A case of primary adrenal diffuse large B-cell lymphoma achieving complete remission with rituximab-CHOP chemotherapy

Abstract

Primary adrenal lymphoma is a very rare extranodal lymphoma; its clinical features consist of a high incidence of bilateral adrenal involvement and diffuse large B-cell lymphoma. We report a patient with primary bilateral adrenal diffuse large B-cell lymphoma who achieved complete remission with R-CHOP (rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy. A 52-yr-old man presented with fever and progressive fatigue for 3 months. Computed tomography (CT) scans of the abdomen and pelvis demonstrated large bilateral adrenal masses, and a needle biopsy of the left adrenal mass revealed diffuse large B-cell lymphoma. After 6 cycles of R-CHOP chemotherapy, CT scans showed no residual disease. To our knowledge, this is the second report to date of a patient with primary bilateral adrenal diffuse large B-cell lymphoma who achieved complete remission using R-CHOP chemotherapy.

Keywords: Complete Remission; Lymphoma, Large B-Cell, Diffuse; Primary Adrenal Lymphoma; R-CHOP.

Fig. 1

Abdominal pelvic CT scan showing bilateral adrenal masses.

Fig. 2

CT-guided core needle biopsy of the left adrenal mass showing a tumor comprised of large cells, immunohistochemically positive for CD20 but negative for CD3 and CD30. The Ki-67 labeling index was about 90%. The tumor was diagnosed as a diffuse large B-cell lymphoma.

Fig. 3

F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) scan showing intense FDG accumulation in both adrenal glands. There was no abnormal FDG uptake in the rest of the body.

Fig. 4

Follow-up CT and FDG-PET scans after 6 cycles of R-CHOP chemotherapy showing no evidence of tumor.