Introduction.

More and more frequently Patients present at Urology and Oncology Departments
with two different contemporary tumours. We herein present the difficult clinical management of a
Patient who presented at our Institution with a small kidney solid mass and a lymphoplasmocytoid
lymphoma (LL).
Case presentation. On June 2011 a 61 year old Caucasian man presented to the Oncology
Department of our Institution with an histollogically proved lymphoplasmocytoid lymphoma (LL).
and a back bone collapse. During the diagnostic workup a small solid lesion (2.2 cm in diameter)
was incidentally identified at ultrasound in the right kidney. Patient underwent a treatment with
Leukeran and deltacorten. Given the prominence of the hematologic neoplasm the renal lesion was
submitted to an active surveillance program.
On July 2009 the right renal lesion was stable (2.2) but LL progressed and therefore a second line
Rituximab-Endoxan-Dexametason treatment was undertake.
On march 2011 a pleural effusion was detected and a Rituximab-bendamustin treatment was
started . At 6 months follow-up CT scan showed the disappearance of the pleural effusion but a
slight increase of the right kidney tumour size (3.0 cm). Given the 3.0 cm nodule size and the
concomitant LL clinical evolution it was confirmed the active surveillance program of the kidney
solid lesion.
On September 2012 a new LL progression was documented ad a bendamustin treatment was started
with a good clinical response for 3 months. At 6 months follow-up CT scan showed an increase in
size of the kidney tumour up to 4.3 cm. Patient was considered eligible for a crio-therapy but a LL
progression was noted and a velcade desametazon regimen was started. On may 2014 LL clinical
response with stable disease was achieved and Patient was considered eligible for crio-therapy. On
June 2014 pre-operatory CT scan showed a kidney tumour progression with marked increase in size
(5.5 cm) and renal vein involvement (V1) and therefore the Patients was no more considered
eligible for crio-therapy and an open surgery was planed. On July 2014 preoperatory workup
disclosed a severe anaemia with LL progression and open surgical procedure was cancelled. Shortly
at CT scan multiple pulmonary metastases were documented and patient entered a palliative care
program ad passed by 6 months later on.
Discussion. The contemporary treatment of 2 different neoplasm may be challenging. Our case
report highlights as probably a more aggressive treatment of a small renal lesion (3cm) may be
appropriate when a concomitant oncological treatment that could alter the usual biological
behaviour of small solid renal masses is ongoing.