Known case of retroperitoneal non-Hodgkin lymphoma that received chemotherapy. Presented with abdominal distension, lower limb weakness, and back pain.
CT abdomen with contrast
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Large pre-vertebral homogenous retroperitoneal soft tissue mass lesion measuring 7.5 x 12.7 x 11 cm. It shows moderate enhancement with no necrosis.The lesion has intraspinal canal extension through the L3-4 neural foramina bilaterally. The lesion compresses the left ureter, causing hydronephrosis. It also markedly compresses the third part of duodenum explaining the gastric outlet obstruction. It encases the infra-renal abdominal aorta, stretches the left renal vessels, and compresses the IVC.
Heterogeneous texture of the L3 vertebral body and pedicles as well as the anterior aspect of L4 suggestive of bone infiltration. Internal fixation of the lumbar spine at the levels of the involved lumbar vertebrae.
Biopsy of the mass confirmed non-Hodgkin's lymphoma that was subsequently treated with chemotherapy with good response. The progression of size of the lesion is consistent with tumour recurrence.
Retroperitoneal neoplasms are often large at the time of presentation due to diagnostic delay. The differential diagnosis for retroperitoneal masses includes retroperitoneal sarcoma (liposarcoma, leiomyosarcoma, rhabdomyosarcoma, or malignant fibrous histiocytoma), retroperitoneal metastasis and retroperitoneal lymphoma.