PMC8079968_01
Abdominal CT scan with contrast. Findings of bilateral enhancing lesions in the kidneys. Multiple rounded hyperdense lesions throughout the renal parenchyma bilaterally, more pronounced in the left kidney. Left perinephric hematoma 8.8 x 5.2 cm. Axial view (left). Diffuse thickening of the stomach wall. No evidence of liver lesions. Axial view (right).
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Figure1
Upon admission, a repeat abdominal CT scan showed interval increase of the perinephric hematoma as well as gastric wall thickening (Figure 1).
Abdominal MRI. Multiple rounded hypo enhancing lesions noted throughout the renal parenchyma bilaterally. Axial view (left). Coronal view (right).
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Figure2
A subsequent abdominal magnetic resonance imaging (MRI) showed multiple rounded hypoenhancing lesions noted throughout the renal parenchyma bilaterally (Figure 2). A kidney biopsy was planned but aborted since the patient became acutely anemic (hemoglobin 5.6 g/dL) after an episode of melena.
Microscopic appearance of the high-grade Burkitt's lymphoma. Stomach. Gastric mucosa with a dense lymphoid infiltrate in the lamina propria consisting of intermediate size monotonous lymphoma cells with round nuclei, fine chromatin, and multiple nucleoli. Mitoses are conspicuous. Multiple apoptotic bodies impart a starry sky pattern to the lesion (A, B: hematoxylin & eosin). Immunohistochemistry was positive for CD20, CD10, BCL6 (C), c-MYC (D), and MUM1, and are negative for CD5, BCL2, CD30, and terminal deoxynucleotidyl transferase (TdT). Fluorescence in situ hybridization (FISH) was 73% positive for MYC-IGH fusion and negative for IGH-BCL2 and BCL6 rearrangements.
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Figure3
Upper gastrointestinal endoscopy with biopsy showed a high-grade Burkitt's lymphoma (Figure 3).