Case of primary bilateral adrenal lymphoma
Timur Britvin, Oleg Bogatyriov, Svetlana Vorontsova, Galina Polyakova, Larisa Gurevich, Irina Kazantseva & Arian Kalinin
Primary bilateral adrenal lymphoma is extremely rare. We report a case of bilateral adrenal lymphoma developing in a 61-year-old woman. The patient presented with weakness, fever, anorexia, nausea, and weight loss. Her vital signs were as follows: body temperature 37.2 °C, pulse rate 98 beats per minute, and blood pressure 125/70 mmHg. Examination of head and neck was unremarkable. Lymphadenopathy and skin lesion werent found. The chest X-ray was normal, without evidence of hilar lymphadenopathy. US and CT-scan revealed bilateral adrenal masses: to the right 90×36×78 mm, to the left 70×35×70 mm. Endocrine studies didnt show adrenal insuffiency the serum cortisol (8AM) was 374 nmol/l (normal range: 180650), serum aldosterone was 0.4 nmol/l (normal range: 0.141.24), and the plasma ACTH (8AM) increased to 13.5 pmol/l (normal range: 2.213.2). The level of 24-hour urine epinephrine was 24 nmol (normal range: 1144), norepinephrine 59 nmol (normal range: 47236), and free cortisol 108 nmol (normal range: 80250). Ultrasound-guided needle biopsy was performed at the right adrenal mass. Cytologic examination showed adrenal cortical carcinoma. We performed right adrenalectomy. Microscopically, the tumor was composed of large, markedly atypical cells showing high mitotic activity. Complete substitution of tumor tissue for adrenal gland was noted as well as the tumor spread through capsule and invasion of surrounding fat. Immunohistochemical staining revealed positive reaction of tumor cells with LCA and B-lymphocyte antigen. But the cells were negative for CD30, cytokeratin A1/A3, vimentin, chromogranin A, synaptophysin and antigen of T-lymphocytes that allowed to diagnose large diffuse B-cell lymphoma. The patient refused chemotherapy and died 6 months later.