Bilateral primary adrenal lymphoma successfully treated with non-CHOP chemotherapy regimen

Abstract

Primary bilateral non-Hodgkin's lymphoma of the adrenal gland is a rare presentation with <200 reported cases. We report a 70-year-old man who presented with vomiting and abdominal pain for 2 weeks and was subsequently diagnosed to have high-grade lymphoma of the adrenal glands. The patient was then started on a rituximab-bendamustine chemotherapy regimen. The patient tolerated treatment well without significant side effects. Repeat positron emission tomography CT scan after four cycles of chemotherapy showed complete response. The patient has completed six cycles of chemotherapy and is on regular follow-up with no signs of relapse.

Keywords: malignant and benign haematology; oncology.

Figure 1

Contrast-enhanced CT scans of abdomen (A: coronal; B: axial view) showing well-defined hypodense lesions (measuring ≈ 7 cm × 6.5 cm × 5.5 cm) in the bilateral suprarenal regions (arrows).

Figure 2

H&E staining of lymph node showing sheets of medium-sized to large-sized monotonous malignant cells (A: ×40; B: ×200). Immuno-histochemical findings of lymph nodes with leucocyte common antigen (LCA) and CD3. (C) LCA positive; (D) CD3 negative.

Figure 3

Immunohistochemistry findings of lymph nodes with CD 20, Bcl-6, MUM-1 and Ki67. (A) CD20 positive, (B) Bcl-6 faint positive (<30% of tumour cells), (C) MUM-1 positive (60%) suggestive of non-germinal centre B cell type. (D) Ki67 60% (suggestive of high proliferative activity).

Figure 4

Positron emission tomography (PET) scan showing increased uptake in bilateral adrenal glands with no evidence of distant metastasis.

Figure 5

Whole-body positron emission tomography scan after four cycles of chemotherapy showing the metabolically complete response.