Retroperitoneal diffuse large B-cell lymphoma
Epigastric pain, weight loss.
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Small to medium left pleural effusion. Extensive retroperitoneal soft tissue mass extending from the left subdiaphragmatic space into the left pelvic sidewall. This mass has a more rounded, nodal appearance anteriorly as it extends into the mesentery. The mass elevates the aorta and involves and surrounds arterial and venous vasculature, resulting in narrowing of the left renal arteries and compression of the left renal vein.
There is mottled, heterogeneous appearance of multiple vertebral body levels in the pelvis, with areas of lucency and sclerosis. This can be best appreciated on the sagittal and coronal reformats.
Final pathology diagnosis retroperitoneal mass core biopsy: Diffuse large B-cell lymphoma, of germinal center origin.
This case illustrates the classic appearance of retroperitoneal lymphomatous infiltration, which lifts the aorta and surrounds vasculature without resulting in significant narrowing of compression. A particularly striking finding in this case is diffusely abnormal bone marrow, with mottled appearance and areas of lucency and sclerosis, suggesting diffuse lymphomatous infiltration of the marrow.