This is the biopsy from a 73-year-old with AKI and normal bone marrow biopsy done for investigation of anemia and thrombocytopenia. What is your diagnosis?
The biopsy shows highly atypical cells within the glomerular capillaries, with high nuclear to cytoplasm ratio, irregular nuclear membranes, loose chromatin, and often several prominent nucleoli. These cells also showed frequent mitosis (Figure 2, circle) as well as apoptosis (not shown). Immunohistochemical stains showed the cells were positive for CD20 (Figure 3), consistent with intravascular B-cell lymphoma.
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