Imaging of primary adrenal lymphoma: case report and literature review

Abstract

Primary adrenal lymphoma is very rare, and correct preoperative diagnosis is difficult because of its nonspecific imaging findings. We report a case of bilateral primary adrenal lymphoma, with the largest dimension of 18 cm, which is the largest one reported so far, to our knowledge. Computed tomography (CT) and magnetic resonance (MR) findings were not specific enough to establish a correct diagnosis, but positron emission tomography/CT (PET/CT) showed high fluorodeoxyglucose (FDG) uptake, indicating its malignant nature. We describe the imaging findings and review the related literature to highlight this uncommon entity.

Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature

“…Primary lymphoma of the adrenal glands is rare with only 70 cases reported in the literature [126][127][128] accounting for 3 % of extra-nodal lymphoma [129]. The most common presentation is with bilateral adrenal masses and symptoms of fever, weight loss, and adrenal insufficiency [129]. In one review, 56/70 cases were bilateral and the majority were of B cell origin with only 6 cases of T cell lymphoma reported [128].…”

“…Disease involvement can range from bilateral small nodules to large masses with contrast washout characteristics similar to other malignant adrenal lesions (RPW \60 % and APW \40 %) [125]. Primary lymphoma of the adrenal glands is rare with only 70 cases reported in the literature [126][127][128] accounting for 3 % of extra-nodal lymphoma [129]. The most common presentation is with bilateral adrenal masses and symptoms of fever, weight loss, and adrenal insufficiency [129].…”

Primary adrenal non-Hodgkin’s lymphoma: Report of two cases

“…It has been reported in the literature that advanced age, primary adrenal insufficiency as an initial sign, tumor size, LDH level, and involvement of other organs can be poor prognostic indicators (10).…”

Computed tomography and magnetic resonance imaging of adrenal lesions

“…Lezije su obično velike i homogene, osim u prisutnosti cistične degeneracije ili nekroze. Postkontrastno se slabo do umjereno opacificiraju 56,57 . Na magnetskoj rezonanciji se prezentira niskim signalom u T1 mjerenim slikama, visokim signalom u T2 mjerenim slikama te minimalnom imbibicijom nakon aplikacije kontrastnog sredstva.…”

“…Na magnetskoj rezonanciji se prezentira niskim signalom u T1 mjerenim slikama, visokim signalom u T2 mjerenim slikama te minimalnom imbibicijom nakon aplikacije kontrastnog sredstva. Ne dolazi do ispada signala u T1 mjerenim slikama izvan faze 57 .…”