Retroperitoneal extra-adrenal non-Hodgkin lymphoma: An uncom
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Non-Hodgkin lymphoma is considered to be one of the most common malignancies of the retro peritoneum, but this location has been very rarely reported as the primary site of the disease.

Published in the journal Urology Case Reports, the authors present a case of a 46-year-old patient complaining of abdominal fullness and dorsal pain, who was diagnosed with an extra-nodal non-Hodgkin lymphoma presenting as a unique and large retroperitoneal mass.

The suggested diagnosis was a malignant retroperitoneal tumor and the patient underwent an excision of the tumor throw a lombotomy followed by an R-CHOP chemotherapy regimen with good outcome.

A 46-year-old diabetic man, presented to our department with progressively increasing pain and fullness in the left upper quadrant of his abdomen. On examination, he had a blood pressure of 130/80 mmHg with no postural drop, a pulse rate of 86 beats/minute, with no palpable mass on abdominal examination, there was no hepatomegaly, or splenomegaly and no palpable lymph nodes.

No alteration was found in the standard hemato chemical investigations. CT scan revealed a heterogeneously enhanced soft tissue retroperitoneal mass, it measured 13 × 12 cm. The kidney and left adrenal gland were normal, there was no splenomegaly or abdominal lymphadenopathy.

In front of tomographic characteristics of the tumor and its size, the suggestive diagnosis was of malignant retroperitoneal tumor, it was decided to excise the tumor throw a lombotomy, per operative findings revealed an adherent large tumor to the adrenal gland, thus it was decided to perform a left adrenalectomy with excision of the tumor.

Histopathological analysis revealed diffuse large B-cell lymphoma, immunohistochemical stains were strongly positive for CD20. For further management, the patient was referred to our hematology clinic and was planned for R-CHOP chemotherapy regimen. After 6 cycles of chemotherapy he was in good condition with no evidence of relapsing lymphoma after 12 months follow up on scan.

Learning Points:-
• Primary retroperitoneal DLBCL is extremely rare, and has a variable and non specific presentation and many resemble other neoplasic or inflammatory conditions.

• Obtaining a definitive histological diagnosis by biopsy or surgery resection and using and using appropriate chemotherapy are essential for recovery and long term survival of these patients.

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