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Case 98

Unusual case of bilateral renal masses

Gavin Low, Richard Edwards

A 23 year old woman presented with a golf ball sized lump in her left axilla. Clinical examination revealed the solitary finding of an enlarged left axillary lymph node. Blood tests showed a Hb of 10.6g/dl, CRP 73mg/l and ESR 28mm/first hour. White cell count and urea and electrolytes were normal. A fine needle aspirate was performed on the left axillary lymph node. This revealed only reactive lymphoid tissue. However, the patient subsequently complained of flu like symptoms, back pain and weight loss. The decision was taken to perform a lymph node excision biopsy, a CT scan and a bone scan.

What are the salient findings, and what is the likely diagnosis? What is the differential diagnosis for the appearances on the abdominal scans?