Retroperitoneal Mass: Lymphoma as Differential Diagnosis To Retroperitoneal Fibrosis. Case Report.

DOI: https://doi.org/10.21203/rs.3.rs-536375/v1

Abstract

Background The nature of a solid retroperitoneal mass can either be autoimmune or neoplastic and should be investigated by imaging and histology. The spectrum of differential diagnoses includes primarily retroperitoneal fibrosis and retroperitoneal tumors. Because treatments of retroperitoneal fibrosis and retroperitoneal tumors vary substantially, accurate and early diagnosis is highly relevant.

Case presentation We present a case of a fifty-four-year old woman that was admitted to our hospital with stroke like symptoms. Suspecting a vasculitis, magnet resonance imaging of the head and abdomen were done, which revealed a circular enhancement of a cranial vessel as well as retroperitoneal and peri-aortic masses. Concerning this specific radiographic patterns, an autoimmune process like retroperitoneal fibrosis was hypothesized. Steroid treatment did not lead to significant remission though. On re-evaluation of the mass because of refractory disease, fine needle aspiration did not show malignant cells while surgery and histologic assessment revealed neoplastic lymphoproliferation. The final diagnosis was a non- Hodgkin B- Cell Lymphoma. Chemo- and Immunotherapy was initiated. A control abdominal computer tomography was performed which revealed a significant remission of the retroperitoneal mass.

Conclusion Initially, the retroperitoneal mass was highly suspicious for RF. The results of imaging can be useful, however, histology should always be taken into consideration when there is an uncertain clinical presentation. Without histology we would have missed a non-Hodgkin B-Cell Lymphoma in this case. Minimal invasive techniques like fine needle aspiration may be practical but can demonstrate false negative results.

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