Follicular lymphomatosis

Discussion:

This case is characterized by lymphomatous infiltration throughout the abdomen and pelvis. The most striking manifestations of disease is the symmetric renal involvement and infiltration of the rectus abdominis musculature. Given the extensive nature of the disease (renal, spleen, probable small bowel, muscular, nodal), it would be difficult to plausibly suggest any other diagnosis than lymphoma. If you had a case with the renal findings alone, a reasonable differential would include lymphoma, IgG4 deposition disease, amyloid, and Erdheim-Chester disease

When reporting, it is most appropriate to suggest a potential target for biopsy, so that the clinician does not have to call the radiologist and ask: in this case, the large left inguinal lymph node is superficial and safe for ultrasound-guided biopsy.

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