Presentation
Presentation to the general practitioner with nocturnal back pain worsening over a few weeks.
Patient Data
Major findings include:
- large, infiltrating left renal lesion centered around the lower pole
- fixation of the lesion to the left psoas major muscle with dilation of the left-sided collecting system
- left-sided retroperitoneal lymphadenopathy with the largest lymph node abutting the left renal vein
Other findings include:
- large bowel diverticulosis
- gallbladder calculi without evidence of acute cholecystitis
- no evidence of lytic or sclerotic metastatic disease within the imaged field
Case Discussion
This gentleman was urgently referred to the urology outpatient service with a history of worsening abdominal and back pain. Imaging shows extensive left-sided retroperitoneal lymphadenopathy and a large, left-sided renal mass centered around the lower pole. Given the CT appearance of the lesion in question, it was felt to be reflective of an infiltrating process such as a lymphoma rather than a primary renal cell carcinoma during the discussion at our genito-urinary MDT meeting.
The patient underwent a CT-guided biopsy of the renal mass. Final histopathology confirmed the diagnosis of diffuse large B cell lymphoma. The patient is currently undergoing treatment via R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone).