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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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Ahmed TM, Rowe SP, Fishman EK, Soyer P, Chu LC. Three-dimensional CT cinematic rendering of adrenal masses: Role in tumor analysis and management. Diagn Interv Imaging 2024; 105:5-14. [PMID: 37798191 DOI: 10.1016/j.diii.2023.09.004] [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: 09/12/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023]
Abstract
The adrenal gland is home to an array of complex physiological and neoplastic disease processes. While dedicated adrenal computed tomography (CT) is the gold standard imaging modality for adrenal lesions, there exists significant overlap among imaging features of adrenal pathology. This can often make radiological diagnosis and subsequent determination of the optimal surgical approach challenging. Cinematic rendering (CR) is a novel CT post-processing technique that utilizes advanced light modeling to generate highly photorealistic anatomic visualization. This generates unique prospects in the evaluation of adrenal masses. As one of the first large tertiary care centers to incorporate CR into routine diagnostic workup, our preliminary experience with using CR has been positive, and we have found CR to be a valuable adjunct during surgical planning. Herein, we highlight the unique utility of CR techniques in the workup of adrenal lesions and provide commentary on the opportunities and obstacles associated with the application of this novel display method in this setting.
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Affiliation(s)
- Taha M Ahmed
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Steven P Rowe
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin-APHP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Linda C Chu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Yasuda H, Ando J, Yoshida S, Ota Y, Komatsu N, Ando M. Diffuse Large B-cell Lymphoma with Adrenal Involvement Presenting as Other Iatrogenic Immunodeficiency-associated Lymphoproliferative Disorders: Sustained Remission with Methotrexate Termination Alone in Two Cases. Intern Med 2023; 62:601-604. [PMID: 35793959 PMCID: PMC10017257 DOI: 10.2169/internalmedicine.0130-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Methotrexate-associated lymphoproliferative disorders (MTX-LPDs) with diffuse large B-cell lymphoma (DLBCL) pathology present with high rates of spontaneous regression after methotrexate (MTX) termination, especially in Epstein-Barr virus-encoded RNA (EBER)-positive cases. DLBCL with adrenal involvement is known for an extremely dismal prognosis. However, the prognosis of adrenal DLBCL in the context of MTX-LPD is unknown. We herein report two EBER-positive adrenal DLBCL MTX-LPD patients who achieved long-term remissions of 22 and 40 months with MTX termination alone. Both patients are doing well with no relapse at the time of reporting. Unlike adrenal DLBCL in general, adrenal involvement may not be a poor prognostic factor when restricted to DLBCL MTX-LPDs.
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Affiliation(s)
- Hajime Yasuda
- Department of Hematology, Juntendo University School of Medicine, Japan
| | - Jun Ando
- Department of Hematology, Juntendo University School of Medicine, Japan
- Department of Cell Therapy and Transfusion Medicine, Juntendo University School of Medicine, Japan
| | - Sayako Yoshida
- Department of Hematology, Juntendo University School of Medicine, Japan
| | - Yasunori Ota
- Department of Pathology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine, Japan
- Laboratory for the Development of Therapies Against MPN, Juntendo University School of Medicine, Japan
- Department of Advanced Hematology, Juntendo University School of Medicine, Japan
| | - Miki Ando
- Department of Hematology, Juntendo University School of Medicine, Japan
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Zeng J, Yan F, Chen Y, Zang L, Chen K, Lyu Z, Dou J, Mu Y, Lin M, Yang G. Primary Adrenal Lymphoma: Two Case Series From China. Front Endocrinol (Lausanne) 2021; 12:778984. [PMID: 35154000 PMCID: PMC8832485 DOI: 10.3389/fendo.2021.778984] [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: 10/20/2021] [Accepted: 12/24/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Primary adrenal lymphoma (PAL) is a rare form of adrenal mass. We summarize our experience in its clinical presentation, biochemical indexes, radiological features, pathological information, therapy regimens, and outcomes. METHODS This was an institutional review board-approved retrospective review of medical records and surgical pathology specimens of patients with a diagnosis of PAL at the Chinese People's Liberation Army General Hospital and the First Affiliate Hospital of Xiamen University between July 2007 and July 2017. RESULTS Twenty-six patients were identified. The mean age at presentation was 60.84 ± 13.14 years with a male-to-female ratio of 2.25:1 (18:8). The most common presenting symptoms were loss of appetite (65%, 17/26), weight loss (62%, 16/26), abdominal pain (58%, 15/26), and fatigue (58%, 15/26). The levels of lactate dehydrogenase (75%, 15/20), β2-microglobulin (100%, 10/10), C-reactive protein (82%, 14/17), and ferritin (88%, 7/8) and the erythrocyte sedimentation rate (83%, 10/12) were elevated. Bilateral involvement was seen in 21 of 26 patients (81%); 12 of 19 evaluated patients with bilateral lesions (63%) were confirmed to have adrenal insufficiency. On computed tomography (CT), the mean tumor diameter was 7.31 ± 3.35 cm and the median Hounsfield density was 37.0 HU (range: 31.0-45.0 HU); 67% (10/15) and 27% (4/15) of lesions presented with mild and moderate enhancement after injection of contrast medium. 18F-fluorodeoxyglucose positron emission tomography (FDG PET)-CT revealed not only an adrenal tumor but also extra-adrenal lesions. Diffuse large B-cell lymphoma (DLBCL) was the most common phenotype (92%, 24/26). Ninety-two percent (24/26) of patients received chemotherapy while 8% (2/26) received unilateral adrenalectomy plus chemotherapy. The prognosis of PAL was poor, with a general survival time of 7.20 ± 5.18 months. CONCLUSION PAL is a rare disease. The clinical characteristics of PAL include loss of appetite and weight loss. Endocrine evaluation should be performed to determine whether patients have adrenal insufficiency, especially patients with bilateral lesions. FDG-PET appears to be more accurate than other imaging modalities in revealing extra-adrenal sites. Better therapy is required to improve the poor prognosis of PAL.
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MESH Headings
- Abdominal Pain/physiopathology
- Adrenal Gland Neoplasms/diagnostic imaging
- Adrenal Gland Neoplasms/metabolism
- Adrenal Gland Neoplasms/physiopathology
- Adrenal Gland Neoplasms/therapy
- Adrenal Insufficiency/physiopathology
- Adrenalectomy
- Adult
- Aged
- Aged, 80 and over
- Anorexia/physiopathology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Asparaginase/administration & dosage
- Blood Sedimentation
- C-Reactive Protein/metabolism
- China
- Cyclophosphamide/therapeutic use
- Dexamethasone/administration & dosage
- Dimethoate/administration & dosage
- Doxorubicin/therapeutic use
- Etoposide/administration & dosage
- Fatigue/physiopathology
- Female
- Ferritins/metabolism
- Humans
- L-Lactate Dehydrogenase/metabolism
- Lymphoma, Extranodal NK-T-Cell/diagnostic imaging
- Lymphoma, Extranodal NK-T-Cell/metabolism
- Lymphoma, Extranodal NK-T-Cell/physiopathology
- Lymphoma, Extranodal NK-T-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Methotrexate/administration & dosage
- Middle Aged
- Positron Emission Tomography Computed Tomography
- Prednisone/therapeutic use
- Rituximab/therapeutic use
- Survival Rate
- Tomography, X-Ray Computed
- Vincristine/therapeutic use
- Weight Loss
- beta 2-Microglobulin/metabolism
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Affiliation(s)
- Jinyang Zeng
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Department of Endocrinology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Fangfang Yan
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Department of Endocrinology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yulong Chen
- Department of Endocrinology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Li Zang
- Department of Endocrinology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Kang Chen
- Department of Endocrinology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhaohui Lyu
- Department of Endocrinology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jingtao Dou
- Department of Endocrinology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yiming Mu
- Department of Endocrinology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Mingzhu Lin
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Guoqing Yang
- Department of Endocrinology, Hainan Branch of People's Liberation Army (PLA) General Hospital, Sanya, China
- *Correspondence: Guoqing Yang,
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Sherlock M, Scarsbrook A, Abbas A, Fraser S, Limumpornpetch P, Dineen R, Stewart PM. Adrenal Incidentaloma. Endocr Rev 2020; 41:bnaa008. [PMID: 32266384 PMCID: PMC7431180 DOI: 10.1210/endrev/bnaa008] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 04/06/2020] [Indexed: 12/14/2022]
Abstract
An adrenal incidentaloma is now established as a common endocrine diagnosis that requires a multidisciplinary approach for effective management. The majority of patients can be reassured and discharged, but a personalized approach based upon image analysis, endocrine workup, and clinical symptoms and signs are required in every case. Adrenocortical carcinoma remains a real concern but is restricted to <2% of all cases. Functional adrenal incidentaloma lesions are commoner (but still probably <10% of total) and the greatest challenge remains the diagnosis and optimum management of autonomous cortisol secretion. Modern-day surgery has improved outcomes and novel radiological and urinary biomarkers will improve early detection and patient stratification in future years to come.
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Affiliation(s)
- Mark Sherlock
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Andrew Scarsbrook
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - Afroze Abbas
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - Sheila Fraser
- Department of Endocrine Surgery, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - Padiporn Limumpornpetch
- Faculty of Medicine & Health, University of Leeds, Worsley Building, Clarendon Way, Leeds, UK
| | - Rosemary Dineen
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul M Stewart
- Faculty of Medicine & Health, University of Leeds, Worsley Building, Clarendon Way, Leeds, UK
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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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7
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Hassan M, Mandal AK, Sidhu JS, Cardenas LM. Gastric diffuse large B-cell lymphoma with bilateral adrenal metastasis. BMJ Case Rep 2019; 12:12/7/e229758. [PMID: 31272994 DOI: 10.1136/bcr-2019-229758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Extranodal adrenal involvement in non-Hodgkin's lymphoma is very rare, estimated to be around less than 0.2%. Most common sites involved are stomach, intestine and testis. It is very rare for adrenal tumours to present as primary adrenal insufficiency, with an incidence of around 1.2% in patients diagnosed with adrenal masses. Diffuse large B cell lymphoma (DLBL) originating from the stomach and metastasizing to bilateral adrenal glands is an extremely uncommon occurrence with only three cases found on review of the literature. We present a case of a 62-year-old African-American man who presented with nausea, vomiting, abdominal pain and hypotension, later being diagnosed as DLBL of the gastric antrum metastasized to bilateral adrenal glands. Initial laboratory workup revealed including hormonal analysis and cosyntropin test revealed adrenal insufficiency. The patient later died during the hospitalisation after developing respiratory failure, severe hypotension refractory to vasopressors and severe metabolic acidosis.
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Affiliation(s)
| | | | | | - Luz Maria Cardenas
- American University of Antigua College of Medicine, New York City, New York, USA
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8
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Clinical characteristics and outcomes of primary adrenal diffuse large B cell lymphoma in a large contemporary cohort: a SEER-based analysis. Ann Hematol 2019; 98:2111-2119. [PMID: 31227873 DOI: 10.1007/s00277-019-03740-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
Primary adrenal lymphoma (PAL) is an extremely rare lymphoma, and the most common histologic type is diffuse large B cell lymphoma (DLBCL). Primary adrenal DLBCL has a quite poor prognosis, but the prognostic determinants are rarely reported. With the Surveillance, Epidemiology, and End Results (SEER) program, we collected the demographic, clinical, therapeutic information of patients with primary adrenal DLBCL from 1983 to 2015. The Kaplan-Meier method was used to obtain overall survival (OS) and cause-specific survival (CSS) curves. The prognostic values of OS and CSS were assessed using Cox proportional hazards regression model with univariate and multivariate analyses. A total of 136 patients were included in our cohort. Adrenal DLBCL predominantly affected male and the aged, and there was a high rate of unilateral adrenal origin. The patients were more likely to present advanced stage disease. The OS rates of the entire cohort of patients with adrenal DLBCL at 5 and 10 years were respectively 19.17% and 3.33%, and the similar results were shown in 5-year and 10-year CSS rates. Age more than 70 years old and bilateral were identified as independent prognostic factors that were correlated with both adverse OS and CSS, and patients with chemotherapy had a superior OS and CSS to the patients without any treatment.
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9
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Altinmakas E, Üçışık-Keser FE, Medeiros LJ, Ng CS. CT and 18F- FDG-PET-CT Findings in Secondary Adrenal Lymphoma with Pathologic Correlation. Acad Radiol 2019; 26:e108-e114. [PMID: 30076085 DOI: 10.1016/j.acra.2018.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVE To evaluate computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) imaging manifestations of lymphomas secondarily involving the adrenal gland. MATERIALS AND METHODS Seven patients (Five men, two women; median age [range], 66 years [34-75 years]) with pathologically proven adrenal lymphoma were assessed retrospectively. Clinical findings, prior history of lymphoproliferative malignancy, CT (n = 7) and fludeoxyglucose positron emission tomography-computed tomography (18F-FDG-PET-CT) (n = 6) features were analyzed. RESULTS Six cases were diffuse large B-cell lymphoma, and one case was peripheral T-cell lymphoma. The longest diameter of the lesions ranged from 3.2 to 6.6 cm (median 4.3 cm). Six lesions were well-defined and one lesion was ill-defined. In five cases, an adreniform shape was preserved. No lesions contained fat, calcification or hemorrhage. Two lesions had necrosis on CT. Median (range) unenhanced CT density of six lesions was 31.8 (29.2-35.2) Hounsfield units. Following administration of IV contrast media (n = 6), three lesions enhanced homogenously whereas three enhanced heterogeneously. The median increase in attenuation was 35.1 Hounsfield units. Two patients had 15-minute delayed CT and they both demonstrated limited wash-out consistent with nonadenoma. Six patients had fludeoxyglucose positron emission tomography-computed tomography(18-F-FDG-PET-CT) and all lesions were fludeoxyglucose (FDG) avid with a median SUVmax of 18.6 (range: 10.3-49.2). CONCLUSION Secondary adrenal lymphomas usually manifest as, large (>3 cm), well-defined, homogenously or slightly heterogeneously enhancing masses on CT with preserved adreniform shape. These lesions tend to show limited wash-out and high fludeoxyglucose (FDG) uptake.
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10
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Alshahrani MA, Bin Saeedan M, Alkhunaizan T, Aljohani IM, Azzumeea FM. Bilateral adrenal abnormalities: imaging review of different entities. Abdom Radiol (NY) 2019; 44:154-179. [PMID: 29938331 DOI: 10.1007/s00261-018-1670-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Bilateral adrenal abnormalities are not infrequently encountered during routine daily radiology practice. The differential diagnoses of bilateral adrenal abnormalities include neoplastic and non-neoplastic entities. The bilateral adrenal tumors include metastasis, lymphoma, neuroblastoma, pheochromocytoma, adenoma, and myelolipoma. Non-neoplastic bilateral adrenal masses include infectious processes and haematomas. There are different diffuse bilateral adrenal changes such as adrenal atrophy, adrenal enlargement, adrenal calcifications, and altered adrenal enhancement. In this pictorial review article, we will discuss the imaging features of these entities with emphasis on their clinical implications.
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Affiliation(s)
- Meshal Ali Alshahrani
- Department of Radiology, King Faisal Specialist Hospital and Research Center, MBC-28, P.O. Box 3354, Riyadh, 11211, Saudi Arabia
| | - Mnahi Bin Saeedan
- Department of Radiology, King Faisal Specialist Hospital and Research Center, MBC-28, P.O. Box 3354, Riyadh, 11211, Saudi Arabia.
| | - Tariq Alkhunaizan
- Department of Radiology, King Faisal Specialist Hospital and Research Center, MBC-28, P.O. Box 3354, Riyadh, 11211, Saudi Arabia
| | - Ibtisam Musallam Aljohani
- Department of Radiology, King Faisal Specialist Hospital and Research Center, MBC-28, P.O. Box 3354, Riyadh, 11211, Saudi Arabia
| | - Fahad Mohammed Azzumeea
- National Guard Health Affairs, King Abdulaziz Medical City, Medical Imaging Department, Riyadh, Saudi Arabia
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11
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Zhang J, Sun J, Feng J, Luo Y, Ling Q, Wu S, Zeng X, Liang Z. Primary adrenal diffuse large B cell lymphoma: a clinicopathological and molecular study from China. Virchows Arch 2018; 473:95-103. [PMID: 29802470 DOI: 10.1007/s00428-018-2378-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/19/2018] [Accepted: 05/14/2018] [Indexed: 12/14/2022]
Abstract
Primary adrenal lymphoma is a rare entity that, in most cases, is derived from B cells. The most commonly seen primary adrenal lymphoma is diffuse large B cell lymphoma (DLBCL). To better understand the clinicopathological and molecular features of these tumors, we studied 14 Chinese patients with DLBCL who initially presented with an adrenal tumor. The clinicopathological features of the 14 primary adrenal DLBCL cases were retrospectively reviewed using immunohistochemistry, immunoglobulin gene rearrangement analysis, evaluation of Epstein-Barr virus status, and fluorescence in situ hybridization. Patient age ranged from 43 to 69 years, with a mean age of 58 years. The patients most commonly presented with abdominal pain and adrenal mass. Ten patients exhibited bilateral adrenal masses, and four had unilateral adrenal masses (three left, one right). Thirteen of 14 DLBCLs were DLBCL not otherwise specified, and one was an intravascular large B cell lymphoma. According to the algorithm of Hans et al. (Blood 103:275-282, 2004), 13 and 1 cases were classified as the non-germinal center B-cell-like subtype and the germinal center B-cell-like subtype, respectively. The Ki-67 index ranged from 35 to 80%. Epstein-Barr virus-encoded RNA was detected by in situ hybridization in 6 of the 12 available cases. Two patients showed BCL-6 rearrangements. The follow-up period ranged from 1 to 87 months. During the follow-up period, four patients died of the disease, five were alive with the disease, four were alive without disease, and one was lost during the follow-up period. In summary, most primary adrenal lymphomas are non-germinal-center B-cell-like subtype DLBCLs, which have high proliferative activity and a poor prognosis.
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Affiliation(s)
- Jing Zhang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1 Shuai Fu Yuan Hu Tong, Beijing, 100730, People's Republic of China
| | - Jian Sun
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1 Shuai Fu Yuan Hu Tong, Beijing, 100730, People's Republic of China
| | - Jun Feng
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Yufeng Luo
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1 Shuai Fu Yuan Hu Tong, Beijing, 100730, People's Republic of China
| | - Qing Ling
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1 Shuai Fu Yuan Hu Tong, Beijing, 100730, People's Republic of China
| | - Shafei Wu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1 Shuai Fu Yuan Hu Tong, Beijing, 100730, People's Republic of China
| | - Xuan Zeng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1 Shuai Fu Yuan Hu Tong, Beijing, 100730, People's Republic of China
| | - Zhiyong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, 1 Shuai Fu Yuan Hu Tong, Beijing, 100730, People's Republic of China.
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Dobrinja C, Trevisan G, Liguori G. Primary Bilateral Adrenal Non-Hodgkin's Burkitt-Like Lymphoma: A Rare Cause of Primary Adrenal Insufficiency. Case Report and Literature Review. TUMORI JOURNAL 2018; 93:625-30. [DOI: 10.1177/030089160709300621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Primary bilateral adrenal non-Hodgkin's lymphoma is an extremely rare entity. Only 44 cases have been reported in the literature. The most common presenting symptoms are abdominal pain, fever, asthenia, constipation, weight loss or typical symptoms of adrenal insufficiency, hypertension, darkening of skin, orthostatic hypotension or an addisonian crisis. Methods The case is presented of a 57-year-old man suffering from primary bilateral adrenal lymphoma with symptoms of adrenal insufficiency syndrome associated with bilateral, stabbing lumbar pain and a palpable mass on the left side. Laboratory tests revealed a considerable increase in lactate dehydrogenase levels, adrenal insufficiency, and high corticotropin levels. Results Abdominal CT scan showed two large adrenal masses. A CT-guided fine needle aspiration biopsy revealed a large B-cell non-Hodgkin's lymphoma. Combination chemotherapy according to the CHOP protocol with cyclophosphamide, doxorubicin, vincristine and prednisolone was initiated, which caused a slight reduction in size of the two adrenal masses. The patient underwent a bilateral adrenalectomy with almost complete excision of the tumors. Replacement therapy with cortisone acetate was initiated postoperatively. Adjuvant combination chemotherapy according to the CHOP protocol was started but renal failure gradually emerged and the treatment could not be completed. The patient died seven months after surgery due to acute bronchial pneumonia and progression of disease. Conclusions Primary bilateral adrenal non-Hodgkin's lymphoma mainly affects adult men. Diagnosis is based on histological examination. Whether associated or not with radiotherapy, chemotherapy is the most recommended treatment. Surgery, where possible, seems to lead to an increase in survival rates, but it is not possible to draw any definite conclusions on its effectiveness as yet.
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Affiliation(s)
- Chiara Dobrinja
- Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli Studi di Trieste, Trieste, Italy
| | - Giuliano Trevisan
- Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli Studi di Trieste, Trieste, Italy
| | - Gennaro Liguori
- Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli Studi di Trieste, Trieste, Italy
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Harada K, Kimura K, Iwamuro M, Terasaka T, Hanayama Y, Kondo E, Hayashi E, Yoshino T, Otsuka F. The Clinical and Hormonal Characteristics of Primary Adrenal Lymphomas: The Necessity of Early Detection of Adrenal Insufficiency. Intern Med 2017; 56:2261-2269. [PMID: 28794358 PMCID: PMC5635296 DOI: 10.2169/internalmedicine.8216-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective To analyze the clinical and endocrine characteristics of patients with primary adrenal lymphoma. Patients We retrospectively reviewed the cases of five patients with primary adrenal lymphoma who were treated in our hospital between April 2004 and March 2015. We investigated the characteristics of the clinical and pathological findings, treatment, prognosis and complications of adrenal insufficiency. Results Adrenal insufficiency, which was confirmed by the laboratory data at the initial presentation, was observed in two cases. One case was complicated by relative adrenal insufficiency during a course of chemotherapy. The plasma adrenaline and urinary adrenaline levels were decreased in four cases and three cases, respectively. Diffusion MRI was radiologically diagnostic. In all of the cases, the patients were pathologically diagnosed with diffuse large-B cell lymphoma and were treated with rituximab and CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone)-like chemotherapy. Two patients received central nervous system prophylaxis with high-dose methotrexate. Four of the patients survived and one patient died during the follow-up period. Conclusion The early detection of adrenal insufficiency and the administration of an appropriate dose of hydrocortisone are necessary during the course of chemotherapy as well as at the initial manifestation. The exclusion of adrenal dysfunction prior to invasive diagnostic procedures, such as CT-guided needle biopsy, is also critical.
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Affiliation(s)
- Ko Harada
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Kosuke Kimura
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Masaya Iwamuro
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Tomohiro Terasaka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yoshihisa Hanayama
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Eisei Kondo
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Eiko Hayashi
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Roque C, Fonseca R, Bello CT, Vasconcelos C, Galzerano A, Ramos S. Thyrotoxicosis leading to adrenal crises reveals primary bilateral adrenal lymphoma. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170002. [PMID: 28567296 PMCID: PMC5445442 DOI: 10.1530/edm-17-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 04/06/2017] [Indexed: 11/13/2022] Open
Abstract
Primary adrenal lymphoma is a rare malignancy. It frequently presents bilaterally and with symptoms of adrenal insufficiency. Amiodarone may induce secondary organ dysfunction, and thyrotoxicosis develops in 15% of cases. The symptomatology of both conditions is nonspecific, especially in the elderly, and a high suspicion index is necessary for appropriate diagnosis. A 78-year-old female presented to the emergency department with confusion, nausea and vomiting. She had recently been to the emergency department with urinary tract infection, vomiting and acute hypochloremic hyponatremia. Upon re-evaluation, the leukocyturia persisted and because of TSH 0.01 µU/mL and free-T4 68 (10–18) pmol/L, she was admitted to the Endocrinology ward. Further evaluation supported amiodarone-induced thyroiditis type 2. Sepsis ensued, in the setting of nosocomial pneumonia. Hemodynamic instability, hyponatremia, hypoglycemia and vomiting raised the suspicion of adrenocortical insufficiency. Fluid resuscitation and hydrocortisone led to clinical improvement, and adrenal insufficiency was admitted. The thoracoabdominal tomography suggested an endobronchic primary lesion with hepatic and adrenal secondary deposits (6.6 and 7 cm), but this was confirmed neither on pleural effusion nor on bronchofibroscopic fluid analyses. The adrenals were not accessible for biopsy. Despite high-dose hydrocortisone maintenance, the patient died before definite diagnosis. The autopsy confirmed primary non-Hodgkin lymphoma.
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Affiliation(s)
| | | | | | | | - António Galzerano
- 2Anatomopathology Department, Hospital de Egas Moniz C.H.L.O.-E.P.E, Lisbon Portugal
| | - Sância Ramos
- 2Anatomopathology Department, Hospital de Egas Moniz C.H.L.O.-E.P.E, Lisbon Portugal
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15
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de Sousa Lages A, Bastos M, Oliveira P, Carrilho F. Diffuse large B-cell lymphoma of the adrenal gland: a rare cause of primary adrenal insufficiency. BMJ Case Rep 2016; 2016:bcr-2016-214920. [PMID: 26994055 DOI: 10.1136/bcr-2016-214920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Although it is a rare entity, primary lymphoma of the adrenal gland should be considered in the differential diagnosis of bilateral nodular adrenal lesions, particularly when there is evidence of associated adrenal insufficiency. We describe the case of an 83-year-old woman admitted to the emergency department due to a month's history of asthenia, weight loss, anorexia and nausea. Abdominopelvic CT showed bilateral nodular lesions of adrenal glands and a stimulation test with tetracosactide was compatible with primary adrenal insufficiency. CT-guided biopsy of the left adrenal gland was performed, and histopathological results were consistent with diffuse large B-cell lymphoma. Positron emission tomography (18)F-fluorodeoxyglucose detected two intensely hypermetabolic lesions limited to both adrenal glands. Replacement therapy with hydrocortisone 15 mg/day and fludrocortisone 0.1 mg/day was promptly started and chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone was initiated after haematology-oncology consultation.
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Affiliation(s)
- Adriana de Sousa Lages
- Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Margarida Bastos
- Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Patrícia Oliveira
- Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Francisco Carrilho
- Department of Endocrinology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Kabnurkar R, Agrawal A, Epari S, Purandare N, Shah S, Rangarajan V. Unilateral primary adrenal natural killer/T-cell lymphoma: Role of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography for staging and interim response assessment. Indian J Nucl Med 2016; 31:52-4. [PMID: 26917897 PMCID: PMC4746844 DOI: 10.4103/0972-3919.172363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary adrenal lymphoma (PAL) is a rare malignancy often involving bilateral adrenal glands. Diffuse large B-cell is the most common histological type. Unilateral presentation and T-cell/natural killer (T/NK) cell histological type is rarer. We report fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography scan findings in a case of unilateral T/NK cell PAL performed for staging and interim treatment response assessment.
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Affiliation(s)
- Rasika Kabnurkar
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nilendu Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
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17
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Itaya M, Nagata S, Ogino S, Ohura M, Kuriki K, Fukaya T, Ohta N, Sugiyama K, Oki Y, Ikegaya N, Hishida A. A case of primary adrenal diffuse large B cell lymphoma presenting with severe hyponatremia. CEN Case Rep 2015; 5:91-94. [PMID: 28509172 DOI: 10.1007/s13730-015-0200-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 09/28/2015] [Indexed: 12/31/2022] Open
Abstract
We herein report a case of primary adrenal lymphoma with severe hyponatremia. The patient was admitted for an evaluation of severe hyponatremia and an enlarged bilateral adrenal mass, which were found in a previous examination for causes of general fatigue and anorexia. Laboratory data, including the serum levels of sodium (115 mEq/L), osmolality (239 mOsm/kgH2O), ADH (5.8 pg/mL), cortisol (11.6 μg/dL), free T3 (2.42 pg/mL), urinary Na (117 mEq/L) and urine osmolality (490 mOsm/kgH2O), fulfilled the diagnostic criteria for the syndrome of inappropriate secretion of ADH (SIADH). An abdominal computed tomography scan revealed a large bilateral adrenal mass. A biopsy of the enlarged left adrenal mass revealed diffuse large B cell lymphoma, which was negative for ADH protein. Hydrocortisone treatment normalized the patient's body temperature and serum sodium concentration. In this case, hyponatremia developed when both adrenal glands were involved and was normalized with hydrocortisone. These findings suggest that adrenal insufficiency was the cause of hyponatremia, although the basal serum cortisol was normal. The current case suggests that the administration of hydrocortisone is recommended if suspicious clinical signs or symptoms are found in severe hyponatremia, even if hyponatremia is associated with a normal serum cortisol level and fulfills the diagnostic criteria for SIADH.
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Affiliation(s)
- Mikiko Itaya
- Department of Nephrology, Yaizu City Hospital, 1000 Doubara, Yaizu, Shizuoka, 425-8505, Japan
| | - Soichiro Nagata
- Department of Internal Medicine, Yaizu City Hospital, 1000 Doubara, Yaizu, Shizuoka, 425-8505, Japan
| | - Shyuhei Ogino
- Department of Internal Medicine, Yaizu City Hospital, 1000 Doubara, Yaizu, Shizuoka, 425-8505, Japan
| | - Masaharu Ohura
- Department of Nephrology, Yaizu City Hospital, 1000 Doubara, Yaizu, Shizuoka, 425-8505, Japan
| | - Ken Kuriki
- Department of Pathology, Yaizu City Hospital, 1000 Doubara, Yaizu, Shizuoka, 425-8505, Japan
| | - Tetsuaki Fukaya
- Department of Radiology, Yaizu City Hospital, 1000 Doubara, Yaizu, Shizuoka, 425-8505, Japan
| | - Nobutaka Ohta
- Department of Urology, Yaizu City Hospital, 1000 Doubara, Yaizu, Shizuoka, 425-8505, Japan
| | - Kazutaka Sugiyama
- Department of Urology, Yaizu City Hospital, 1000 Doubara, Yaizu, Shizuoka, 425-8505, Japan
| | - Yutaka Oki
- Department of Endocrinology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Ikegaya
- Department of Internal Medicine, Yaizu City Hospital, 1000 Doubara, Yaizu, Shizuoka, 425-8505, Japan
| | - Akira Hishida
- Department of Nephrology, Yaizu City Hospital, 1000 Doubara, Yaizu, Shizuoka, 425-8505, Japan.
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Kasaliwal R, Goroshi M, Khadilkar K, Bakshi G, Rangarajan V, Malhotra G, Lila A, Bandgar T, Shah NS. PRIMARY ADRENAL LYMPHOMA: A SINGLE-CENTER EXPERIENCE. Endocr Pract 2015; 21:719-24. [PMID: 25716633 DOI: 10.4158/ep14471.or] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe the clinical presentation, biochemistry, imaging features, and treatment outcome of patients with primary adrenal lymphoma (PAL) presenting to a single tertiary care center. METHODS We performed a retrospective analysis of case records of 7 patients diagnosed with PAL between January 2011 and May 2014 at our institution in Mumbai, India. RESULTS Median age of presentation in our series was 48 years (range, 41 to 60 years), with a male to female ratio of 6:1. Bilateral adrenal involvement was seen in 4 of 7 patients (58%). Adrenal insufficiency (AI) was seen in 3 of the 4 patients with bilateral involvement (75%). Computed tomography showed slight to moderate contrast enhancement of adrenal masses in 4 of 5 patients (80%). Diffuse, large, B-cell lymphoma (DLBCL) was the most common immunophenotype (85%). One patient died due to rapid disease progression even before starting chemotherapy. Six patients were treated with chemotherapy and/or external beam radiotherapy. After 1 year, 2 more patients had died, whereas 4 patients were in remission. CONCLUSION PAL should always be considered in differential diagnosis of bilateral adrenal mass with AI. DLBCL is the most common histologic subtype of PAL. Despite treatment, long-term prognosis of PAL remains poor.
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Abstract
Adrenal malignancies can be either primary adrenal tumors or secondary metastases, with metastases representing the most common malignant adrenal lesion. While imaging cannot always clearly differentiate between various adrenal malignancies, presence of certain imaging features, in conjunction with appropriate clinical background and hormonal profile, can suggest the appropriate diagnosis. The second part of the article on adrenal imaging describes adrenal medullary tumors, secondary adrenal lesions, bilateral adrenal lesions, adrenal incidentalomas and provides an algorithmic approach to adrenal lesions based on current imaging recommendations.
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Affiliation(s)
- Ekta Dhamija
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ananya Panda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Chandan J. Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A. K. Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Fan J, Tang J, Fang J, Li Q, He E, Li J, Wang Y. Ultrasound imaging in the diagnosis of benign and suspicious adrenal lesions. Med Sci Monit 2014; 20:2132-41. [PMID: 25363391 PMCID: PMC4228948 DOI: 10.12659/msm.890800] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The purpose of this study was to define the ultrasound imaging characteristics of adrenal tumors and to assess the performance of ultrasound in differentiating benign ‘leave-alone’ lesions from suspicious lesions. Material/Methods We enrolled 882 patients in this study. The nature of each lesion was determined by histopathology. Ultrasound finding of each lesion was compared with its corresponding histopathologic result. The final study group consisted of 911 adrenal masses in 882 patients. All images were reviewed by 2 experienced investigators in a double blind manner. Results There were 553 adenomas identified in the study, which constituted 60.70% of the lesions. There were 161 pheochromocytomas (17.67%), 49 myelolipomas (5.38%), 39 cysts (4.28%), 37 metastasis (4.06%), 35 ganglioneuromas (3.84%), 22 lymphomas (2.41%), and 15 cortical carcinomas (1.65%). The sensitivity, specificity, and accuracy of ultrasound-based diagnosis were 89%, 99%, and 93.9%, respectively. A positive predictive value of 90.9% and a negative predictive value of 94.2% were obtained in this study. Conclusions This large-sample study showed that ultrasound was a reliable method in differentiating benign ‘leave-alone’ lesions from suspicious lesions.
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Affiliation(s)
- Jin Fan
- Department of Ultrasound, General Hospital of People's Liberation Army of China, Beijing, China (mainland)
| | - Jie Tang
- Department of Ultrasound, General Hospital of People's Liberation Army of China, Beijing, China (mainland)
| | - Jiabin Fang
- Department of Hand Surgery, Yuquan Hospital of Tsinghua University, Beijing, China (mainland)
| | - Qiuyang Li
- Department of Ultrasound, General Hospital of People's Liberation Army of China, Beijing, China (mainland)
| | - Enhui He
- Department of Ultrasound, General Hospital of People's Liberation Army of China, Beijing, China (mainland)
| | - Jia Li
- Department of Ultrasound, General Hospital of People's Liberation Army of China, Beijing, China (mainland)
| | - Yanqiu Wang
- Department of Ultrasound, General Hospital of People's Liberation Army of China, Beijing, China (mainland)
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22
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Dasararaju R, Avery RA. Primary adrenal lymphoma with paraneoplastic syndrome. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 5:721-3. [PMID: 24404557 PMCID: PMC3877536 DOI: 10.4103/1947-2714.123275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Context: The adrenal gland is a common site for neoplastic diseases and primary adrenal lymphoma (PAL) is a rare tumor with around 120 cases reported so far. Case Report: We present a rare case of 76-year-old male who presented with headache, confusion, inappropriate body movements and abdominal pain. Adrenal biopsy revealed PAL and he has had an excellent neurologic outcome to date with chemotherapy and involved field radiation. Conclusion: The majority of cases of PAL are B cell lymphomas with diffuse large cell in 70% of cases. Clinical symptoms are variable and patients may present with abdominal pain, fever, anorexia, weight loss, fatigue or symptoms of adrenal insufficiency. Therapeutic modalities for PAL include surgery, chemotherapy and radiotherapy and corticosteroid replacement. With this case report, we hope to raise awareness about this rare disease and to include lymphoma in the differential of adrenal masses.
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Affiliation(s)
- Radhika Dasararaju
- Department of Internal Medicine, University of Alabama at Birmingham, WP P230, Birmingham, Alabama 35249-7331, USA
| | - Robert A Avery
- Hematology-Oncology, Montgomery Cancer Center, Montgomery, Alabama 36107, USA
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Ichikawa S, Fukuhara N, Inoue A, Katsushima H, Ohba R, Katsuoka Y, Onishi Y, Yamamoto J, Sasaki O, Nomura J, Fukuhara O, Ishizawa K, Ichinohasama R, Harigae H. Clinicopathological analysis of primary adrenal diffuse large B-cell lymphoma: effectiveness of rituximab-containing chemotherapy including central nervous system prophylaxis. Exp Hematol Oncol 2013. [PMID: 23915571 DOI: 10.1186/2162-3619-2-19.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary adrenal lymphoma (PAL) is an extremely rare subtype of extranodal non-Hodgkin's lymphoma. Some researchers have reported some of the characteristics of PAL and its association with poor prognosis; however, the clinicopathological features of PAL remain to be elucidated. METHODS From 2008 to 2011 we experienced seven cases of PAL in our institutions. We retrospectively analyzed the clinical and pathological features of these patients. RESULTS The patients ranged in age from 50 to 85 years, with a median of 71 years. The overall male:female ratio was 6:1. All seven patients were diagnosed with diffuse large B-cell lymphoma (DLBCL) pathologically. Bilateral adrenal involvement was confirmed in five patients. The median largest tumor diameter at diagnosis was 58 mm. The Ki-67 index was generally high (>70%). All patients were treated with rituximab-containing chemotherapy, and central nervous system (CNS) prophylaxis was conducted for three patients. One patient with CNS involvement at the time of the diagnosis also received whole-brain radiation. The overall survival rate at two years was 57% (median follow-up; 24.8 months). It is noteworthy that the three patients who received a full course of the rituximab-containing regimen and CNS prophylaxis are currently alive without disease relapse, and that none of the seven patients died due to progression of lymphoma. CONCLUSIONS Primary adrenal DLBCL can be a clinically aggressive disease entity. Rituximab-containing chemotherapy combined with CNS prophylaxis could be a reasonable option for the treatment of PAL; however, analyses of more PAL cases are needed for the establishment of this strategy.
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Affiliation(s)
- Satoshi Ichikawa
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Sendai 980-8574, Japan.
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24
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Ichikawa S, Fukuhara N, Inoue A, Katsushima H, Ohba R, Katsuoka Y, Onishi Y, Yamamoto J, Sasaki O, Nomura J, Fukuhara O, Ishizawa K, Ichinohasama R, Harigae H. Clinicopathological analysis of primary adrenal diffuse large B-cell lymphoma: effectiveness of rituximab-containing chemotherapy including central nervous system prophylaxis. Exp Hematol Oncol 2013; 2:19. [PMID: 23915571 PMCID: PMC3750298 DOI: 10.1186/2162-3619-2-19] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 07/31/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Primary adrenal lymphoma (PAL) is an extremely rare subtype of extranodal non-Hodgkin's lymphoma. Some researchers have reported some of the characteristics of PAL and its association with poor prognosis; however, the clinicopathological features of PAL remain to be elucidated. METHODS From 2008 to 2011 we experienced seven cases of PAL in our institutions. We retrospectively analyzed the clinical and pathological features of these patients. RESULTS The patients ranged in age from 50 to 85 years, with a median of 71 years. The overall male:female ratio was 6:1. All seven patients were diagnosed with diffuse large B-cell lymphoma (DLBCL) pathologically. Bilateral adrenal involvement was confirmed in five patients. The median largest tumor diameter at diagnosis was 58 mm. The Ki-67 index was generally high (>70%). All patients were treated with rituximab-containing chemotherapy, and central nervous system (CNS) prophylaxis was conducted for three patients. One patient with CNS involvement at the time of the diagnosis also received whole-brain radiation. The overall survival rate at two years was 57% (median follow-up; 24.8 months). It is noteworthy that the three patients who received a full course of the rituximab-containing regimen and CNS prophylaxis are currently alive without disease relapse, and that none of the seven patients died due to progression of lymphoma. CONCLUSIONS Primary adrenal DLBCL can be a clinically aggressive disease entity. Rituximab-containing chemotherapy combined with CNS prophylaxis could be a reasonable option for the treatment of PAL; however, analyses of more PAL cases are needed for the establishment of this strategy.
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Affiliation(s)
- Satoshi Ichikawa
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Sendai 980-8574, Japan.
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D'Antonio A, Addesso M, Caleo O, Caleo A. Adrenal gland non-Hodgkin's lymphoma in a patient with pulmonary adenocarcinoma. BMJ Case Rep 2013; 2013:bcr-2013-009318. [PMID: 23682088 DOI: 10.1136/bcr-2013-009318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Although primary neoplasms of adrenal gland are uncommon, adrenal metastases are frequently encountered in patients with malignancy, and lung is the most common primary tumour site. Among primary tumours of the adrenal gland non-Hodgkin's lymphoma (NHL) is a very rare entity. We describe a case of a 79-year-old man with a previous diagnosis of adenocarcinoma of the lung who presented after 2 years with a unilateral adrenal gland mass. A solitary metastasis from pulmonary carcinoma was suspected and a laparoscopic adrenalectomy was performed. Histological examination revealed a diffuse large B-cell NHL. The patient was treated with CHOP regimen plus rituximab and a total remission was achieved. After an 8-month follow-up the patient was free of disease. This is the first reported case of a rare non-synchronous tumoral combination involving lung and adrenal gland, emphasising at the incidental discovery of the NHL during a procedure performed for a pulmonary adenocarcinoma.
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Affiliation(s)
- Antonio D'Antonio
- Department of Pathologic Anatomy, AUO San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
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26
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Primary Bilateral Non-Hodgkin's Lymphoma of the Adrenal Gland: A Case Report. Case Rep Urol 2013; 2012:325675. [PMID: 23304624 PMCID: PMC3529873 DOI: 10.1155/2012/325675] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 11/19/2012] [Indexed: 11/17/2022] Open
Abstract
Primary bilateral non-Hodgkin's lymphoma (NHL) of the adrenal gland is a very rare entity. Indeed less than 60 cases have been reported in the literature. Hence, we report a case of high-grade lymphoma of both adrenal glands that was found in a young patient of 32 years of age. The patient was admitted in the emergency department of our hospital with a profile of hemorrhagic shock. After stabilization, the imaging investigations demonstrated large bilateral adrenal masses. The CT-scan guided biopsy of both adrenal glands allowed the diagnosis of primary bilateral adrenal NHL. The patient died after the first chemotherapy session. The presence of bilateral adrenal masses associated with a rapid increase of volume should raise the diagnosis of primary adrenal non-Hodgkin's lymphoma.
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Tsukahara T, Takasawa A, Murata M, Okumura K, Nakayama M, Sato N, Hasegawa T. NK/T-cell lymphoma of bilateral adrenal glands in a patient with pyothorax. Diagn Pathol 2012; 7:114. [PMID: 22931631 PMCID: PMC3487841 DOI: 10.1186/1746-1596-7-114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 08/26/2012] [Indexed: 11/10/2022] Open
Abstract
Primary lymphoma of adrenal glands is rare, and non-B-cell lymphoma associated with pyothorax is also very rare. Here we report the first autopsy case of non-B-cell lymphoma in bilateral adrenal glands of a 79-year-old woman with pyothorax who had an aggressive clinical course. Immunohistochemically, tumor cells showed CD3+, CD45RO+, CD5-, CD7-, CD4-, CD8-, CD10-, CD20-, CD30-, CD79a-, CD138-, CD56-, granzyme B-, TIA-1+ and ALK-. In addition, tumor cells were strongly EBER1-positive by in situ hybridization. In genomic DNA of tumor cells, T-cell receptor rearrangements were not detected by southern blotting. We finally diagnosed this case as extranodal NK/T-cell lymphoma (nasal type). Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/8050621197741854.
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Affiliation(s)
- Tomohide Tsukahara
- Department of Pathology, Sapporo Medical University, South-1, West-17, Chuo-ku, Sapporo, 060-8556, Japan.
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28
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Kim YR, Kim JS, Min YH, Hyunyoon D, Shin HJ, Mun YC, Park Y, Do YR, Jeong SH, Park JS, Oh SY, Lee S, Park EK, Jang JS, Lee WS, Lee HW, Eom H, Ahn JS, Jeong JH, Baek SK, Kim SJ, Kim WS, Suh C. Prognostic factors in primary diffuse large B-cell lymphoma of adrenal gland treated with rituximab-CHOP chemotherapy from the Consortium for Improving Survival of Lymphoma (CISL). J Hematol Oncol 2012; 5:49. [PMID: 22889180 PMCID: PMC3445827 DOI: 10.1186/1756-8722-5-49] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 08/07/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The objective of this study was to identify prognostic factors for survival in patients with primary diffuse large B-cell lymphoma (DLBCL) of the adrenal gland. METHODS Thirty one patients diagnosed with primary adrenal DLBCL from 14 Korean institutions and treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) were analyzed. RESULTS Complete remission (CR) and overall response rate after R-CHOP chemotherapy were 54.8% and 87.0%. The 2-year estimates of overall survival (OS) and progression-free survival (PFS) were 68.3% and 51.1%. In patients achieving CR, significant prolongations of OS (P = 0.029) and PFS (P = 0.005) were observed. Ann Arbor stage had no influence on OS. There was no significant difference in OS between patients with unilateral involvement of adrenal gland and those with bilateral involvement. When staging was modified to include bilateral adrenal involvement as one extranodal site, early stage (I or II) significantly correlated with longer OS (P = 0.021) and PFS (P <0.001). CONCLUSIONS Contrary to prior reports, our data suggests that outcomes of primary adrenal DLBCL are encouraging using a regimen of R-CHOP, and that achieving CR after R-CHOP is predictive of survival. Likewise, our modified staging system may have prognostic value.
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Affiliation(s)
- Yu Ri Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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29
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Taffel M, Haji-Momenian S, Nikolaidis P, Miller FH. Adrenal imaging: a comprehensive review. Radiol Clin North Am 2012; 50:219-43, v. [PMID: 22498440 DOI: 10.1016/j.rcl.2012.02.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The discovery of an incidental adrenal mass (adrenal incidentaloma) continues to rise with the increasing use of cross-sectional imaging. Although most adrenal lesions are benign and asymptomatic, radiologists should guide evaluation of these lesions, whether benign or malignant. This article reviews the various imaging techniques used to evaluate adrenal masses and their relative strengths and weaknesses. It focuses on the most prevalent adrenal pathologies and their typical imaging characteristics, and concludes with a brief discussion of developing techniques, including diffusion-weighted imaging and dual-energy CT.
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Affiliation(s)
- Myles Taffel
- Department of Radiology, George Washington University Medical Center, Washington, DC, USA.
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30
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Primary adrenal lymphoma: Radiological; pathological, clinical correlation. Eur J Radiol 2012; 81:401-5. [DOI: 10.1016/j.ejrad.2010.11.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 11/13/2010] [Accepted: 11/18/2010] [Indexed: 11/17/2022]
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31
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Abstract
BACKGROUND Rarely, a patient presents to a surgeon for evaluation of an adrenal incidentaloma where the final pathology is primary malignancy. For primary adrenal lymphoma, fewer than 100 cases have been reported in the literature. CASE REPORT We report a case of unilateral primary adrenal aggressive B cell lymphoma discovered incidentally in a 41-year-old female. Preoperative testing demonstrated the 6-cm mass to be biochemically silent. Subsequently, the patient underwent a laparoscopic adrenalectomy. Following pathologic diagnosis of B cell lymphoma, a metastatic workup was negative, and she underwent treatment with systemic chemotherapy. She is currently disease free 6 months postoperatively. CONCLUSION Primary adrenal lymphoma should be considered in patients with unilateral adrenal incidentaloma. We believe that adherence to guidelines of resection of incidentalomas allowed for early surgical intervention and possible cure.
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Affiliation(s)
- Alexis Smith
- Division of General Surgery, University of Maryland Medical Center, Baltimore, Maryland 21201, USA
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32
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Hernández IR, Hernández Lavado R, Ortega PR, Carmona CG, Pérez de Madrid JD. [Primary adrenal insufficiency due to bilateral adrenal lymphoma]. ACTA ACUST UNITED AC 2011; 58:96-7. [PMID: 21317051 DOI: 10.1016/j.endonu.2010.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 07/29/2010] [Accepted: 09/01/2010] [Indexed: 11/19/2022]
MESH Headings
- Addison Disease/etiology
- Adrenal Gland Neoplasms/complications
- Adrenal Gland Neoplasms/diagnosis
- Adrenal Gland Neoplasms/diagnostic imaging
- Adrenal Gland Neoplasms/drug therapy
- Adrenocorticotropic Hormone/blood
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Female
- Glucocorticoids/therapeutic use
- Humans
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Neoplasms, Multiple Primary/complications
- Prognosis
- Tomography, X-Ray Computed
- Vomiting/etiology
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33
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Most primary adrenal lymphomas are diffuse large B-cell lymphomas with non-germinal center B-cell phenotype, BCL6 gene rearrangement and poor prognosis. Mod Pathol 2009; 22:1210-7. [PMID: 19525926 DOI: 10.1038/modpathol.2009.87] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Primary adrenal lymphoma is extremely rare, accounting for <1% of non-Hodgkin lymphomas, and lymphoma-associated chromosomal translocations have yet to be reported in this entity. We performed a retrospective study of 10 cases in immunocompetent patients including 4 males and 6 females with a median age of 68 years. The most common presenting symptoms were abdominal pain and fever; unexpectedly, clinically evident adrenal insufficiency was detected only in one patient. The mean tumor size at diagnosis was 8.5 cm. Half of the patients had bilateral involvement. All cases presented with stage IE disease without regional nodal involvement. Histologically, eight cases were diffuse large B-cell lymphoma, all of which carried a non-germinal center B-cell phenotype. Fluorescence in situ hybridization revealed BCL6 gene rearrangement in 5 (83%) of 6 diffuse large B-cell lymphomas investigated. The remaining cases were one case each of plasmablastic lymphoma and extranodal NK/T-cell lymphoma, nasal type, the first and third case of primary adrenal lymphoma of these particular lymphoma subtypes in the English literature, respectively. At a median follow-up of 4.5 months, 7 patients died of lymphoma, 1 died of an unrelated disease, 1 was alive with disease, and 1 was alive without disease. The prognosis of these patients was poor as compared with those with nodal diffuse large B-cell lymphoma. We speculate that the poor outcome of primary adrenal lymphoma might be related to the bulky tumor size at presentation, non-germinal center B-cell phenotype, and frequent BCL-6 gene rearrangement.
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34
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Ide M, Fukushima N, Hisatomi T, Tsuneyoshi N, Tanaka M, Yokoo M, Tomimasu R, Funai N, Sueoka E. Non-germinal cell phenotype and bcl-2 expression in primary adrenal diffuse large B-cell lymphoma. Leuk Lymphoma 2009; 48:2244-6. [DOI: 10.1080/10428190701636450] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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35
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Kim KM, Yoon DH, Lee SG, Lim SN, Sug LJ, Huh J, Suh C. A case of primary adrenal diffuse large B-cell lymphoma achieving complete remission with rituximab-CHOP chemotherapy. J Korean Med Sci 2009; 24:525-8. [PMID: 19543522 PMCID: PMC2698205 DOI: 10.3346/jkms.2009.24.3.525] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2007] [Accepted: 02/27/2008] [Indexed: 01/22/2023] Open
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.
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MESH Headings
- Adrenal Gland Neoplasms/diagnostic imaging
- Adrenal Gland Neoplasms/drug therapy
- Adrenal Gland Neoplasms/pathology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Drug Therapy, Combination
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Positron-Emission Tomography
- Prednisone/therapeutic use
- Rituximab
- Tomography, X-Ray Computed
- Vincristine/therapeutic use
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Affiliation(s)
- Kyung Min Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Geun Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Nam Lim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Lyu Jin Sug
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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36
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Toba A, Tamura Y, Osajima Y, Kinbara Y, Sato M, Yamaga R, Hashimoto R, Mori S, Miyakoshi S, Ota M, Ito H, Araki A. [A case of nasal NK/T cell lymphoma presenting with bilateral giant adrenal tumors]. Nihon Ronen Igakkai Zasshi 2009; 45:660-5. [PMID: 19179800 DOI: 10.3143/geriatrics.45.660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 76-year-old woman presented to a clinic with fever and loss of body weight. Abdominal echogram showed bilateral adrenal swelling (left adrenal 90x80 mm, right adrenal 50x20 mm) and she was admitted to the hospital for further examination. A tumor was also found inside nasal cavity by enhanced computed tomography (CT), and abnormal uptake in the nasal cavity and adrenal gland was shown in gallium scintigraphy. Laboratory tests revealed the elevation of lactate dehydrogenase (LDH) and sIL-2R. Biopsy of the nasal tumor revealed nasal natural killer or thymus-derived (NK/T) cell lymphoma. No Epstein-Barr virus (EBV) -encoded RNA was detected in tissue. After THP-COP chemotherapy regimen, both the nasal and adrenal tumors decreased in size. However, a CT scan taken on admission revealed a pulmonary embolism. After treatment with heparin and warfarin, emboli disappeared. Chemotherapy was continued, but perforation of the small intestine occurred. Since the prognosis was poor, no operation was performed. Her condition slowly, and she died 60 days after admission. Since she had a high level of plasma ACTH (158.0 pg/ml) and normal serum cortisol (14.6 microg/dl), partial adrenal insufficiency was suspected. In addition, since her cortisol circadian rhythm was lost and cortisol levels were not completely suppressed by the 1 mg and 8 mg dexamethasone test, she met the criteria of the diagnosis of preclinical Cushing syndrome. NK/T cell lymphoma with giant adrenal tumor is extremely rare, but should be considered as one of the differential diagnoses of bilateral adrenal tumor.
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Affiliation(s)
- Ayumi Toba
- Department of Endocrinology, Tokyo Metropolitan Geriatric Hospital
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37
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Barzon L, Trevisan M, Marino F, Guzzardo V, Palù G. Primary bilateral adrenal B-cell lymphoma associated with EBV and JCV infection. Infect Agent Cancer 2009; 4:1. [PMID: 19146683 PMCID: PMC2630304 DOI: 10.1186/1750-9378-4-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 01/15/2009] [Indexed: 12/05/2022] Open
Abstract
Primary lymphoma of the adrenal gland is a rare and highly aggressive disease, with only a few reports in the literature. The pathogenesis is unknown, but detection of Epstein Barr virus (EBV) genome sequences and gene expression in some cases of primary adrenal lymphomas suggested the virus might be a causative agent of the malignancy. While investigating the presence of genome sequences of oncogenic viruses in a large series of adrenal tumors, both EBV and JC polyomavirus (JCV) DNA sequences were detected in a diffuse large primary bilateral B-cell non-Hodgkin lymphoma of the adrenal gland, which was diagnosed only at postmortem examination in a 77 year-old woman with incidentally discovered adrenal masses and primary adrenal insufficiency. The presence of both EBV and JCV genome sequences suggests the relevance of EBV and JCV coinfection in the pathogenesis of this rare form of B-cell lymphoma.
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Affiliation(s)
- Luisa Barzon
- Department of Histology, Microbiology and Medical Biotechnologies, University of Padova, I-35121 Padova, Italy.
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38
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Uehara T, Yokota A, Onoda M, Yamamoto K, Terano T. Successful Autologous Peripheral Blood Stem Cell Transplantation for a Patient with Primary Adrenal Lymphoma with Hemophagocytic Syndrome. ACTA ACUST UNITED AC 2008; 8:184-7. [DOI: 10.3816/clm.2008.n.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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39
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Schreiber CSO, Sakon JR, Simião FPC, Tomarchio MP, Huayllas M, Pereira LCMM, Stella LC, Santomauro Jr AC, Bueno SSS, Fraige FF. Primary adrenal lymphoma: a case series study. Ann Hematol 2008; 87:859-61. [DOI: 10.1007/s00277-008-0492-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 03/22/2008] [Indexed: 10/22/2022]
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40
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Safi S, Kassmaoui H, Hassikou H, Alami M, Homadi A, Tabache F, Baaj M, Hadri L. Lymphome malin non hodgkinien primitif de la surrénale. À propos d'un cas. ANNALES D'ENDOCRINOLOGIE 2007; 68:208-11. [PMID: 17531185 DOI: 10.1016/j.ando.2007.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Revised: 12/20/2006] [Accepted: 02/12/2007] [Indexed: 11/24/2022]
Abstract
Bilateral primary non-Hodgkin's lymphoma (NHL) of the adrenals is uncommon. Less than 70 cases have been described in the literature. The symptoms of disease are variable and depend on the tumor size and the presence of adrenal insufficiency . We report a case of large diffuse B-cell adrenal lymphoma discovered in a 40-year-old woman presenting bilateral lumbar pain. Hormonal exploration demonstrated adrenal insufficiency. Imaging explorations showed a large and bilateral adrenal mass. Percutaneous CT-guided biopsy of the adrenal and search for extension revealed primary bilateral adrenal lymphoma. After glucocorticoid substitution, treatment was based on a CHOP regimen chemotherapy; outcome was unfavourable after the second cure; the patient died from septic shock. The diagnosis of primary adrenal non-Hodgkin lymphoma should be investigated in patients with a rapidly growing bilateral adrenal mass associated with adrenal insufficiency.
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Affiliation(s)
- S Safi
- Service de médecine interne, hôpital militaire Moulay-Ismail, BP S15, Meknès, Maroc.
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41
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Airaghi L, Greco I, Carrabba M, Barcella M, Baldini IM, Bonara P, Goldaniga M, Baldini L. Unusual presentation of large B cell lymphoma: a case report and review of literature. ACTA ACUST UNITED AC 2006; 28:338-42. [PMID: 16999726 DOI: 10.1111/j.1365-2257.2006.00816.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Diffuse large B cell lymphoma (DLBCL) is the largest subtype of non-Hodgkin's lymphomas (NHLs) and is characterized by relatively frequent extranodal presentation. In these cases, the most common extranodal localizations are stomach, CNS, bone, testis and liver. Simultaneous detection of multiple extranodal involvement at presentation is quite uncommon, with the majority of these cases characterized by gastric or intestinal disease localization. Retrospective analysis concerning multifocal extranodal NHLs never pointed out disease features such as those described here. We report a patient with an unusual presentation of DLBCL, characterized by adrenal and renal involvement, associated with symptoms and signs of the cold agglutinin disease and a hypercoagulable state. Subsequently, computed tomography (CT) and fluorodeoxyglucose-positron emission tomography (FDG-PET) scanning disclosed a rapidly extensive spread to nodes and bones. Cytofluorimetric analysis of a renal specimen showed medium-to-large lympho-monocytoid elements positive for CD20 with monoclonal expression of immunoglobulin kappa light chain. Histopathological examination confirmed a renal CD20 positive DLBCL localization.
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MESH Headings
- Adrenal Gland Neoplasms/diagnosis
- Adrenal Gland Neoplasms/pathology
- Anemia, Hemolytic, Autoimmune/etiology
- Biopsy, Needle
- Bone Marrow Examination
- Female
- Humans
- Kidney Neoplasms/diagnosis
- Kidney Neoplasms/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Middle Aged
- Paresthesia/etiology
- Positron-Emission Tomography
- Thrombophilia/etiology
- Tomography, X-Ray Computed
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Affiliation(s)
- L Airaghi
- First Division of Internal Medicine, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, Milan, Italy.
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42
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Inokuchi T, Shincho M, Moriwaki Y, Ka T, Takahashi S, Tsutsumi Z, Lin Y, Hirota S, Yamamoto T. Coexistent B-cell lymphoma and cutaneous T-cell lymphoma. Intern Med 2006; 45:641-7. [PMID: 16755097 DOI: 10.2169/internalmedicine.45.1564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 78-year-old man with a history of mycosis fungoides was referred for evaluation of a right adrenal mass. A physical examination showed the left cervical lymph node to be palpable, which was later shown to be caused by a diffuse large B-cell lymphoma. The patient was diagnosed with concurrent mycosis fungoides and a diffuse large B-cell lymphoma. Three courses of chemotherapy were performed, however, the patient died of advanced disease. Autopsy findings showed that the right adrenal and soft tissue masses had an identical B-cell origin. Although the exact mechanism remains unclear, the pathogenesis of this rare association is discussed.
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Affiliation(s)
- Taku Inokuchi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya
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