Primary adrenal lymphoma: radiological; pathological, clinical correlation

Abstract

Objective: The purpose of this study was to analyze CT and MR imaging (MRI) manifestation of primary adrenal lymphoma in order to better understand of this rare disease.

Materials and methods: Six patients (4 men, 2 women; median age, 65.5 years) with pathologically proven primary adrenal lymphoma were retrospectively reviewed. Imaging findings (CT&MRI, n=3; only CT, n=3) were analyzed and correlated with clinical and pathologic findings.

Results: All cases were pathologically proven primary adrenal diffuse large B-cell lymphoma with bilateral lesions in 3 cases respectively. Maximum diameters of the 9 lesions were 6.1-14.8 cm, median 10.5 cm. Seven lesions were round, oval or oblong, and 2 lesions irregular. Seven lesions were well-defined and 2 had ill-defined margins. Unenhanced CT density of 9 lesions and MR signal intensity of T1 weighted images of 6 lesions were similar to that of muscle, and all 6 lesions were hyperintense on T2-weighted MR images. Following intravenous injection of contrast media, 6 lesions had mild enhancement and 3 lesions had moderate enhancement on parenchymal phase imaging. Enhancement was homogenous in three, slightly inhomogeneous in four, and heterogeneous in two. Seven lesions, in 5 cases, infiltrated the adjacent tissues or organs in patients with large tumors.

Conclusion: Primary adrenal lymphoma usually manifests as large, well-defined, soft-tissue masses replacing the adrenal gland with homogeneous or slightly inhomogeneous enhancement. Large tumors especially tend to infiltrate adjacent structures.