A case report of primary adrenal lymphoma

Abstract

Rationale: Primary adrenal lymphoma (PAL) is an extremely rare and highly invasive malignant disease. Imaging examination usually shows bilateral adrenal involvement with large tumor masses and local infiltration. However, it is unclear how lymphoma dynamically develops into huge tumor masses in the adrenal glands. The overall survival rate of PAL is generally poor, and the underlying mechanism might be related to prooncogenic mutation but not fully elucidated. Patient concerns: A 52-year-old woman complaining of a large mass in the left adrenal region for 1 month was admitted to our department. Diagnosis: Computed tomography firstly showed a huge mass (8.9 × 7.5 cm) in the left adrenal gland and diffusely enlarged right adrenal gland. A month later, the mass in the left adrenal gland further enlarged (9.5x7.5 cm) with infiltration of the left renal artery and retroperitoneal lymphadenopathy, and the right adrenal gland rapidly progressed into a huge mass (8.0x4.7 cm). Additionally, her chest computed tomography revealed mediastinal and bilateral hilar lymphadenopathy. Then an adrenal biopsy confirmed the diagnosis of diffuse large B-cell lymphoma, nongerminal center B-cell type, stage IV by Ann Arbor staging system. Immunohistochemistry showed positivity for Ki-67 (approximately 90%), BCL2 (approximately 80%) and MYC (approximately 70%) double-expressor lymphoma. Interventions: The patient's condition progressed rapidly, there was no opportunity to use pathology-based chemotherapy. Dexamethasone was given intravenously by thoracic and intraperitoneal injection; antibiotics and supporting treatment were also given. Outcomes: The patient's condition progressed rapidly, with the development of malignant chest and abdominal cavity fluid and lung infection, and eventually developed septic shock and respiratory failure. She responded poorly to treatment regimens, and eventually died 8 days after the diagnosis of PAL. Lessons: PAL grows progressively throughout the adrenal glands, high Ki-67 positivity and BCL2/ MYC co-expression predict rapid progress and poor prognosis.

A Novel Diagnostic Model for Primary Adrenal Lymphoma

“…Early diagnosis of PAL is essential, but no quick diagnostic method is available. Patients with PAL might die before pathological confirmation (13,35). In addition, recent studies suggested that unlike other adrenal malignancies, adrenalectomy preceding surgery provided no benefit to PAL patients (4,5,9).…”

“…Some PALs can mimic PCC, presenting with moderate to clear elevation of catecholamines (11,12). PCC preoperative preparation is time-consuming, but the progression of PAL can be extremely aggressive, and patients may even die before receiving chemotherapy (13). Moreover, the diagnosis of hormonally inactive diseases, such as PAL, adrenal metastasis, or silent adrenocortical carcinoma, remains elusive.…”

Synchronous gastric cancer and primary lymphoma of right adrenal gland: a case report

“…This finding agreed with the previous studies that all patients with confirmed adrenal insufficiency had bilateral adrenal lymphomas, and no patients with unilateral adrenal lymphoma showed adrenal insufficiency [ 32 , 34 ]. Chemotherapy with R-CHOP is the widely recognized treatment strategy for primary adrenal lymphoma [ 2 ]. R-miniCHOP was administered to the patient in this case report because the patient was elderly, had just undergone gastrectomy, and had multiple comorbidities [ 35 ].…”

“…Primary adrenal lymphoma is based on a histologically confirmed lymphoma involving unilateral or bilateral adrenal glands without a previous history of lymphoma. Primary adrenal lymphoma requires a significant dominance of adrenal lesions when other organs or lymph nodes are involved by lymphoma concurrently with the adrenal glands [ 2 ].…”

Impact Evaluation of Comfort Care on the Prognosis of Giant Thoracic Tumor Patients with Computerized Tomography Imaging under Intelligent Reconstruction Algorithm

“…A giant thoracic tumor is a kind of rare tumor clinically [1][2][3]. Because of its complicated pathological types and prognosis, there is no unified standard for the diagnosis and treatment, and surgical resection becomes the major clinical treatment means [4][5][6][7].…”