Presentation
One week history of left-sided abdominal pain. History of HIV.
Patient Data
Large heterogenous mass lesion in the left pararenal space contiguous with the inferior pole of the left kidney. Left kidney and its associated renal vasculature are displaced anterosuperiorly. The mass is extending into the posterior mediastinum. Mild left hydronephrosis and the ureter is encased by the mass lesion. Descending colon is also encased and displaced to the left with associated fat strending. Moderate left pleural effusion.
Conclusion: Appearance of the large heterogenous pararenal mass is most consistent with lymphoma.
Case Discussion
The patient underwent ultrasound-guided biopsy of the left pararenal mass.
Histology:
MICROSCOPIC DESCRIPTION: The core biopsies show atypical lymphoid infiltrate with complete architectural effacement, forming diffuse sheets. Parts of the infiltrate are widely separated apart because of very limited fixation. Though a starry-sky pattern is not well-seen as a result of poor fixation, occasional tingible body macrophages with ingested apoptotic debris are present. The atypical lymphocytes are medium sized. They have enlarged hyperchromatic nuclei, clefted nuclear contour, prominent nucleoli and scanty cytoplasm. The background contains occasional eosinophils. The overall features are those of non-Hodgkin lymphoma. The tumor cells are CD138, CD30, EBER-CISH (EBV), MUM1, EMA and CD79a positive. They are CD20, CD3, CD5, CD10, bcl-2, bcl-6, PAX-5, HHV-8, ALK-1, myeloperoxidase, TdT and LMP1 negative. The Ki-67 index is more than 95%. C-myc immunostain stains about 90% of the cells. The features are those of plasmablastic lymphoma.
FINAL DIAGNOSIS: Plasmablastic lymphoma
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