Non Hodgkin lymphoma in a patient with ankylosing spondylitis

Case contributed by Dr MT Niknejad

Presentation

Abdominal pain, breath shortness and spinal deformity.

Patient Data

Age: 45 years
Gender: Male

Bilateral pleural effusions are present, left more than the right side, accompanied by left lower lobe partial collapse. There are no intrapulmonary nodules.
Multiple lymphadenopathies are seen at mediastinum and both hilar regions with maximum SAD of 20mm. Multiple para-aortocaval, peripancreatic, celiac and mesenteric lymphadenopathies are seen. The largest one measures 57×37mm. Additionally, several lymphadenopathies are also seen at para-iliac and inguinal regions. The largest one measured 39×30mm. 
The spleen is enlarged and its cephalocaudal height measured 156mm.
A few cortical cysts are seen at both kidneys less than 33mm. Several stones are noted at right kidney with a maximum diameter of 20mm, accompanied by mild hydronephrosis. Two 6mm and 3mm stones are also observed at left kidney without hydronephrosis.

A small amount of free fluid is present. Diffuse ankylosis of thoracolumbar spine is present with bilateral sacroiliac joints narrowing.

Control CT scan post chemotherapy.

CT

Pleural effusions present bilaterally, right more than the left side. There are also several atelectatic bands scattered bilaterally.
The right kidney is relatively small than left kidney and shows relatively parenchymal atrophic changes. A few non-enhanced simple cortical cysts are seen at both kidneys, with maximum diameters of 35mm. Several stones are seen at right kidney less than 23mm causing mild hydronephrosis. Additionally, several stones are also noted at left side less than 15mm. 
Lymphadenopathy with SAD of 15mm is present at upper paracaval region.
The prostate gland is enlarged.
Degenerative changes as osteophytosis are seen at the cervicothoracolumbar spine. Additionally, diffuse ankylosis of whole spine is evident with bilateral sacroiliac joint narrowing. 

With respect to prior CT scan the process is relatively subsided. 

Case Discussion

Pathology proven lymphoma in a patient with ankylosing spondylitis.

Ankylosing spondylitis is a seronegative spondyloarthropathy, which results in fusion (ankylosis) of the spine and sacroiliac (SI) joints, although involvement is also seen in large and small joints.

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