PMC3619040_01
Imaging studies on admission. (A) Abdominal ultrasonography shows a mass lesion in the superior pole of the right kidney (white circle). (B) Abdominal magnetic resonance imaging shows a marginally enhanced tumor invading into the adrenal gland (white circle). The left kidney is normal.
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No masses could be felt in the abdomen on palpitation, but ultrasonography revealed a mass in the right kidney (Figure 1A), and the patient was referred to our hospital for further evaluation. Abdominal magnetic resonance imaging (MRI) revealed a marginally enhanced 12-cm tumor-like lesion in the superior pole of the right kidney that appeared to be invading the adrenal gland (Figure 1B).
Histopathological study. (A) Tumor cells are round, with a high N/C ratio with HE staining. (B) Immunohistochemical staining shows diffuse positive results for CD20.
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Histopathological examination showed diffuse proliferation of large lymphoid cells, and immunostaining showed positive results for CD20, bcl-2 and bcl-6 and negative results for CD3, CD5 and CD10 (Figure 2A, 2B).
Whole-body investigation after right nephrectomy. (A,B) PET/CT shows abnormal uptake in the right lobe of the thyroid gland (black circle). (C) CT of the neck shows a 9-mm low-density area at the same site in the thyroid gland (black circle). (D) Aspiration cytology shows many inmature and abnormal lymphocytes with Papanicolau staining.
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Positron emission tomography-computed tomography (PET/CT) was performed to examine the entire body, revealing an abnormal accumulation in the right lobe of the thyroid gland (Figure 3A, 3B). CT of the neck revealed a 9-mm low-density area in the same region (Figure 3C). Aspiration cytology under ultrasonographic guidance revealed an aggregation of immature atypical lymphocytes (Figure 3D) that was thought to represent invasion of the DLBCL.