Presentation
Microscopic hematuria.
Patient Data
Infiltrative mass in the left renal pelvis with adjacent retroperitoneal adenopathy. Surrounds renal vessels and may involve renal vein. Upper pole calyceal dilation with excretion in the lower poles.
Case Discussion
Lymphoma can have a variety of manifestations involving the kidneys. Symmetric renal involvement may be most memorable, but I have personally seen more cases of perinephric masses of various sizes. This one is challenging but perhaps the fact that it seems centered on the hilum rather than within the collecting system, the bulky conglomerate RP adenopathy, and lack of lower pole obstruction might tip you toward an alternative diagnosis from urothelial carcinoma. Either way, this needs to be biopsied, which was performed with CT and confirmed high grade b-cell lymphoma. The patient also had testicular involvement of lymphoma.
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