CASE 519: LYMPHOMA in RETROPERITONEUM, Dr LY VAN PHAI, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 51 YO WITH  LUMBAGO, PAIN IN RIGHT LEG FOR  3 MONTHS. 
X-RAYS OF LUMBAR SPINE IS NORMAL.

ULTRASOUND  DETECTED  RETROPERITONEAL HYPOECHOIC MASS   COVERING  THE RIGHT PSOAS MUSCLE.
US1 = LONGITUDINAL SCAN OF RIGHT PSOAS MUSCLE  HYPOECHOIC LIKE CYST.

US 2  = PSOAS MUSCLE IS BEING PULL UP ;  US 3  = AVASCULAR HYPOECHOIC AREA ; US 4,  US 5  = BENDING AORTA  AND ILIAC ARTERY .

MSCT CE = CT 1 :CROSSED-SECTION NON CE: THIS MASS  PARAVERTEBRAL; CT 2 : CROSSED- SECTION AT PELVIS  CT3, CT4 : FRONTAL VIEW OF  THIS MASS WITH VERY HIGH CE ENHANCEMENT,  ILIAC ARTERY DEPLACED AND PSOAS MUSCLE  IS  INTACT.

MRI  WITH GADO =  MRI 1:CROSSED- SECTION VIEW, THIS MASS IS SOLID,  PULL UP THE ILIAC ARTERY;   MRI 2 : CROSSED- SECTION AT PELVIS

MRI 3 : FRONTAL VIEW;   MRI 4 : SAGITTAL VIEW,  PSOAS MUSCLE IS ENROUNDED BY TUMOR.

MRI contrast got down intra urinary bladder  looks like a  picture of camel.

MRI 5:  sagittal view of lumbar spine  shows the tumor invaded to spinal canal.

BLOOD TESTS= WBC, CRP ARE NORMAL, MARKER  BETA2 MICROGLOBULINE, LDH, FERRITIN ARE IN NORMAL  LEVELS.

RADIOLOGIST SUGGESTION IS RETROPERITONEAL LYMPHOMA.

BIOPSY WAS DONE .

RESULT OF HISTOLOGY WITH IMMUNO-HISTO -CHEMISTRY  IS  LYMPHOMA B SMALL CELL.