Primary Bilateral Non-Hodgkin's Lymphoma of the Adrenal Gland: A Case Report

Bouchikhi, Ahmed Amine; Tazi, Mohammed Fadl; Amiroune, Driss; Mellas, Soufiane; Ammari, Jalaledine El; Khallouk, Abdelhak; Fassi, Mohammed Jamal El; Farih, Moulay Hassan

doi:10.1155/2012/325675

Cited by 8 publications

(10 citation statements)

References 10 publications

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“…The aetiopathogenesis is unclear but may be related to previous autoimmune adrenalitis, Epstein–Barr virus and mutations p53 and c-Kit 3. As with our case report, primary adrenal lymphoma is common in elderly men (median age 68 years and 2–3:1 male:female ratio) 4. Treatment of adrenal lymphoma includes surgery, radiotherapy and chemotherapy.…”

Section: Discussionsupporting

confidence: 63%

Adrenal lymphoma presenting as primary hypoadrenalism in the elderly

Bhargava¹,

Dixon

2019

BMJ Case Rep

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Adrenal lymphoma causing primary hypoadrenalism in the elderly is a very rare finding. We describe a case of an 85-year-old man who was admitted to our hospital. He had a short history of hypotension and unresponsiveness. He was referred to the endocrine team, after a CT scan of his thorax abdomen and pelvis demonstrated significant enlargement of both his adrenal glands with associated lymphadenopathy. This scan was originally done to rule out an occult intra-abdominal malignancy. In addition, a tetracosactide (short Synacthen) test demonstrated adrenal insufficiency. This case demonstrates that adrenal lymphoma should be considered as an important differential when there is evidence of adrenal gland hyperplasia, lymphadenopathy and adrenal insufficiency.

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Section: Discussionsupporting

confidence: 63%

Adrenal lymphoma presenting as primary hypoadrenalism in the elderly

Bhargava¹,

Dixon

2019

BMJ Case Rep

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“…The recommended treatment regimen for PAL is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone), a classical chemotherapy regimen (20), with chemotherapy being the typical treatment. It has been reported that surgery is not recommended for treatment (21). This disease appears to have a poor prognosis, and the median survival of patients with PAL is reported to be ~1 year (22).…”

Section: Discussionmentioning

confidence: 99%

Bilateral primary adrenal diffuse large B cell lymphoma without adrenal insufficiency: A case report and review of the literature

Chen

Jin

et al. 2017

Molecular and Clinical Oncology

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Abstract. Primary adrenal lymphoma (PAL) is an infrequent malignant tumor, occurring in the bilateral adrenal glands as a mass in the majority of cases. The current study presents a case of bilateral primary adrenal diffuse large B cell lymphoma in a 52-year-old female patient, who presented with abdominal pain in the left lumbar region for ~2 weeks. Abdominal ultrasound examination and computed tomography scanning revealed a mass of 132x119x101 mm on the left adrenal gland and a mass of 53x27 mm on the right adrenal gland. A percutaneous biopsy was performed and histopathological examination further confirmed this lesion as diffuse large B cell lymphoma. The present study highlights the importance of early diagnosis of PAL, and performs a literature review of the subject. IntroductionAlthough the adrenal glands contain no lymphoid tissue, primary adrenal lymphoma (PAL) is identified in <1% of cases of non-Hodgkin lymphoma (1). As a type of extranodal lymphoma, PAL is rare and constitutes <1% of cases of extranodal lymphomas; PAL is primarily bilateral but secondary involvement of the adrenal gland is typically unilateral (2,3). Diffuse large B cell lymphoma (DLBCL) is the most common subtype of PAL, which represents ~70% of PAL cases (4,5). Characteristically, PAL predominantly affects elderly patients without nodular lesions. Diagnosis of PAL is frequently challenging due to its nonspecific clinical manifestation and imaging results, and pathological examination is the only method of confirming this diagnosis (6). The prognosis of PAL is typically poor, and the 1-year survival rate is 17.5% (3). The current study reports a case of bilateral primary adrenal diffuse large B cell lymphoma and performs a review of the literature. Case reportIn June 2016, a 52-year-old female patient was admitted to the Department of Urology of Peking University Shenzhen Hospital (Shenzhen, China) due to abdominal pain in the left lumbar region lasting ~2 weeks. The patient had experience anorexia and weight loss of ~15 kg in the previous 0.5 months. The patient's past medical history included grade one hypertension for ~3 years and cerebral infarction ~2 years previously. On admission, physical examination revealed that no enlarged superficial lymph nodes were palpable and there was no hepatosplenomegaly. A full blood count revealed that had a hemoglobin level of 91 g/l (normal range, 115-150 g/l), a white blood cell count of 5.45x10 9 /l (normal range, 3.5-9.5x10 9 /l), 55.2% neutrophils (normal range, 40-75%), 27.2% lymphocytes (normal range, 20-50%), 13.8% monocytes (normal range, 3-10%), 3.1% eosinophils (normal range, 0.4-8%), 0.7% basophils (normal range, 0-1%), and a platelet count of 449x10 9 /l (normal range, 125-350x10 9 /l). A biochemical profile revealed a potassium level of 2.8 mmol/l (normal range, 3.5-5.3 mmol/l), a sodium level of 138 mmol/l (normal range, 137-147 mmol/l), an albumin level of 33.7 g/l (normal range, 40-55 g/l), a uric acid level of 558 µmol/l (normal range, 155-357 µmol/l), triglyceride levels of 2...

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“…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. Elderly men are most commonly affected by PAL; in particular, a prior study observed that PAL patients ranged between 39 and 89 years of age with a mean age of 68 years 8.…”

Section: Discussionmentioning

confidence: 99%

“…PAL often presents with bilateral tumour masses (in 70% of cases) 7 8. Elderly men are most commonly affected by PAL; in particular, a prior study observed that PAL patients ranged between 39 and 89 years of age with a mean age of 68 years 8. Primary adrenal non-Hodgkin's lymphoma is a rare extranodal involvement that accounts for <3% of PAL cases 9…”

Section: Discussionmentioning

confidence: 99%

Bilateral primary adrenal lymphoma with adrenal insufficiency

Ekhzaimy¹,

Mujamammi

2016

BMJ Case Reports

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Primary adrenal lymphoma is an extremely rare condition. We describe a case of bilateral adrenal lymphoma in a man aged 55 years who was admitted to our hospital. He had a 3-month history of left flank pain, nausea and vomiting with weight loss. A CT scan at a private hospital revealed bilateral large adrenal masses; the patient was referred to our centre based on these findings. He was evaluated for pheochromocytoma by an endocrinology team; however, all findings were negative. In addition, a cosyntropin stimulation test indicated adrenal insufficiency. A Trucut biopsy of the adrenal gland revealed diffuse large B-cell lymphoma of the adrenal glands, and the patient responded extremely well to chemotherapy.

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Primary Bilateral Non-Hodgkin's Lymphoma of the Adrenal Gland: A Case Report

Cited by 8 publications

References 10 publications

Adrenal lymphoma presenting as primary hypoadrenalism in the elderly

Adrenal lymphoma presenting as primary hypoadrenalism in the elderly

Bilateral primary adrenal diffuse large B cell lymphoma without adrenal insufficiency: A case report and review of the literature

Bilateral primary adrenal lymphoma with adrenal insufficiency

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