Presentation
Recurrent pleural effusion and weight loss. Physical examination revealed decreased breath sounds in the right hemithorax, hepatomegaly and submandibulary, axillary and inguinal adenopathy.
Patient Data
Computed tomography (CT) of the thorax, abdomen and pelvis was performed. Oral administration of positive contrast was administered. Unenhanced CT and enhanced CT, in portal and excretory phase were acquired.
CT revealed perinephric disease in the left kidney, with maximum thickness of 18mm, demonstrating soft tissue density in unenhanced CT and slight enhancement after contrast administration. This finding was associated with mild irregularity of renal contour and heterogeneity of renal parenchyma. This mass surrounded two renal simple cysts. Vascular invasion was not identified.
Multiple pathologically enlarged lymph nodes were identified in the following topographies: infracarinal; right axillary; retro-caval; peri-celiac; internal iliac and left inguinal. Other smaller lymph nodes, without pathological volumetric criteria, were identified.
A large right hydropneumothorax was also revealed.
Perinephric lymphomatous involvement of the left kidney (green arrow), with mild irregularity of renal contour (red arrow). A simple renal cyst is also seen (yellow arrow).
A left inguinal low attenuation lymph node is present (blue arrow).
Case Discussion
Image guided biopsy was performed and revealed renal infiltration of low grade lymphoma (CD20+, BCL2+, CD3-, CD5-, CD23-, CD10-, BCL6- e cyclin D1-).
The patient underwent chemotherapy. He died 4 months after the diagnosis.
In the setting of widespread extranodal lymphoma, renal involvement may not affect prognosis, however, size >10 cm, involvement of the renal hilum and diffuse renal infiltration may have a poorer prognosis.
Images courtesy of Dr Lucinda Bogalho.