In July 2000 and in the Nephrology Department where the patient was being studied for chronic renal failure secondary to nephroangiopathy, it affected a 77-year-old male with an echographic finding of a 6 cm renal mass.
His personal history included COPD, hypertension and duodenal ulcer with pyloric stenosis.
To complete studies, we performed a CT scan of the abdomen and pelvis, which was reported as 'the lesion affecting the left kidney's upper 2/3 with involvement of the perianal space and ill-defined borders'.
The presence of a monoclonal gammopathy with IgM of 4640 g/l (38-231) kappa by immunofixation was very remarkable analytically.
Other tests: positive hammer proteinuria, bone marrow aspirate with 12.5% atypia and bone series without lytic lesions.
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With the first diagnosis of renal mass associated with IgM monoclonal gammopathy (without meeting criteria for IgM myeloma), it was performed in August 2000 left radical nephrectomy.
The anatomopathological result was primary renal non-hodking B lymphoma type MALT (lymphoid tumor associated with mucous membranes).
The patient has a good postoperative evolution and is discharged with outpatient controls.
In December 2000, a first control treatment was performed, with an IgM of 3430 g/l in a first analysis and 4340 g/l in a second, so it was decided to start by the Hematology Service
A control CT scan was performed and reported as ' thickening of the perirenal fascia with fat deflagration compatible with inflammatory or similar lesions'.
Since there was no total evidence of recurrence, it was decided to strictly monitor the patient with analytical controls and maintain treatment with Clorambucil.
A new CT scan was performed in January 2002 and no signs of recurrence were found.
Currently the patient remains asymptomatic, with stable levels of IgM (last control 48 g/l) to treatment with Clorambucil.
