Extranodal and nodal lymphoma

• Lymph nodes features are those of relatively soft consistency lesions resulting in matting rather than displacing each other, and surrounding and encasing rather than pushing nor pulling adjacent structures, with mild mass effects relative to their size-expected effects.
• Pear-shaped urinary bladder is a classical radiologic sign of extraluminal pelvic mass lesion.
• Chronically, these lesions mostly resulted in stasis/slow flow of the lower limb veins (more on the left side) which can be related to the known chronic deep venous thrombosis of the left lower limb.
• In the context of the enlarged and matted lymph nodes, the cutaneous thickening and masses (with their chronic history presumably of skin plaque evolving into a mass, before the other manifestations) are suggestive of primarycutaneous lymphoma with differential diagnosis including CD30 positive primary cutaneous lymphoma or mycosis fungoides.
• Collectively, these features makes lymphoma on top of the differential diagnosis. 
• The faint hypodense focal area in the lower pole of left kidney, that is not opacified with contrast excretion (not a calyx) and show no convincing cystic features (ill-defined hypodense but with questionable contrast enhancement), raises the possibility of being a mass lesion, needing correlation with ultrasound study or PET-CT scan, and/or follow up accordingly.
• The subcutaneous fat stranding/edema of the lower abdomen and lower limbs could be due to the chronic thrombosis; however, the presence of overlying skin thickening raises the possibility of neoplastic involvement or cellulitis.

• Biopsies were taken from a cervical lymph node and the left breast mass and showed:

- fragmented lymphoid tissue, with histopathologic diagnosis reportdiffuse effacement of architecture by atypical large cells with wide areas of necrosis, and infiltration into adjacent adipose, and strong positivity for CD30, in cell membrane with some cells showing CD3 positivity.- CD20, CD5, EMA and ALK are negative.- Proliferation index is footed as follows:

DIAGNOSIS:high "about 80%", measured by Ki67.(1) Left- The breast mass, excisional biopsy:Involvement by is negative for CK (excluding lobular carcinoma).

- The overall features are most consistent with anaplastic large cell lymphoma.(2) Right cervical lymph node, excisional biopsy:High grade lymphoma with features most consistent with anaplastic large celllymphoma, ALKnegative.