Endocrine Abstracts

Introduction: The non-Hodgkin lymphomas (NHL) involve extralymphatic sites more often than does Hodgkin lymphoma; consequently, tumor involvement of almost every abdominal organ has been recorded. Adrenal involvement in patients with NHL may be present at the time of initial assessment. however, adrenal insufficiency as a consequence of adrenal invasion is rare. We report a case of a patient diagnosed with NHL with breast and bilateral adrenal involvement.

Case report: A 41-years-old female patient, diagnosed 2 months before with a 4 cm breast left tumor classified ACR 4, she had excisional biopsy of this tumor. Anatomopathological analysis revealed lymphomatous malignant tumor proliferation with immunohistochemical appearance consistent with diffuse B-type NHL. She underwent positron emission tomography (PET) scan which showed intensely hypermetabolic disease within the left mammary and bilateral adrenal glands. a computed tomography (CT) scan of adrenal glands was done showing Well-limited rounded left adrenal nodular lesion measuring 1.1x1.2 cm (42uh) right adrenal gland was normal. The patient reported asthenia with moderate weight loss and anorexia. Clinical examination noted hypotension 89/61mmhg. Blood tests showed normal natremia and kaliemia, Cortisolemia at 8am was low confirming diagnosis of adrenal insufficiency for which she was started on oral hydrocortisone. The patient received 4 courses of chemotherapy. Control PET-CT scan done after revealed complete morphological and metabolic regression of both adrenal and mammary lesions. The response of these adrenal masses to chemotherapy in a manner similar to the response of mammary masse reinforces the impression that the adrenal pathology was indeed due to the non-Hodgkin lymphoma. During follow up Cortisolemia at 8am was within normal range, oral hydrocortisone was discontinued. Regular follow up is maintained.

Discussion: Lymphoma disseminating to both the adrenals is a common cause of bilateral masses. Adrenals are involved in 24% of cases with disseminated NHL in an autopsy study. Adrenal insufficiency was reported only in four cases with adrenal involvement in a series of 127 patients with NHL. Primary NHL of the adrenal gland is extremely uncommon. Breast’s malignant lymphoma can present itself as a primary mammary neoplasm or it can involve the breast as part of a generalized process. Primary NHL of the breast is a rare disease that has been assessed to represent from 0.04–0.52% of all malignant tumors of the breast. In our case we can not propose which organ system was primarily involved, for this reason we presented our case as the NHL involvement mammary and adrenal glands.