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images in haematology Bilateral primary renal lymphoma A 57-year-old male complained of dyspnoea. He was found to have renal failure and anaemia. A computed tomography [CT] scan demonstrated marked abdominal and thoracic (mediastinal and hilar) lymphadenopathy and marked enlargement of the kidneys [top]. He started haemodialysis. A biopsy of the right kidney demonstrated infiltration of the renal parenchyma by a polymorphic population of large, non-cohesive cells [bottom]. Immunohistochemical stains were positive for CD45, CD20 and CD79a. Scattered CD3+/CD5+ T cells were present. Ki-67 stained 80–90% of the neoplastic cells. Bone marrow biopsy demonstrated active trilineage haematopoiesis without evidence of lymphoma. The patient was treated with cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab [CHOP-R]. Kidney function improved following the first cycle and haemodialysis was no longer required. Repeat CT after the second cycle showed marked regression of the lymphoma. Primary renal lymphoma is rare. Due to the aggressive features of our patient’s disease, six cycles of CHOP-R will be followed by high-dose chemotherapy with an autologous stemcell transplant. T. C. James H. Shaikh L. Escuadro J. Lee Villano Section of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL, USA. E-mail: tjames3@uic.edu ª 2008 The Authors Journal Compilation ª 2008 Blackwell Publishing Ltd, British Journal of Haematology, 143, 1 First published online 30 May 2008 doi:10.1111/j.1365-2141.2008.07250.x