An unanticipated case of B‐cell lymphoma, presenting as skin bruises, detected incidentally during initial sonography

Abstract

IntroductionLymphomas are cancers of lymphatic origins, commonly presenting as a painless swelling of the lymph gland (adenopathy). Lymphomas are broadly categorised into Hodgkin and Non‐Hodgkin lymphoma. This report aims to present an unexpected case of B‐cell lymphoma that presented as skin bruises, incidentally detected on ultrasound as a nonspecific retroperitoneal mass.Case PresentationA 75‐year‐old female presented with a vaccine‐induced flare of her known Immune Thrombocytopenic Purpura (ITP). An initial ultrasound scan requested to examine her spleen revealed a right retroperitoneal abnormality affecting the adjacent right kidney and IVC. A subsequent triple‐phase contrast‐enhanced computed tomography (CT) scan revealed a large infiltrative mass involving the right kidney extending across the midline to the right of the patient's abdominal aorta. Lymphoma was suspected. Immunohistochemistry analysis of the CT‐guided biopsy samples revealed the presence of CD5‐negative low‐grade B‐cell lymphoma.DiscussionThis report presents a unique case of B‐cell lymphoma that manifested as skin bruises.Although ultrasound is not the gold standard imaging modality to test for lymphoma in the abdomen, it is imperative that ultrasound practitioners continue to complete a thorough abdominal ultrasound, even when specific organ requests are made, as in this case report. Ultrasound has a role in the detection of clinically asymptomatic incidental abdominal masses.ConclusionIt is important that a targeted ultrasound examination is avoided for patients with no recent imaging history within the department. This case highlights the importance of thorough ultrasound scanning to avoid missing incidental abnormalities as opposed to an organ‐specific targeted scanning.