Primary Adrenal lymphoma presented with adrenal insufficiency

Abstract

We report a 71-year old man who presented with symptoms of adrenal insufficiency and large bilateral adrenal masses. Computed tomography guided FNA biopsy was not diagnostic. However, because of the rapid growth of the masses, the negative workup for primary malignancy and the strong clinical suspicion of a lymphoma, an open biopsy was performed and a B-cell lymphoma was disclosed.

Bilateral primary adrenal lymphoma with adrenal insufficiency

“…Diagnoses of PAL are relatively rare. Certain conditions associated with bilateral adrenal lesions with adrenal insufficiency are metastatic lung carcinoma, pheochromocytoma, tuberculosis and amyloidosis 6. PAL often presents with bilateral tumour masses (in 70% of cases) 7 8.…”

“…The clinical presentation of patients with adrenal lymphoma is typically non-specific and can include abdominal pain, weight loss, fever, anaemia, nausea and vomiting 6. All of these symptoms can mask the adrenal insufficiency diagnosis and the patient could have presented with adrenal crisis if unrecognised early.…”

“…In addition, other less likely causes of adrenal mass are given in table 2 6. Final diagnosis of PAL was confirmed by Trucut biopsy of adrenal tissues.…”

Small round tumour cells (CD38, CD 79a positive) in the adrenal gland

“…Primary adrenal lymphoma is usually suspected in a patient with bilateral adrenal masses, with/without lymphadenopathy and with/without any signs of adrenal insufficiency 1, 2. The most common symptom observed in nearly 70% patients is presence of bilateral adrenal mass.…”

Imaging of primary adrenal lymphoma: case report and literature review

“…To date, only about 70 cases of adrenal lymphoma have been presented in the English medical literature (1,5,9,10,12,16) and about 30 cases in the Chinese literature (4,7,13,14). Preoperative diagnosis of adrenal lymphoma is very difficult because of its nonspecific clinical presentation and imaging findings.…”