Figure 514

Interstitial tumor infiltration due to leukemia. Leukemic infiltrates in this case of acute myelocytic leukemia are diffusely present throughout the cortex of the kidney. The pelvic and parenchymal hemorrhages are secondary to severe thrombocytopenia. Microscopically, many myeloblasts are seen in the interstitial infiltrates. Interstitial infiltration by hematologic neoplasms is usually bilateral, diffuse, and more prominent in the cortex [14]. Renal failure is unusual. When it does occur, affected patients generally present with relatively acute renal failure and a benign urinalysis. The kidneys are grossly enlarged, as may be demonstrated by renal ultrasound, by CT scan, or in some cases even by physical examination. The differential diagnosis in this setting includes obstruction and other tubulointerstitial disorders. The presence of large kidneys without hydronephrosis on ultrasonography in a patient with lymphoma or leukemia, however, is highly suggestive of tumor infiltration. The renal prognosis is dependent on the responsiveness of the tumor to radiation or chemotherapy. A rapid reduction in renal size and return of renal function toward the baseline level may be seen within a few days with responsive tumors. (From Skarin [31]; with permission.)

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