Endocrine Abstracts

Introduction : Primary adrenal lymphomas (PAL) are extremely rare and constitute 0.5% of all adrenal tumors. The number of cases described is approximately 70 cases [1] and It is bilaterally manifested in approximately 70% of cases [2]. The diagnosis is made on histological features, as there is no specific symptoms. Treatement is based on chemotherapy and prognosis is usually poor. We report two cases of bilateral PAL.

Cases: First case: A 63-year-old woman, admitted for exploration of a bilateral adrenal mass discovered on CT-Scan requested after a 3 week history of asthenia, weight loss, vomiting and abdominal pain. Her medical history comprised hypertension and and stroke. Clinical examination revealed no signs of hypersecretion. Biology showed elevated lactate deshydrogenase(362 UI/l) and β-2 microglobulin levels (4.97 mg/l). On imaging, there was large adrenal masses measuring 7 cm on the right and 9 cm on the left side with 32UH of spontaneous density and signs of vascular infiltration. CT-guided biopsy concluded on diffuse large B-cell lymphoma. Chemotherapy treatment was decided, unfortunately, the patient died before starting treatement.

Second case: A 52-year-old man, with a medical history of diabetes mellitus, was admitted for exploration of a deterioration of general condition. Adrenal insufficiency was confirmed by low cortisol level and required hydrocortisone replacement therapy. β-2 microglobulin level was elevated (3.34 mg/l). Abdominal CT-scan revealed 2 adrenal masses measuring 7 cm on the right and 3 cm on the left side with a spontaneous density of 35UH infiltrating the stomach greater curvature, the pancreas tail and The upper pole of the left spleen. The biopsy had shown a Diffuse large B-cell lymphoma. Chemotherapy was decided and patient is still receiving courses.

Conclusion : The prognosis of PAL is usually poor, it grows progressively throughout the adrenal glands. Thus early diagnosis and treatment is the key to saving patients.[1] SALVATORE J.R., ROSS R.S. Primary bilateral adrenal lymphoma. Leuk. Lymphoma, 1999, 34, 111-117. [2] Khurana A, Kaur P, Chauhan AK, et al. Primary non Hodgkin’s lymphoma of left adrenal gland – a rare presentation. J Clin Diagn Res 2015;9:XD01–3