PMC6081529_01
(a-c) CT imaging of the chest without contrast. The heart is normal in size with trace pericardial effusion. Cardiac mass can be appreciated in these images. (d-j) CT abdomen and pelvis with intravenous contrast. The pancreas enlarged without focal mass. (e-j) Multiple soft tissue densities are seen in the left midkidney eroding the renal cortex. There is a mild perirenal soft tissue density rim that can be noted, more prominent in (j), left greater than right. Diffuse mesenteric edema, mild mesenteric lymphadenopathy, is also noted. (k) A high-power slide of kidney mass biopsy showing sheets of large atypical lymphocytes infiltrating the renal interstitium; scattered renal tubules are also seen (H&E, x400). The atypical cells are immunopositive for CD45, CD20, PAX-5, and CD10, and they are negative for CD3, CD5, CD30, MUM-1, cyclin D1, BCL-2, BCL-6, CD68, and c-myc. The immunoprofile is consistent with diffuse large B-cell lymphoma (DLBCL). (l) Low-power slide of bone marrow biopsy showing bony trabeculae with diffuse infiltration of large atypical lymphocytes and dispersed marrow elements in the background (H&E, x100). The histomorphology and immunoprofile are similar to infiltrates seen in kidney mass.
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fig1
A CT of the abdomen and pelvis with contrast was performed, which revealed an enlarged pancreas without a focal mass, diffuse surrounding mesenteric edema, mild retroperitoneal lymphadenopathy, mild mesenteric lymphadenopathy, rectal wall thickening with perirectal lymphadenopathy, left renal mass measuring 3.7 x 1.4 x 1.4 cm, right renal mass measuring 2.3 x 4.3 x 5.2 cm, marked diffuse urinary bladder wall thickening, and trace pericardial effusion (Figure 1). A subsequent bone marrow biopsy revealed involvement by DLBCL (Figure 1).
(a-c) CT imaging of the chest without contrast. Illustrates are new paratracheal and pericardiac masses, compared with Figure 1. (d-h) 2D echocardiographic images obtained after results of the CT imaging in (a-c). (d) A small pericardial effusion around the left ventricle, with a larger loculated pericardial effusion compressing the right ventricle. (e) A mass effect on the IVC, which also reduced with inspiration. (f) A mass around the right atrium. (g-h) The loculated pericardial effusion compressing the right ventricle.
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fig2
Cardiac mass size was 2.1 cm  x  2.5 cm (Figure 2).