Diffuse large B cell lymphoma - renal involvement

Case contributed by Aiyapa Aruna Ajjikuttira


Presentation to the general practitioner with nocturnal back pain worsening over a few weeks.

Patient Data

Age: 70 years
Gender: Male

CT abdomen and pelvis


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).

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