Primary adrenal lymphoma is an extremely rare entity which constitutes less than 1% of extranodal lymphomas. Most cases present with bilateral adrenal masses and without extraadrenal involvement, which can lead to symptoms of adrenal insufficiency. The prognosis is usually poor and chemotherapy is the first-line treatment option. We report here on a 78-year-old man admitted to our Internal Medicine Department because of constitutional symptoms and high fever spikes. He was diagnosed with adrenal insufficiency and a CT-scan revealed bilateral adrenal masses of about 6 cm in diameter. A percutaneous biopsy was performed and the histological exam was consistent with diffuse large B cell lymphoma. A review of the literature of this unusual entity was also carried out.

A 64-year-old man presented with a persistent cough. His past medical history included COVID-19 pneumonia one month previously. On admission, a full blood count showed a haemoglobin concentration of 120 g/l, a platelet count of 98 9 10 9 /l and a leukocyte count of 44 9 10 9 /l. A peripheral blood film showed 80% atypical lymphoid cells. Many of the abnormal cells had deeply basophilic cytoplasm with a markedly irregular nuclear contour producing a petal-shaped nucleus, mimicking the flower cells of adult T-cell leukaemia/lymphoma (ATLL) (all images; May-Gr€ unwald-Giemsa stain, 9100 objective), while other atypical cells showed either bilobed or rounded nuclei.Flow cytometric analysis showed strong expression of CD38, CD56 and CD138 with no expression of CD3, CD4, CD7, CD8, CD19, CD20, CD25 or CD45. Serum calcium was normal. Serum protein electrophoresis and immunofixation showed a lambda monoclonal component (12 g/l) with lambda-free light chains being quantified at 42.9 g/l. Antibodies to the human T-cell lymphotropic virus-1 (HTLV-1) were not detected. A diagnosis of primary plasma cell leukaemia was made.A bone marrow aspirate film was hypercellular with 95% abnormal plasma cells. Cytogenetic analysis showed a complex karyotype: 42,X,ÀY,add(1)(q?),+del(1)(p21),del(2) (q32),À5,À10,del(11)(q23),À12,À13,add(14)(q32) [16]/46,XY [9]. Fluorescence in situ hybridisation (FISH) analysis showed deletion of RB1 and LAMP1 on 13q, t(4;14) (IGH/ FGFR3 rearrangement) and amp(1q21).Plasma cell leukaemia rarely presents with flower-shaped nuclei. A differential diagnosis of ATLL should be considered in these cases, especially in HTLV-1 endemic areas.

A 76-yr-old man developed necrotizing fasciitis due to Salmonella enteritidis 1 month after an episode of gastroenteritis due to the same microorganism. The fact that S. enteritidis was the only organism isolated despite adequate anaerobic cultures confirm the ability of salmonellae to produce severe monomicrobial soft tissue infections.

No abstract

No abstract