DECODING THE RETROPERITONEAL MYSTERY: A CASE OF FOLLICULAR LYMPHOMA
DOI:
https://doi.org/10.22159/ajpcr.2025v18i8.55592Keywords:
Retroperitoneal mass,, Follicular lymphoma, Non-Hodgkin lymphoma, R-CHOP chemotherapy, ImmunohistochemistryAbstract
Retroperitoneal masses are rare and often difficult to diagnose due to similarities between benign and malignant conditions. Follicular lymphoma (FL), a common indolent subtype of non-Hodgkin lymphoma, can present atypically, complicating early identification. We report a 60-year-old male with abdominal distension, weight loss, and breathlessness. Imaging revealed a large retroperitoneal mass encasing major vessels and associated lymphadenopathy. Biopsy of an enlarged inguinal lymph node confirmed FL through characteristic immunohistochemical markers. The patient was treated with six cycles of R-CHOP chemotherapy, resulting in complete remission. This case highlights the importance of histopathological evaluation in differentiating FL from other retroperitoneal pathologies like retroperitoneal fibrosis. Early and accurate diagnosis enables timely initiation of appropriate therapy, improving patient outcomes. Clinicians should consider FL in the differential diagnosis of retroperitoneal masses with atypical clinical presentations.
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1. Gulati V, Swarup MS, Kumar J. Solid primary retroperitoneal masses in adults: An imaging approach. Indian J Radiol Imaging. 2022 Jul;32(2):235-52. doi: 10.1055/s-0042-1744142, PMID 35924125
2. Shankland KR, Armitage JO, Hancock BW. Non-Hodgkin lymphoma. Lancet. 2012 Sep;380(9844):848-57. doi: 10.1016/S0140- 6736(12)60605-9, PMID 22835603
3. Singh R, Shaik S, Negi BS, Rajguru JP, Patil PB, Parihar AS, et al. Non-Hodgkin’s lymphoma: A review. J Fam Med Prim Care. 2020 Apr;9(4):1834-40. doi: 10.4103/jfmpc.jfmpc_1037_19, PMID 32670927
4. PDQ Adult Treatment Editorial Board. Non-hodgkin lymphoma treatment (PDQ®). patient version. In: PDQ Cancer Information Summaries. Bethesda: National Cancer Institute (US); 2002.
5. Gaziano D, Akbar A, Lakhani K, Okafor TL, Bhesania S. Concurrent incidental presentation of primary retroperitoneal follicular lymphoma with acute pancreatitis. Cureus. 2020 Nov;12(11):e11687. doi: 10.7759/ cureus.11687, PMID 33274167
6. Carreras J. The pathobiology of follicular lymphoma. J Clin Exp Hematop. 2023 Sep;63(3):152-63. doi: 10.3960/jslrt.23014, PMID 37518274
7. Weber B, Luke ND. Rapid onset chylous ascites presenting as the initial manifestation of follicular lymphoma: A case report. Cureus. 2022;14(7):e27199. doi: 10.7759/cureus.27199, PMID 36035034
8. Ur Rahman A, Ramaraj R, Humphreys E, Slowinska E. Retroperitoneal fibrosis as a cause of chylous ascites. ACG Case Rep J. 2017;4:e115. doi: 10.14309/crj.2017.115, PMID 29090239
9. Zhang S, Chen M, Li CM, Song GD, Liu Y. Differentiation of lymphoma presenting as retroperitoneal mass and retroperitoneal fibrosis: Evaluation with multidetector-row computed tomography. Chin Med J (Engl). 2017 Mar;130(6):691-7. doi: 10.4103/0366-6999.201606, PMID 28303852
10. Cho J. Basic immunohistochemistry for lymphoma diagnosis. Blood Res. 2022 Apr;57(Suppl 1):55-61. doi: 10.5045/br.2022.2022037, PMID 35483927
11. Lan X, Hu R, Song T, Gan L, Sun W. A case of follicular lymphoma mimicking idiopathic retroperitoneal fibrosis. Cureus. 2022 Nov;14(11):e32031. doi: 10.7759/cureus.32031, PMID 36600821
12. Solal-Céligny P, Roy P, Colombat P, White J, Armitage JO, Arranz- Saez R, et al. Follicular lymphoma international prognostic index (FLIPI). Blood. 2004;104(5):1258-65. doi: 10.1182/ blood-2003-12-4434, PMID 15126323
13. Van de Schans SA, Steyerberg EW, Nijziel MR, Creemers GJ, Janssen- Heijnen ML, Van Spronsen DJ. Validation, revision and extension of the follicular lymphoma international prognostic index (FLIPI) in a population-based setting. Ann Oncol. 2009;20(10):1697-702. doi: 10.1093/annonc/mdp053, PMID 19549712
14. Watanabe T, Tobinai K, Wakabayashi M, Maruyama D, Yamamoto K, Kubota N, et al. R-CHOP treatment for patients with advanced follicular lymphoma: Over 15-year follow-up of JCOG0203. Br J Haematol. 2024;204(3):849-60. doi: 10.1111/bjh.19213, PMID 37996986
15. Tomita N, Takasaki H, Fujisawa S, Miyashita K, Ogusa E, Kishimoto K, et al. Standard R-CHOP therapy in follicular lymphoma and diffuse large B-cell lymphoma. J Clin Exp Hematop. 2013;53(2):121-25. doi: 10.3960/jslrt.53.121, PMID 23995108
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Copyright (c) 2025 Raviteja Nalabothula, Taruguvandla Sandhya Rani, Budumuri Venkata Siva Karthik, Keerthi Reddy Karra
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