Primary adrenal lymphoma: Differential involvement with varying adrenal function

Abstract

Primary adrenal Non-Hodgkin's lymphoma is rare. The symptoms of the disease and response to treatment are variable depending on the type of lymphoma, tumor size, and presence of adrenal insufficiency. We report two cases of primary adrenal lymphoma who had varied presentations. One presenting with abdominal pain and weight loss was documented to have unilateral disease without any adrenal insufficiency and showed a good response to combination chemotherapy, while the second one had bilateral adrenal involvement with adrenal insufficiency and died after second chemotherapy. Functional adrenal involvement in lymphoma depends on the extent of involvement; patients with bilateral involvement almost always have adrenal insufficiency.

Keywords: Adrenal insufficiency; primary adrenal Non-Hodgkin's lymphoma; unilateral disease.

Figure 1

a) CECT abdomen revealing a large heterogeneously enhancing mass in the left suprarenal area involving superior pole of left kidney. b) CECT abdomen (post-chemotherapy) demonstrating a regressed left adrenal mass

Figure 2

a) CECT abdomen revealing bilateral adrenal mass encasing renal vessels and inferior vena cava. b) Microphotograph showing total replacement of adrenal tissue by diffuse lymphomatous infiltrate of NHL (H and E, ×100). c) Immunohistochemistry showing diffuse CD20 positivity of lymphomatous cells