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Primary non-Hodgkin's lymphoma of the adrenals. A case report
Authors:Safi S  Kassmaoui H  Hassikou H  Alami M  Homadi A  Tabache F  Baaj M  Hadri L
Affiliation:1. Service de médecine interne, hôpital militaire Moulay-Ismail, BP S15, Meknès, Maroc;2. Service d''urologie, hôpital militaire Moulay-Ismail, BP S15, Meknès, Maroc;3. Service de radiologie, hôpital militaire Ismaël-Moulay, BP S15, Meknès, Maroc;1. Service d’ophtalmologie, CHU Purpan, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France;2. Ophtalmologie, Clinique du Parc, 105, rue Achille-Viadieu, 31400 Toulouse, France;3. Ophtalmologie, clinique Saint-Nicolas, 55, allées Charles-de-Fitte, 31300 Toulouse, France;4. Service de chirurgie maxillo-faciale, CHU Purpan, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France;5. Service d’endocrinologie, maladies métaboliques et nutrition, pôle cardio-vasculaire et métabolique, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse, France;1. Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA;2. Department of Radiology, Martin Army Community Hospital, 6600 Van Aalst Boulevard, Fort Benning, GA 31905-5637, USA;3. American Institute for Radiologic Pathology, 1010 Wayne Avenue, Suite 320, Silver Spring, MD 20910, USA;4. Department of Radiology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814, USA;1. Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1482, Houston, TX 77030-4009, USA;2. Ophthalmic Plastic Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1488, Houston, TX 77030-4009, USA;3. Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, No 18, College Road, Chennai 600006, India;1. Department of Radiology, Kingston Health Sciences Centre, 76 Stuart Street Kingston, ON, K7L 2V7, Canada;2. Joint Department of Medical Imaging, Toronto General Hospital, 585 University Avenue, Toronto, ON, M5G 2N2, Canada;3. Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada;1. Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States;2. Ponce Health Sciences University, Ponce, PR, United States;3. Department of Pathology (Neuropathology), Oregon Health & Science University, Portland, OR, United States;4. Department of Radiology, Oregon Health & Science University, Portland, OR, United States;5. Department of Neurology, Oregon Health & Science University, Portland, OR, United States
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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