Endocrine Abstracts

Introduction: Adrenal gland involvement can be seen in about 25% of lymphomas. However, primary adrenal lymphomas (PAL) are rare. The most common is diffuse large B-cell lymphoma (DLBCL). It is seen usually after the age of 60 years as bilateral, large masses.

Case report: A 64-year-old woman with a complaint of abdominal pain was referred to our clinic after bilateral surrenal masses were detected upon abdominal ultrasonography (USG) and computed tomography (CT). She did not have weight loss and fever. Physical examination showed widespread abdominal tenderness without guarding or rebound. Peripheral lymphadenopathy was absent. Laboratory tests showed cytopenia with elevated levels of lactate dehydrogenase, erythrocyte sedimentation rate, and C-reactive protein. Bilateral mass lesions, 10×6 cm sized in the right surrenal lodge, about 8.5×5.5 cm in the left surrenal lodge, 30HU in density was detected upon dynamic surrenal CT. Several pathological lymph nodes with a short axis up to 23 mm in the paraaortic region on the left adjacent to the mass lesions were seen. Cortisole levels and urinary catecholamines and methanephrine results were normal. She underwent surrenal biopsy. Histopathological and immunohistochemical staining was diagnosed as CD20 positive DLBCL. No involvement was found upon bone marrow biopsy. The patient was started on rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy by hematology. The adrenal masses had disappeared after the patient had been treated with 6 courses of chemotherapy. The patient is currently being observed in remission after 19 months after the last chemotherapy course.

Discussion: PAL’s are constitute <1% of non-hodgkin lymphomas. 75% of these masses are bilateral and the mean diameter is 8 cm. PAL’s are usually symptomatic due to mass effect, adrenal insufficiency due to infiltration of tumor cells. Our patient’s complaint was abdominal pain. Adrenal insufficiency was not found. It is difficult to distinguish lymphoma from metastatic lesions. Lymphoma can be diagnosed by biopsies or after adrenalectomy with suspicion of adrenocortical cancer. The prognosis of PAL is generally poor. Complete remission with chemotherapy has been reported in several articles in the literature. Early diagnosis is important. Although primary adrenal lymphoma is rare, it should be kept in mind among differential diagnosis especially in patients with advanced age, bilateral and large masses. Therefore our case is worth to present as a case of primary adrenal lymphoma without adrenal insufficiency to underline the importance of this pathology.