A 24-year-old man presented with recurrent lower abdominal pain, abdominal distension and vomiting for 5 months. He was found to have a large mass occupying the left lower abdomen. On rectal examination, there was luminal narrowing with rectal mucosal sparing. Computed tomography (CT) (, ) revealed a 20-cm mass, which seemed to arise from small bowel, and enlarged retroperitoneal lymph nodes. There was also a hyperdense, round lesion measuring 2 cm in the superior pole of the left kidney. This appeared to be solid on ultrasonography, suggesting a renal cell carcinoma.
FIG. 1. Contrast-enhanced computed tomography scan showing a circumferential small bowel mass occluding the lumen.
FIG. 2. Contrast-enhanced computed tomography scan showing a left renal mass.
CT-guided biopsy specimens of both the bowel mass and the renal lesion were obtained. The former was reported as high-grade non-Hodgkins lymphoma, possibly BL, but findings from the latter specimen were inconclusive.
At laparotomy, a tumour measuring 30 × 20 cm was found, possibly arising from the sigmoid colon or ileum. In the upper pole of the left kidney, there was a solid lesion measuring 2 × 2 cm. The patient underwent anterior resection, with anastomosis of a segment of ileum and a partial left nephrectomy. His postoperative recovery was uncomplicated.
Histopathological evaluation showed a high-grade non-Hodgkins lymphoma, consistent with BL, of the small bowel and mesenteric lymph nodes, with tumour cells positive for CD20 and CD10 and negative for Bcl-2. The MIB-1 labelling index was 100%, indicating a very high proliferation rate. The left partial nephrectomy specimen showed renal cell carcinoma Fuhrman grade 2.
The patient received chemotherapy for BL and was disease-free at follow-up 2 years later.