal fat but not beyond Gerota's fascia. The mass also invaded one small renal vein branch in the renal hilus. The surgical margins were free and no lymph nodes were detected in the specimen.

A PET/CT MULTI SLICE (positron emission tomography- computed tomography) was performed later to determine the tumour staging accurately. It showed no metastases, with no abnormal uptake.

Accordingly, the patient was a stage 3 RCC (T3a, N0, M0). Thus, there was no need for immunotherapy or target therapy.