31st May 2023

A 61-year-old female presents to ED with a 6-week history of worsening back pain, significant weight loss and night sweats

A 61-year-old female presents to ED with a 6-week history of worsening back pain, significant weight loss and night sweats. She has been unable to work for the last week as she has felt too unwell. She has previously been very well with no significant past medical history.

Her bloods show Hb of 112 with a raised LDH and CRP and a stage 1 AKI. A CT scan is performed which shows a 10cm retroperitoneal mass, which is obstructing the right ureter and compressing the L3/L4 vertebral bodies. It encases the infra-renal abdominal aorta. An urgent biopsy is obtained, and the provisional report is suggestive of lymphoma.

Of the following options, what is the most likely diagnosis?