Bilateral Adrenal Primary Diffuse Large B-Cell Lymphoma not Accompanied by Adrenal Insufficiency: A Report of Two Cases

Abstract

Abstract:Primary adrenal lymphoma (PAL) is uncommon in clinical settings, which is considered a rare high grade malignant lymphoma with a poor prognosis, patients with bilateral mass are rarer, and patients with normal adrenal function are extremely rare. We present 2 cases of patients with bilateral adrenal primary diffuse large B-cell lymphoma (PA-DLBCL) whose adrenal functions were normal. 2 patients were treated with unilateral adrenalectomy and a combination of chemotherapy. We summarized cases, reviewed the literature and discussed important issues with regard to the pathology change, diagnosis, treatment and prognosis. Keywords: Bilateral primary adrenal lymphoma; Diffuse large B-cell lymphoma Case Report 1A 64-year-old man was admitted into hospital because of bilateral adrenal mass were found during a body check-up. There are not special history of present illness and previous medical history in this patient, such as hypertension, diabetes, and other tumors, and there are not similar relevant diseases in his families. On examination: blood pressure 166/88 mmHg, heart rate 88/min, respiration rate 21/min, superficial lymph nodes swelling (-), heart, lungs, abdominal pathological sign (-). Lab findings: routine blood and urine check were normal; liver and kidney function and electrolytes level were normal; the blood glucose was 6.4 mmol/L (normal: 3.9-6.1mmol/L); Aldosterone 74.02 pg/ml (normal: 73-239 pg/ml); Cortisol 330.34 nmol/L; ACTH 80.38 pg/ml; urine VMA divided into three times as 5.13, 6.41, 3.20 mg/24h. CXR: no abnormalities. Abdominal ultrasound: hypoechoic solid mass revealed on bilateral adrenal gland, right side 13 cm × 10 cm × 5 cm, left side 8.5 cm × 6 cm × 6.5 cm. CT scanhomogenous soft tissue mass on both adrenal area and entirely replacing adrenal gland, CT scan done with contrast enhancements was not obvious changes, right side 13 cm × 10 cm × 5 cm, left side 8.5 cm × 6 cm × 6.5 cm ( Figures 1A-1C Microscope examination: diffuse distribution of tumor, similar rounded size, small amount of nuclear shaped cytoplasm could be observed scattered around the tumor cells. IHC: Bcl1-2 (+), Bcl-6 (weak+), CD20 (+), MUM-1 (+), CD3 (reactive T+), CD43 (partly+), CD138 (-), Kappa (-), Ki-67 (+70%), Lambda (+), CydinD1 (-), Mpo (-) ( Figures 3A and 3B). Surgical findings: Tumor found above kidney, right kidney obviously displaced downwards by compression, renal pedicle vessel are displaced by tumor, proximal to the vena cava, medium in texture, poor blood supply, no obvious adhesion with surrounding tissues, size 13 cm × 10 cm × 5 cm, no swollen lymph nodes were observed around tumor, Complete tumor resection. Left side did not undergo surgery. Post operation therapy: chemotherapy with CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolone). Follow up in 9 months. Case Report 2A 77-year-old man was admitted to our hospital with a 3-month history of abdominal pain .There are not similar relevant diseases in his patients' families. Previous medical history was unremarkable other than sligh...