A Huge Primary Retroperitoneal Diffuse Large B-cell Lymphoma: A Case Report

Retroperitoneal diffuse large B-cell lymphoma (DLBCL) is generally rare and often presents with late symptoms. A 60-year-old female presented with abdominal pain for 3 days with associated symptoms of altered bowel habits and constitutional symptoms. Physical examination was unremarkable. The blood investigations were generally within normal limits except for a 10-fold rise in serum CA-125. Transabdominal ultrasonography revealed an ill-defined lesion, with a cystic component within, at the inferior pole of the spleen. Computed tomography scan showed a large lobulated soft tissue tumour in the left retroperitoneal space with local infiltration to adjacent organs with multiple subcentimeter para-aortic and aortocaval lymph nodes. Laparotomy revealed a locally advanced retroperitoneal tumour measuring 10 x 10cm in size. The left retroperitoneal tumour was resected en-bloc with the left kidney, the spleen, the distal part of the pancreas and a part of the left diaphragm. Histopathological examination of the retroperitoneal tumour revealed a DLBCL (germinal centre type) as CD10, CD20, and BCL-6 were positive among all the markers, confirming the final diagnosis. She was started on CHOP regimen chemotherapy and is currently well. A complete en-bloc resection of the retroperitoneal lymphoma is recommended in fit patients with resectable retroperitoneal tumours. The decision between core needle biopsy and surgical resection should be made on a case-by-case basis following a multidisciplinary team approach discussion to achieve the best outcome for these patients.