Differential Diagnosis for a 60-year-old Patient with a Retroperitoneal Mass and History of Hodgkin Lymphoma

• Single most likely diagnosis:
  • Lymphosarcoma: Given the patient's history of Hodgkin lymphoma, the presence of a large retroperitoneal mass and multiple liver masses suggests a possible recurrence or progression of lymphoma. Lymphosarcoma, another term for lymphoma, can present with such widespread disease, especially in someone with a prior history of lymphoma.
• Other Likely diagnoses:
  • Liposarcoma: This is a type of soft tissue sarcoma that can occur in the retroperitoneum and grow to a large size before becoming symptomatic. The dull aching swelling described could be consistent with a slowly growing tumor like liposarcoma.
  • Germ cell tumor: Although less common in this age group and typically associated with testicular cancer, germ cell tumors can metastasize to the liver and retroperitoneum. However, they are less likely given the patient's age and history.
• Do Not Miss diagnoses:
  • Metastatic disease: It's crucial not to miss the possibility of metastatic disease from another primary cancer. Given the patient's age, other malignancies such as colorectal, lung, or pancreatic cancer could metastasize to the liver and retroperitoneum.
  • Neuroendocrine tumors: These can present with large retroperitoneal masses and liver metastases. They might not be the first consideration but are important to rule out due to their distinct management and prognosis.
• Rare diagnoses:
  • Neural tube tumor: These are rare in adults and would be an unusual diagnosis for a retroperitoneal mass in a 60-year-old. They are more commonly associated with pediatric or young adult populations.
  • Other rare sarcomas: There are many other types of sarcomas that could present in this manner, but they are less common than liposarcoma and would be considered after more likely diagnoses have been ruled out.