ECE2015 Eposter Presentations Clinical Cases–Pituitary/Adrenal (95 abstracts)
Positive MIBG scan in a patient with adrenal failure secondary to lymphoma: a coexistent paraganglioma or false positive involvement?
Didem Ozdemir 1 , Sefika Burcak Polat 1 , Betul Asan 2 , Aydan Kilicarslan 3 , Sabire Y Aksoy 4 , Seyda Turkolmez 4 , Reyhan Ersoy 1 & Bekir Cakir 1
1Department of Endocrinology and Metabolism, School of Medicine, Yildirim Beyazit University, Ataturk Education and Research Hospital, Ankara, Turkey; 2Department of Internal Medicine, School of Medicine, Yildirim Beyazit University, Ataturk Education and Research Hospital, Ankara, Turkey; 3Department of Pathology, School of Medicine, Yildirim Beyazit University, Ataturk Education and Research Hospital, Ankara, Turkey; 4Department of Nuclear Medicine, School of Medicine, Yildirim Beyazit University, Ataturk Education and Research Hospital, Ankara, Turkey.
Introduction: We report stage IV B cell lymphoma in a patient presenting with adrenal failure and an intraabdominal mass which imaging techniques were suggestive for paraganglioma.
Case report: A 71-years-old woman admitted to our emergency clinic with severe fatigue and stupor. She was diagnosed to have primary adrenal failure since serum ACTH was 229 pg/ml and cortisol response to 250 μg co-syntropin was 6.17 μg/dl. In abdominal MRI, bilateral adrenal enlargement and a 35×31 mm paraaortic lesion consistent with paraganglioma (heterogenous, markedly increased contrast uptake, milimetric cystic foci) were detected. 123I-MIBG showed diffuse uptake in the lesion. 24 h urine metanephrin, normetanephrin and VMA levels were moderately increased. She did not have persistent or intermittent hypertension. During investigation for the cause of adrenal failure, multiple mediastinal and hilar lymph nodes (24×7 mm the biggest) were observed in thoracal CT and a lesion of 94 mm destructing cortex of left iliac crest and extending to soft tissue was detected in pelvic MRI. 18F-FDG PET/CT confirmed high uptakes with high SUVmax indexes in the lesion inferior to the left adrenal gland, bilateral adrenal glands, paravertebral and mesenteric lymph nodes, intestinal serosal surfaces and left iliac crest. A CT-guided biopsy was taken from the lesion surrounding iliac crest and the histopathological result was high grade B cell lymphoma infiltration. Rituximab-CHOP chemotherapy treatment was started.
Conclusion: To our knowledge, coexistent paraganglioma and lymphoma was not reported in the literature previously. However, since we did not have histopathological confirmation, false positive MIBG uptake secondary to lymphoma could not be excluded. Although 123I-MIBG is known to have a sensitivity of 77–90% and specificity of 88–99% for localizing paragangliomas, lymphoma might be one of the causes of false positivity in addition to some other rare causes such as angiomyolipoma.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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