Primary T-cell Non – Hodgkin lymphoma of the Urinary Bladder Presenting as Haematuria and Bilateral Hydronephrosis: Report of a Rare Case

Introduction: Primary T cell lymphoma of the urinary bladder is extremely rare disease. Most of the lymphomas of urinary bladder are B-cell lymphomas. We encountered a case of T-cell lymphoma of the urinary bladder presenting as haematuria and bilateral hydronephrosis. Presentation of Case: A 42-year-old man was admitted to our hospital because of intermittent painful gross haematuria associated with bilateral loin pain and vomiting lasting for 3-4 weeks. Results of his general examination were normal. An ultrasonographic study and Computed Tomography (CT) of his abdomen and pelvis revealed bilateral gross hydro-ureteronephrosis with significantly thickened urinary bladder wall with large circumferential growth involving the entire bladder occluding both ureteric orifices with internal calcification. A cystoscopy procedure with Trans Urethral Resection of Bladder Tumour (TURBT) was performed. Postoperative microscopic examination and immunohistochemistry showed medium to large lymphocytes with hyperchromatic nuclei and strong expression of CD3 in the tumour cells and negativity for CD20 and cytokeratin. A diagnosis of T-cell non Hodgkin Lymphoma was entertained. Conclusion: Presentation of bilateral hydronephrosis with primary T cell lymphoma has not been reported previously. This sort of presentation can mimic other bladder malignancy and present a diagnostic challenge. An ancillary technique, Immunohistochemistry in our case, helped us arrive at the correct diagnosis and subsequent appropriate management