Limits...
Necrotic lymphoma in a patient with post-transplantation lymphoproliferative disorder: ultrasonography and CT findings with pathologic correlation.

Lee M, Kim SK, Chung YE, Choi JY, Park MS, Lim JS, Kim MJ, Kim H - Ultrasonography (2014)

Bottom Line: Contrast-enhanced computed tomography displayed a mild degree of enhancement only at the periphery of the mass, while the center lacked perceivable intensification.The final pathological diagnosis was non-Hodgkin lymphoma (diffuse large B-cell lymphoma), and extensive necrosis was observed on microscopic examination.We found that the prominent heterogeneous echogenicity of the mass (an unusual finding of lymphoma) demonstrated on ultrasonography is a result of extensive necrosis, which may sometimes occur in patients with post-transplantation lymphoproliferative disorder.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea ; Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Seventeen months after kidney transplantation for the treatment of nephrotic syndrome, a retroperitoneal mass was incidentally detected in a 30-year-old man during routine follow-up. Ultrasonography revealed a mass measuring 5.5 cm×4.3 cm located between the liver and the atrophic right kidney, which showed markedly heterogeneous internal echogenicity. Contrast-enhanced computed tomography displayed a mild degree of enhancement only at the periphery of the mass, while the center lacked perceivable intensification. The patient underwent surgical resection. The final pathological diagnosis was non-Hodgkin lymphoma (diffuse large B-cell lymphoma), and extensive necrosis was observed on microscopic examination. We found that the prominent heterogeneous echogenicity of the mass (an unusual finding of lymphoma) demonstrated on ultrasonography is a result of extensive necrosis, which may sometimes occur in patients with post-transplantation lymphoproliferative disorder.

No MeSH data available.


Related in: MedlinePlus

A 31-year-old man who underwent kidney transplantation 17 months prior.A. Routine follow-up ultrasonography shows an incidental mass (arrows) located between the liver and the atrophic right kidney with markedly heterogeneous echogenicity on the B-mode. B. On color Doppler ultrasonography, no flow signal can be detected within the mass (arrows). C, D. Pre-contrast computed tomography (CT) (C) and CT performed during the hepatic venous phase (D) demonstrate a mass (arrows) located at the right retroperitoneal space, abutting the liver, atrophic right kidney, and duodenum. A mild degree of enhancement is observed at the mass periphery but not in the central portion, suggesting the necrosis of the inner portion. E. A low-power field microphotograph shows extensive necrosis in the inner portion of the mass (H&E, ×40). The extent of the kidney (blue), extrarenal mass (yellow), and necrotic portion (red) are marked with underlying bars. F. A microphotograph under higher magnification of the non-necrotic portion demonstrates a high cellularity tumor that consists of large cells showing atypia (H&E, ×200). G. On immunohistochemistry staining, the tumor cells are diffusely positive for CD20 (×200).
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4372711&req=5

f1-usg-14050: A 31-year-old man who underwent kidney transplantation 17 months prior.A. Routine follow-up ultrasonography shows an incidental mass (arrows) located between the liver and the atrophic right kidney with markedly heterogeneous echogenicity on the B-mode. B. On color Doppler ultrasonography, no flow signal can be detected within the mass (arrows). C, D. Pre-contrast computed tomography (CT) (C) and CT performed during the hepatic venous phase (D) demonstrate a mass (arrows) located at the right retroperitoneal space, abutting the liver, atrophic right kidney, and duodenum. A mild degree of enhancement is observed at the mass periphery but not in the central portion, suggesting the necrosis of the inner portion. E. A low-power field microphotograph shows extensive necrosis in the inner portion of the mass (H&E, ×40). The extent of the kidney (blue), extrarenal mass (yellow), and necrotic portion (red) are marked with underlying bars. F. A microphotograph under higher magnification of the non-necrotic portion demonstrates a high cellularity tumor that consists of large cells showing atypia (H&E, ×200). G. On immunohistochemistry staining, the tumor cells are diffusely positive for CD20 (×200).

Mentions: Abdominal ultrasonography for further evaluation of hepatitis was performed using Philips iU22 Ultrasound System (Philips Healthcare, Best, The Netherlands) with a 1.0-5.0-MHz (C5-1) wideband convex transducer. Underlying liver cirrhosis with multiple nodular lesions and atrophic native kidneys were observed. In addition, an incidental mass measuring 5.5 cm×4.3 cm with marked heterogeneous internal echogenicity was found between the liver and the atrophic right kidney (Fig. 1A, B). The patient underwent subsequent triple-phase contrast-enhanced abdominal computed tomography (CT) for further evaluation of the mass. The CT revealed a 5.5-cm-sized right-sided retroperitoneal mass that showed mild peripheral enhancement, but the center of the mass seemed to lack perceivable intensification, suggesting that extensive necrosis had occurred. The mass was abutting the right kidney, liver segment 6, and the duodenum (Fig. 1C, D). The retroperitoneal location of the mass and the assumed extensive necrotic change led to the impression of retroperitoneal sarcoma. Desmoid tumor, inflammatory pseudo-tumor, and tuberculous abscess were other disease entities considered for the differential diagnosis. We excluded lymphoma because extensive necrosis is a very unusual finding.


Necrotic lymphoma in a patient with post-transplantation lymphoproliferative disorder: ultrasonography and CT findings with pathologic correlation.

Lee M, Kim SK, Chung YE, Choi JY, Park MS, Lim JS, Kim MJ, Kim H - Ultrasonography (2014)

A 31-year-old man who underwent kidney transplantation 17 months prior.A. Routine follow-up ultrasonography shows an incidental mass (arrows) located between the liver and the atrophic right kidney with markedly heterogeneous echogenicity on the B-mode. B. On color Doppler ultrasonography, no flow signal can be detected within the mass (arrows). C, D. Pre-contrast computed tomography (CT) (C) and CT performed during the hepatic venous phase (D) demonstrate a mass (arrows) located at the right retroperitoneal space, abutting the liver, atrophic right kidney, and duodenum. A mild degree of enhancement is observed at the mass periphery but not in the central portion, suggesting the necrosis of the inner portion. E. A low-power field microphotograph shows extensive necrosis in the inner portion of the mass (H&E, ×40). The extent of the kidney (blue), extrarenal mass (yellow), and necrotic portion (red) are marked with underlying bars. F. A microphotograph under higher magnification of the non-necrotic portion demonstrates a high cellularity tumor that consists of large cells showing atypia (H&E, ×200). G. On immunohistochemistry staining, the tumor cells are diffusely positive for CD20 (×200).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372711&req=5

f1-usg-14050: A 31-year-old man who underwent kidney transplantation 17 months prior.A. Routine follow-up ultrasonography shows an incidental mass (arrows) located between the liver and the atrophic right kidney with markedly heterogeneous echogenicity on the B-mode. B. On color Doppler ultrasonography, no flow signal can be detected within the mass (arrows). C, D. Pre-contrast computed tomography (CT) (C) and CT performed during the hepatic venous phase (D) demonstrate a mass (arrows) located at the right retroperitoneal space, abutting the liver, atrophic right kidney, and duodenum. A mild degree of enhancement is observed at the mass periphery but not in the central portion, suggesting the necrosis of the inner portion. E. A low-power field microphotograph shows extensive necrosis in the inner portion of the mass (H&E, ×40). The extent of the kidney (blue), extrarenal mass (yellow), and necrotic portion (red) are marked with underlying bars. F. A microphotograph under higher magnification of the non-necrotic portion demonstrates a high cellularity tumor that consists of large cells showing atypia (H&E, ×200). G. On immunohistochemistry staining, the tumor cells are diffusely positive for CD20 (×200).
Mentions: Abdominal ultrasonography for further evaluation of hepatitis was performed using Philips iU22 Ultrasound System (Philips Healthcare, Best, The Netherlands) with a 1.0-5.0-MHz (C5-1) wideband convex transducer. Underlying liver cirrhosis with multiple nodular lesions and atrophic native kidneys were observed. In addition, an incidental mass measuring 5.5 cm×4.3 cm with marked heterogeneous internal echogenicity was found between the liver and the atrophic right kidney (Fig. 1A, B). The patient underwent subsequent triple-phase contrast-enhanced abdominal computed tomography (CT) for further evaluation of the mass. The CT revealed a 5.5-cm-sized right-sided retroperitoneal mass that showed mild peripheral enhancement, but the center of the mass seemed to lack perceivable intensification, suggesting that extensive necrosis had occurred. The mass was abutting the right kidney, liver segment 6, and the duodenum (Fig. 1C, D). The retroperitoneal location of the mass and the assumed extensive necrotic change led to the impression of retroperitoneal sarcoma. Desmoid tumor, inflammatory pseudo-tumor, and tuberculous abscess were other disease entities considered for the differential diagnosis. We excluded lymphoma because extensive necrosis is a very unusual finding.

Bottom Line: Contrast-enhanced computed tomography displayed a mild degree of enhancement only at the periphery of the mass, while the center lacked perceivable intensification.The final pathological diagnosis was non-Hodgkin lymphoma (diffuse large B-cell lymphoma), and extensive necrosis was observed on microscopic examination.We found that the prominent heterogeneous echogenicity of the mass (an unusual finding of lymphoma) demonstrated on ultrasonography is a result of extensive necrosis, which may sometimes occur in patients with post-transplantation lymphoproliferative disorder.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea ; Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Seventeen months after kidney transplantation for the treatment of nephrotic syndrome, a retroperitoneal mass was incidentally detected in a 30-year-old man during routine follow-up. Ultrasonography revealed a mass measuring 5.5 cm×4.3 cm located between the liver and the atrophic right kidney, which showed markedly heterogeneous internal echogenicity. Contrast-enhanced computed tomography displayed a mild degree of enhancement only at the periphery of the mass, while the center lacked perceivable intensification. The patient underwent surgical resection. The final pathological diagnosis was non-Hodgkin lymphoma (diffuse large B-cell lymphoma), and extensive necrosis was observed on microscopic examination. We found that the prominent heterogeneous echogenicity of the mass (an unusual finding of lymphoma) demonstrated on ultrasonography is a result of extensive necrosis, which may sometimes occur in patients with post-transplantation lymphoproliferative disorder.

No MeSH data available.


Related in: MedlinePlus