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Ahmed TM, Fishman EK, Morris-Wiseman LF, Baraban E, Chu LC. Cinematic rendering of primary adrenal lymphoma. Curr Probl Diagn Radiol 2024:S0363-0188(24)00081-1. [PMID: 38735793 DOI: 10.1067/j.cpradiol.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024]
Abstract
Primary adrenal lymphoma (PAL) is a particularly rare subset of malignant adrenal neoplasms, accounting for ∼1% of all non-Hodgkin's lymphomas. Reported outcomes of PAL, though limited, are dismal, with a 12-month survival rate of ∼20%. PAL is treated with polychemotherapy and early tissue diagnosis to allow initiation of chemotherapy is associated with improved outcomes. Early and accurate radiological diagnosis of PAL is therefore essential in improving outcomes through informing decisions to biopsy and thereby facilitating timely initiation of chemotherapy. To date, however, imaging features of PAL have not been conclusively defined, and a range of divergent imaging appearances have been reported. Cinematic rendering (CR) is a 3D post-processing technique that simulates the propagation and interaction of photons as they pass through the imaged volume. This results in the generation of more photorealistic images that may allow for more comprehensive visualization, description and interpretation of anatomical structures. This manuscript presents the first characterization of the various CR appearances of PAL in the reported literature and provides commentary on the clinical opportunities afforded by CR in the workup of these heterogenous tumors.
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Affiliation(s)
- Taha M Ahmed
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD 21287, United States
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD 21287, United States
| | - Lilah F Morris-Wiseman
- Division of Endocrine Surgery, Department of Surgery, Johns Hopkins University School of Medicine, MD, United States
| | - Ezra Baraban
- Department of Pathology, Johns Hopkins University School of Medicine, MD, United States
| | - Linda C Chu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD 21287, United States.
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2
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Figueiredo I, Guimarães F, Duarte C, Fontes L. Adrenal Gland Incidentaloma: A Rare Case of Extranodal B-cell Lymphoma. Cureus 2024; 16:e53231. [PMID: 38425629 PMCID: PMC10902736 DOI: 10.7759/cureus.53231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
The prevalence of adrenal incidentalomas (i.e., incidental findings) has grown in recent years with the evolution of imaging methods. Adrenal masses can be benign or malignant. Malignant ones are less frequent, but the detection of primary adrenal neoplasms is even less frequent, especially in the case of a diffuse large B-cell lymphoma (DLBCL). This case concerns a 68-year-old man who presented to the emergency department due to fatigue and anorexia. Given his blood test results on admission, he underwent a computed tomography (CT) with angiography that identified a mass in the left adrenal gland with displacement of the ipsilateral kidney. Left tumorectomy, adrenalectomy, and nephrectomy were performed, and the mass corresponded to a nongerminal center-type DLBCL. This case highlights the importance of prompt diagnosis and surgical and pharmacologic treatment of DLBCL.
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Affiliation(s)
- Inês Figueiredo
- Department of Internal Medicine, Hospital Companhia União Fabril (CUF) Descobertas, Lisboa, PRT
| | - Francisco Guimarães
- Department of Internal Medicine, Hospital Companhia União Fabril (CUF) Descobertas, Lisboa, PRT
| | - Cristina Duarte
- Department of Internal Medicine, Hospital Companhia União Fabril (CUF) Descobertas, Lisboa, PRT
| | - Luísa Fontes
- Department of Internal Medicine, Hospital Companhia União Fabril (CUF) Descobertas, Lisboa, PRT
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3
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Xing Q, Hu C, Zhao Q, Zhang C, Cao T, Gao X, He L, Guo F. Primary adrenal diffuse large B cell Lymphoma with Tumor thrombus in central adrenal vein: a case report and literature review. BMC Endocr Disord 2023; 23:258. [PMID: 37996831 PMCID: PMC10668467 DOI: 10.1186/s12902-023-01496-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Primary adrenal lymphoma (PAL) is a rare disease confined wholly or chiefly to extramural involvement. Tumor thrombus in the central adrenal vein, renal vein, and inferior vena cava has been reported in adrenal pheochromocytoma, adrenocortical carcinoma, adrenal metastasis carcinoma, and adrenal leiomyosarcoma. Primary adrenal diffuse large B cell lymphoma with tumor thrombus in the central adrenal vein has rarely been reported in the current study. ( We searched in PubMed, Web of Science databases, Embase, and Medline in the English language from 1970 to December 2022. The keywords used were "Primary adrenal lymphoma " and " tumor thrombus".) CASE PRESENTATION: In this report, we discuss the case of a 57-year-old woman who complained of abdominal discomfort following cold stimulation, low back pain, anorexia, fatigue, and weight loss for 1 year. Contrast-enhanced spiral computed tomography (CT) showed mild-to-moderate enhancement of the bilateral masses and central adrenal vein tumor thrombus. After an exhaustive study, the patient was diagnosed with primary adrenal diffuse large B-cell lymphoma. In the diagnosis of PAL, the possibility of a tumor embolism in the central adrenal vein, renal vein, or inferior vena cava should be considered, although this is rare.
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Affiliation(s)
- Qingfei Xing
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chunhai Hu
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Qingqing Zhao
- Department of pathology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chunling Zhang
- Department of Medical Imaging, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Tingshuai Cao
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xinghua Gao
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Li He
- Department of Health, Shandong Province Hospital, Jinan, China.
| | - Feng Guo
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China.
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4
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Sun S, Wang Y, Yao W, Yue P, Guo F, Deng X, Zhang J, Zhang Y. Development and validation of nomograms to predict survival of primary adrenal lymphoma: a population-based retrospective study. Sci Rep 2023; 13:14428. [PMID: 37660207 PMCID: PMC10475110 DOI: 10.1038/s41598-023-41839-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 08/31/2023] [Indexed: 09/04/2023] Open
Abstract
While it is known that accurate evaluation of overall survival (OS) and disease-specific survival (DSS) for patients with primary adrenal lymphoma (PAL) can affect their prognosis, no stable and effective prediction model exists. This study aimed to develop prediction models to evaluate survival. This study enrolled 5448 patients with adrenal masses from the SEER Program. The influencing factors were selected using the least absolute shrinkage and selection operator regression model (LASSO) and Fine and Gray model (FGM). In addition, nomograms were constructed. Receiver operating characteristic curves and bootstrap self-sampling methods were used to verify the discrimination and consistency of the nomograms. The independent influencing factors for PAL survival were selected by LASSO and FGM, and three models were built: the OS, DSS, and FGS (DSS analysis by FGM) model. The areas under the curve and decision curve analyses indicated that the models were valid. This study developed survival prediction models to predict OS and DSS of patients with PAL. The FGS model was more accurate than the DSS model in the short term. Above all, these models should offer benefits to patients with PAL in terms of the treatment modality choice and survival evaluation.
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Affiliation(s)
- Shiwei Sun
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Yue Wang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Wei Yao
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Peng Yue
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Fuyu Guo
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Xiaoqian Deng
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Jiandong Zhang
- Institute of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yangang Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China.
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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5
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Al-Maghrabi J. Histopathological Experience of Primary Adrenal Lymphoma From Two Tertiary Hospitals. Cureus 2023; 15:e42940. [PMID: 37667690 PMCID: PMC10475321 DOI: 10.7759/cureus.42940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Primary adrenal lymphoma (PAL) is a rare tumor. The aim of this study was to demonstrate the histopathological features of PAL at two tertiary hospitals. MATERIALS AND METHODS All PALs diagnosed between January 2003 and February 2023 were retrieved. Pathology and immunohistochemistry slides were reviewed. Additional immunohistochemical markers were done in selected cases. Follow-up data were obtained. RESULTS There were 7 cases of PAL. The age range of the patients was 52 to 73 years (median 64 years; mean 63.3 years). There were 4 males (57.1%) and 3 females (42.9%). The clinical manifestations included abdominal pain nausea, vomiting, and loss of weight. There were 4 cases of diffuse large B-cell lymphoma (DLBCL), 2 cases of high-grade B-cell lymphomas, and 1 case of follicular lymphoma. There were 5 cases that were unilateral and 2 cases that were bilateral, and both were high-grade B-cell lymphoma. During follow-up, the 1-year and 2-year overall survival rates were 50% and 33%, respectively. CONCLUSION PAL is a disease of the elderly, and DLBCL is the most common pathological type. The prognosis is generally poor. Further reporting of PAL cases might help in understanding this disease and could lead to improvement in its management.
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Affiliation(s)
- Jaudah Al-Maghrabi
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, SAU
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6
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Chen YQ, Yue ZF, Chen SN, Tong F, Yang WH, Wei RL. Primary diffuse large B-cell lymphoma of orbit: A population-based analysis. Front Med (Lausanne) 2022; 9:990538. [PMID: 36186798 PMCID: PMC9520977 DOI: 10.3389/fmed.2022.990538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/19/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Primary orbital lymphoma (POL) accounts for an essential part of adult orbital malignancies. Nevertheless, it remains a relatively rare lymphoid malignancy, accounting for <1% of all non-Hodgkin's lymphoma (NHL) cases. Orbital diffuse large B-cell lymphoma (DLBCL) is one of the most prevalent subtypes of POL that confers the worst outcomes. The prognostic determinants of orbital DLBCL remain unknown. Therefore, a retrospective analysis was conducted by investigating the Surveillance, Epidemiology, and End Results (SEER) database for independent predictive factors for the prognosis of orbital DLBCL. Materials and methods Using the SEER program, we acquired patient data including demographics, clinical characteristics, and treatment strategies. Our cohort included cases of primary orbital DLBCL diagnosed from 2000 to 2017. We conducted Kaplan-Meier analyses to visualize the overall survival (OS) and cause-specific survival (CSS). The Cox proportional hazard regression models were applied to assess the effects of these prognostic factors on OS and CSS. Results The present cohort included 332 patients with orbital DLBCL. Age was the most impacted variable by orbital DLBCL. Three independent prognostic variables of orbital DLBCL were identified on diagnosis: advanced age, no radiation treatment, and late-stage (Stage IV). Moreover, patients who underwent chemotherapy demonstrated a greater OS when compared with those who did not. In orbital DLBCL, being unmarried was also a poor prognostic factor. Conclusion The current study is the largest population-based case series of orbital DLBCL. The age at the time of diagnosis, marital status, absence of chemotherapy or radiotherapy, and tumor stage were all found to be correlated with worse prognosis.
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Affiliation(s)
- Yu-Qing Chen
- Department of Ophthalmology, Changzheng Hospital of Naval Medicine University, Shanghai, China
| | - Zi-Fan Yue
- Department of Ophthalmology, Changzheng Hospital of Naval Medicine University, Shanghai, China
| | - Sai-Nan Chen
- Department of Ophthalmology, Changzheng Hospital of Naval Medicine University, Shanghai, China
| | - Fei Tong
- Department of Ophthalmology, Changzheng Hospital of Naval Medicine University, Shanghai, China
| | - Wei-Hua Yang
- Shenzhen Eye Hospital, Jinan University, Shenzhen, China
- Eye Hospital, Nanjing Medical University, Nanjing, China
- Wei-Hua Yang
| | - Rui-Li Wei
- Department of Ophthalmology, Changzheng Hospital of Naval Medicine University, Shanghai, China
- *Correspondence: Rui-Li Wei
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7
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Yu K, Xie W, Zhao L, Wang H, Ren Y, Zheng C, Chen X, Su Z, Tang Y, Zhou F, Tian H, Zhu Y, Chen T. sIL-2R: A Novel Diagnostic Biomarker for Primary Adrenal Lymphoma. J Clin Endocrinol Metab 2022; 107:e2284-e2290. [PMID: 35254444 DOI: 10.1210/clinem/dgac131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Indexed: 02/08/2023]
Abstract
CONTEXT Primary adrenal lymphoma (PAL) is difficult to distinguish from other adrenal masses. Soluble interleukin-2 receptor (sIL-2R) is a diagnostic biomarker for nodal non-Hodgkin lymphoma, whose association with PAL is unknown. OBJECTIVE The aim of this study was to determine the diagnostic utility of serum sIL-2R for Patients with PAL. DESIGN Prospective cohort study. SETTINGS AND PARTICIPANTS A total of 118 patients with adrenal masses who were willing to be tested for levels of serum sIL-2R from a tertiary hospital between 2019 and 2021 were included. MAIN OUTCOMES AND MEASURES Serum sIL-2R and lactate dehydrogenase (LDH) levels. RESULTS Patients with PAL had significantly higher sIL-2R levels than those of patients with other adrenal masses with indetermined and benign computed tomography (CT) features (both Ps < 0.001). The LDH levels of patients with PAL were also significantly higher than those of patients with other adrenal masses with indeterminate and benign CT features (both Ps < 0.001). Good discrimination of patients with PAL from other patients (PAL vs other adrenal masses with indeterminate CT features/non-PAL) was achieved with an area under the receiver operating characteristic curve (AUC) of 0.984 (95% CI, 0.95-1)/0.992 (95% CI, 0.975-1.000) using the serum levels of sIL-2R and further improved (AUC = 0.998, 95% CI, 0.994-1.000; AUC = 0.999, 95% CI, 0.996-1.000) after adjusting by LDH category. CONCLUSIONS For the first time, we have identified that serum sIL-2R and LDH category-adjusted sIL-2R levels have good diagnostic performances for PAL.
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Affiliation(s)
- Kai Yu
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan, P. R. China
| | - Wei Xie
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, P. R. China
| | - Lianling Zhao
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan, P. R. China
| | - Hanxiao Wang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, P. R. China
| | - Yan Ren
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan, P. R. China
| | - Chang Zheng
- Department of Endocrinology, The First People's Hospital of Guiyang, Guiyang, Guizhou, P. R. China
| | - Xixiao Chen
- Department of Diabetes, Fushun Hospital of Traditional Chinese Medicine, Fushun, Sichuan, P. R. China
| | - Zhenli Su
- Department of Endocrinology, Baoji Centre Hospital, Baoji, Shanxi, P. R. China
| | - Yeyi Tang
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan, P. R. China
| | - Fangli Zhou
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan, P. R. China
| | - Haoming Tian
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan, P. R. China
| | - Yuchun Zhu
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Tao Chen
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan, P. R. China
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8
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Kawano T, Tsuyuki Y, Suzuki Y, Shimada K, Kato S, Takahara T, Mori M, Nakaguro M, Sakakibara A, Nakamura S, Satou A. Clinicopathologic Analysis of Primary Adrenal Diffuse Large B-Cell Lymphoma: A Reappraisal of 23 Japanese Patients Based on EBV Association and PD-L1 Expression in Tumor Cells. Am J Surg Pathol 2021; 45:1606-1615. [PMID: 34534136 DOI: 10.1097/pas.0000000000001809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Primary adrenal diffuse large B-cell lymphoma (PA-DLBCL) is rare. We investigate 23 Japanese patients with PA-DLBCL to understand the clinicopathologic features and biological behavior of this disease. The 17 males and 6 females had a median age of 74 years (range: 40 to 86 y). Tumor cells harbored Epstein-Barr virus-encoded small RNA (EBER) in 9 (39%) samples, including samples from the 2 patients with methotrexate-associated B-cell lymphoproliferative disorder. Programmed cell death ligand 1 (PD-L1) expression was detected in tumor cells of 6 (26%) samples, including 1 EBER+ and 5 EBER- samples. Four (17%) patients exhibited an intravascular proliferating pattern, and all 4 patient samples showed positive staining for PD-L1 in tumor cells. Among those patients, 3 showed intravascular proliferating pattern accompanied by a diffuse extravascular proliferation of tumor cells, and 1 patient was diagnosed with intravascular large B-cell lymphoma. We divided the 23 patients into 3 groups: EBER+ (n=9, 39%), EBER-PD-L1+ (n=5, 22%), and EBER-PD-L1- (n=9, 39%). A comparison of the outcomes among the 3 groups showed significant differences in overall survival (P=0.034). The EBER+ group had the worst prognosis, and the EBER-PD-L1- group had the best prognosis. We also compared the outcomes among the 3 groups that received rituximab-containing chemotherapies. Both the overall survival and progression-free survival were significantly different among these groups (P<0.001 and P=0.002, respectively). In conclusion, we evaluated 3 types of PA-DLBCL and found that each had unique clinical, pathologic, and prognostic features. Our results suggested that immune senescence, iatrogenic immunodeficiency, and immune evasion contribute to the development of PA-DLBCL.
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MESH Headings
- Adrenal Gland Neoplasms/immunology
- Adrenal Gland Neoplasms/pathology
- Adrenal Gland Neoplasms/therapy
- Adrenal Gland Neoplasms/virology
- Adrenalectomy
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- B7-H1 Antigen/analysis
- Biomarkers, Tumor/analysis
- Epstein-Barr Virus Infections/immunology
- Epstein-Barr Virus Infections/pathology
- Epstein-Barr Virus Infections/therapy
- Epstein-Barr Virus Infections/virology
- Female
- Herpesvirus 4, Human/genetics
- Humans
- Japan
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Large B-Cell, Diffuse/virology
- Male
- Middle Aged
- Progression-Free Survival
- RNA, Viral/genetics
- Retrospective Studies
- Risk Factors
- Rituximab/therapeutic use
- Time Factors
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Affiliation(s)
- Tasuku Kawano
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
- Departments of Diagnostic Pathology
| | - Yuta Tsuyuki
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Yuka Suzuki
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Kazuyuki Shimada
- Hematology and Oncology, Nagoya University Graduate School of Medicine
| | - Seiichi Kato
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya
| | - Taishi Takahara
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Aichi Prefecture, Japan
| | - Mayuko Mori
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Masato Nakaguro
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Ayako Sakakibara
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Aichi Prefecture, Japan
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9
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Fukuda S, Wakasa T, Hanamoto H, Koyama T, Ohta Y, Inoue M, Terashita D, Gakuhara A, Tomihara H, Ohta K, Kitani K, Hashimoto K, Ishikawa H, Hida JI, Kimura Y. Synchronous gastric cancer and primary lymphoma of right adrenal gland: a case report. Clin J Gastroenterol 2021; 14:1350-1357. [PMID: 34283402 PMCID: PMC8437920 DOI: 10.1007/s12328-021-01482-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/13/2021] [Indexed: 11/28/2022]
Abstract
This report presents an extremely rare case of synchronous gastric cancer and primary adrenal diffuse large B-cell lymphoma (DLBCL). An 82-year-old man underwent computed tomography, which revealed a heterogeneous appearing and hypodense adrenal mass and a gastric mass with no enlarged lymph nodes in the neck, mediastinum, abdomen, and inguinal region. Upper gastrointestinal endoscopy revealed a protruding gastric tumor. The specimens obtained from endoscopic biopsy were histologically confirmed to be adenocarcinoma. The hormonal findings eliminated functional adrenal tumor. The patient underwent distal gastrectomy with regional lymph node resection for gastric cancer and incisional biopsy of the adrenal mass. Based on the pathological findings, diagnoses of mixed mucinous and tubular adenocarcinomas of the stomach and adrenal DLBCL were confirmed. Postoperation, the patient received rituximab combined with low-dose doxorubicin, cyclophosphamide, vincristine, and prednisone (R-miniCHOP). Six courses of R-miniCHOP were planned, but were completed in only one course at the patient’s request. The patient died 2 months after surgery.
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Affiliation(s)
- Shuichi Fukuda
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, 630-0293, Japan.
| | - Tomoko Wakasa
- Department of Pathology, Kindai University Nara Hospital, Nara, Japan
| | - Hitoshi Hanamoto
- Department of Hematology, Kindai University Nara Hospital, Nara, Japan
| | - Taichi Koyama
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Yoshio Ohta
- Department of Pathology, Kindai University Nara Hospital, Nara, Japan
| | - Masatoshi Inoue
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Daisuke Terashita
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Atsushi Gakuhara
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Hideo Tomihara
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Katsuya Ohta
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Kotaro Kitani
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Kazuhiko Hashimoto
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Hajime Ishikawa
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Jin-Ichi Hida
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, 630-0293, Japan
| | - Yutaka Kimura
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, 630-0293, Japan
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10
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Zhang HZ, Wang SY. Primary adrenal diffuse large B cell lymphoma arising within an adrenal myelolipoma: A case report and review of the literature. Curr Probl Cancer 2021; 45:100724. [PMID: 33744015 DOI: 10.1016/j.currproblcancer.2021.100724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/23/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
Adrenal myelolipoma (AML) is a benign tumor that consists of mature adipose tissue and bone marrow elements. We report a case of a 57-year-old woman who presented with complaint of lower abdominal discomfort. Computed tomography scan of abdomen and pelvis revealed a mass in the left adrenal measuring 2.0 cm which was radiologically considered to be AML. Pathological evaluation of the lesion showed foci of lymphoid aggregate in a background of AML that were confirmed to be diffuse large B cell lymphoma by immunohistochemistry and gene rearrangement. To our knowledge, this collision tumor has not been reported previously. The clinical, radiological, pathological features, and treatment are discussed.
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Affiliation(s)
- Hui-Zhi Zhang
- Department of Pathology, Ningbo Diagnostic Pathology Center, Ningbo, Zhejiang, China.
| | - Su-Ying Wang
- Department of Pathology, Ningbo Diagnostic Pathology Center, Ningbo, Zhejiang, China
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Yu K, Xue Q, Zhou F, Tian H, Xiang Q, Chen T, Ren Y. A Novel Diagnostic Model for Primary Adrenal Lymphoma. Front Endocrinol (Lausanne) 2021; 12:636658. [PMID: 33868171 PMCID: PMC8050348 DOI: 10.3389/fendo.2021.636658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/15/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Primary adrenal lymphoma (PAL) is easily misdiagnosed as other adrenal masses, such as adrenocortical carcinoma and pheochromocytoma, but patients with PAL benefit little from surgery. The diagnostic method for PAL thus far is limited to adrenal biopsy. In our study, we aimed to develop a quick and efficient diagnostic method for PAL. METHODS AND RESULTS At the same institution, 505 patients (between 2009 and 2019) and 171 patients (between 2019 and 2020) were separately included in the primary and validation studies. Univariate and multivariate analyses were conducted to evaluate clinical manifestations, laboratory findings, and radiological characteristics. Four determinants (age, bilateral masses, high-density lipoprotein cholesterol, and lactate dehydrogenase) were selected and further incorporated into a regression model to screen PAL. Accordingly, the nomogram was developed for clinical practice. In the primary study, the nomogram showed good discrimination, with an area under the receiver operating characteristic (ROC) curve (AUC) of 95.4% (95% CI, 90.6%-100.0%). Further validation study verified the efficacy of the nomogram, with an AUC of 99.0% (95% CI, 96.9%-100.00%) and 100.0% in all patients and patients with bilateral masses, respectively, and a sensitivity/specificity/positive predictive value (PPV)/negative predictive value (NPV) of 66.67%/99.40%/66.67%/99.40%, 66.67%/100%/100%/92.86%, 50%/99.20%/50%/99.20%, and 100%/100%/100%/100%, in all patients, patients with bilateral adrenal masses, patients with nonfunctional adrenal masses, and patients with positive catecholamine results, respectively. The validation study also revealed a diagnostic specificity of 99.35% and 100% for patients with a unilateral adrenal mass and functional PCC, respectively. CONCLUSIONS The presented nomogram is the first user-friendly diagnostic model for PAL that simplifies the complex diagnostic process into personalized numeric estimates. We deem that patients who score below 50 are less likely to have PAL. We suggest that clinicians should arrange adrenal biopsy and surgery for patients with nonfunctional tumors and overt catecholamine-secreting tumors, respectively, who receive a score of 50 points or higher to confirm the diagnosis as soon as possible.
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Affiliation(s)
- Kai Yu
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Qingping Xue
- Department of Public Health, Chengdu Medical College, Chengdu, China
- West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Fangli Zhou
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Haoming Tian
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Qiao Xiang
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Chen
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Ren
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yan Ren,
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12
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Ke YL, Hsu JF, Wei YC, Hsiao HH. Unusual bilateral adrenal tumors: Primary adrenal diffuse large B-cell lymphoma. JOURNAL OF CANCER RESEARCH AND PRACTICE 2021. [DOI: 10.4103/jcrp.jcrp_34_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Petroianu A, Alberti LR, Orsi VL, Viana FCT, Moura CB. ETIOPATHOGENIC, EPIDEMIOLOGIC AND CLINICAL-THERAPEUTIC COMPARISON OF NON-HODGKIN'S LYMPHOMA AND KAPOSI'S SARCOMA. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2020; 33:e1521. [PMID: 33237165 PMCID: PMC7682145 DOI: 10.1590/0102-672020200002e1521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/25/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Non-Hodgkin's lymphomas (NHL) are primary neoplasms derived from lymphocytes, and Kaposi's sarcoma (SK) is a multicentric disease of viral etiology and is associated with HIV. AIM To study the etiopathogenesis and clinical characteristics of NHL and KS, describing their mutual factors. METHODS This retrospective investigation was performed on 101 medical charts. The patients were studied according to their age, gender, and HIV-positivity, following the PRISMA guidelines. The characteristics of the tumors and comorbidities were analyzed according to their age and lymphatic metastasis. RESULTS The mean age of the patients ranged between 15-87 years for NHL and between 25-54 for KS, but the age of patients with NHL associated with HIV did not surpass 34 years. The ratio male: female was 1,8:1 for NHL, but only men presented KS. HIV-positivity was found in five patients with NHL and in 14 with KS. The stages of NHL were: I (21%), II (18,4%), III (26,3%), and IV (34,2%), but KS were found only at III (40%) and IV (60%) stages. The lymphatic metastases were positive in 62 patients NHL and in four with KS. HIV-positivity occurred in 60% of patients with NHL and in 50% with KS. CONCLUSION The HIV seropositivity was revealed for most of patients during the NHL and SK propaedeutic and none of them present clinical manifestations of AIDS. NHL associated with HIV was found only in young patients. NHL and KS patients have similar epidemiological, clinical, and therapeutic characteristics.
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Affiliation(s)
- Andy Petroianu
- Surgery, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Luiz Ronaldo Alberti
- Surgery, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
- Surgery of the Digestive System, Felício Rocho Hospital, Belo Horizonte, MG, Brazil
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Kim TS, Cheng K, Jaiswal R, Gautam-Goyal P, Myers AK. Suspected Primary Adrenal Lymphoma (PAL) Associated With Hemophagocytic Lymphohistiocytosis (HLH). J Endocr Soc 2020; 5:bvaa156. [PMID: 33294760 PMCID: PMC7684868 DOI: 10.1210/jendso/bvaa156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Indexed: 12/07/2022] Open
Abstract
Adrenal incidentalomas, masses noted on imaging performed for other purposes, are common, with 10% to 15% presenting as bilateral adrenal masses. These cases can be challenging as the differential diagnosis is broad, including metastatic disease, primary adrenal lymphoma (PAL), or infection, and often requiring a biopsy if initial biochemical workup is unrevealing. We present here a relevant case description, laboratory and radiologic imaging studies, and discussion of literature. A 62-year-old Korean woman presented with altered mental status and fevers. She was found to have bilateral adrenal incidentalomas and retained acupuncture needles. Adrenal workup did not show biochemical evidence of hormonal excess. Infectious workup was unrevealing, as was a metal/toxin workup due to retained acupuncture needles. Fevers and episodes of hypotension persisted which prevented the patient from obtaining an adrenal biopsy. Bone marrow biopsy was obtained for pancytopenia and revealed B-cell lymphoma with large cell morphology and few histiocytes with hemophagocytosis, raising concern for lymphoma-induced hemophagocytic lymphohistiocytosis (HLH). PAL associated with HLH was highly suspected in our patient, given the large (7 cm) bilateral adrenal masses and bone marrow biopsy findings of lymphoma. The patient was treated for diffuse large B-cell lymphoma, with clinical improvement. PAL is a rare but aggressive lymphoma with few reported cases. It should be considered in the differential for both unilateral and bilateral adrenal masses. An early diagnosis is crucial as the main treatment is chemotherapy rather than surgery and it confers a significant survival benefit.
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Affiliation(s)
- Tara S Kim
- Department of Internal Medicine, Division of Endocrinology, Lenox Hill Hospital, New York, New York.,David and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,Center for Health Innovations and Outcomes Research (CHIOR), Northwell Health, Manhasset, New York
| | - Kwan Cheng
- Department of Internal Medicine, Division of Endocrinology, North Shore University Hospital, Manhasset, New York
| | - Radhika Jaiswal
- Department of Internal Medicine, Division of Endocrinology, North Shore University Hospital, Manhasset, New York
| | - Pranisha Gautam-Goyal
- David and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,Department of Internal Medicine, Division of Infectious Diseases, Northwell Health, Manhasset, New York
| | - Alyson K Myers
- David and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,Center for Health Innovations and Outcomes Research (CHIOR), Northwell Health, Manhasset, New York.,Department of Internal Medicine, Division of Endocrinology, North Shore University Hospital, Manhasset, New York.,The Feinstein Institute for Medical Research, Manhasset, New York
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Morphologic Patterns and the Correlation With MYD88 L265P, CD79B Mutations in Primary Adrenal Diffuse Large B-Cell Lymphoma. Am J Surg Pathol 2020; 44:444-455. [PMID: 31609782 DOI: 10.1097/pas.0000000000001386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary adrenal diffuse large B-cell lymphoma (PA-DLBCL) is a rare subtype of extranodal DLBCL. Because of the rarity of this disease, its morphologic and genetic features are not comprehensively studied. Here, we systematically reviewed the clinicopathologic features of 42 cases of PA-DLBCL from our institution and investigated the frequency of MYD88 L265P and CD79B (exon 5) mutation in 29 eligible cases using Sanger sequencing. Clinically, PA-DLBCL was predominant in elderly male patients with advanced clinical stage and poor outcomes. Morphologically, the tumors often showed a sinusoidal and/or cohesive pattern with condensed chromatin and inconspicuous nucleolus which mimicked neuroendocrine carcinoma. Moreover, increased Reed-Sternberg-like cells were observed frequently. These confounding morphologic manifestations may lead to misdiagnosis. Genetically, PA-DLBCL harbored a high prevalence of MYD88 L265P (24%) and CD79B mutations (52%) which may be involved in lymphomagenesis. The CD79B mutation was significantly associated with a worse prognosis. A novel Histo-Molecular Classification system (4 categories) was proposed based on correlation with genetic changes. Generally, the neuroendocrine carcinoma-like type was associated with CD79B mutation, whereas the RS-like cell type indicated MYD88 L265P. The biphasic type was correlated with coexisting mutations of MYD88 and CD79B, whereas the common type implied no mutation. Furthermore, the common type showed significantly better survival. In conclusion, the proposed new category system could indicate the genetic changes as well as facilitate risk stratification to guide treatment and predict prognosis. Although this study augmented our understanding of PA-DLBCL, further analysis is required to validate our results and extend them to extranodal DLBCL at other sites.
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Yang Y, Xie W, Ren Y, Tian H, Chen T. A case report of primary adrenal lymphoma: A rare but aggressive and invasive disease. Medicine (Baltimore) 2020; 99:e20938. [PMID: 32664092 PMCID: PMC7360224 DOI: 10.1097/md.0000000000020938] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Primary adrenal lymphoma (PAL) is an extremely rare and highly invasive malignant disease. Imaging examination usually shows bilateral adrenal involvement with large tumor masses and local infiltration. However, it is unclear how lymphoma dynamically develops into huge tumor masses in the adrenal glands. The overall survival rate of PAL is generally poor, and the underlying mechanism might be related to prooncogenic mutation but not fully elucidated. PATIENT CONCERNS A 52-year-old woman complaining of a large mass in the left adrenal region for 1 month was admitted to our department. DIAGNOSIS Computed tomography firstly showed a huge mass (8.9 × 7.5 cm) in the left adrenal gland and diffusely enlarged right adrenal gland. A month later, the mass in the left adrenal gland further enlarged (9.5x7.5 cm) with infiltration of the left renal artery and retroperitoneal lymphadenopathy, and the right adrenal gland rapidly progressed into a huge mass (8.0x4.7 cm). Additionally, her chest computed tomography revealed mediastinal and bilateral hilar lymphadenopathy. Then an adrenal biopsy confirmed the diagnosis of diffuse large B-cell lymphoma, nongerminal center B-cell type, stage IV by Ann Arbor staging system. Immunohistochemistry showed positivity for Ki-67 (approximately 90%), BCL2 (approximately 80%) and MYC (approximately 70%) double-expressor lymphoma. INTERVENTIONS The patient's condition progressed rapidly, there was no opportunity to use pathology-based chemotherapy. Dexamethasone was given intravenously by thoracic and intraperitoneal injection; antibiotics and supporting treatment were also given. OUTCOMES The patient's condition progressed rapidly, with the development of malignant chest and abdominal cavity fluid and lung infection, and eventually developed septic shock and respiratory failure. She responded poorly to treatment regimens, and eventually died 8 days after the diagnosis of PAL. LESSONS PAL grows progressively throughout the adrenal glands, high Ki-67 positivity and BCL2/ MYC co-expression predict rapid progress and poor prognosis.
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Affiliation(s)
- Yunyun Yang
- Department of Endocrinology and Metabolism, Adrenal Center
| | - Wei Xie
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yan Ren
- Department of Endocrinology and Metabolism, Adrenal Center
| | - Haoming Tian
- Department of Endocrinology and Metabolism, Adrenal Center
| | - Tao Chen
- Department of Endocrinology and Metabolism, Adrenal Center
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