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Bilateral primary adrenal non-Hodgkin's lymphoma without adrenal insufficiency.

Simpson WG, Babbar P, Payne LF - Urol Ann (2015 Apr-Jun)

Bottom Line: Adrenal function testing was normal.Repeat CT imaging revealed rapidly growing lesions with high attenuations; both masses >10 HU.Histological examination of core biopsies discovered malignant lymphoma with no known past history of lymphoma.

View Article: PubMed Central - PubMed

Affiliation: West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901, USA.

ABSTRACT
We are presenting a rare case of bilateral adrenal non-Hodgkin's lymphoma (NHL) that presented as a primary malignancy. An 83-year-old man presented with newly discovered bilateral adrenal incidentalomas, fatigue, and 30 pound weight loss. Of the 116 cases of primary adrenal NHL reported, over half have presented bilaterally and occur with adrenal insufficiency. Therefore, the finding of bilateral adrenal masses requires an urgent work-up of the functional status of the adrenal gland as well as a thorough analysis of the imaging characteristics seen on noncontrast computed tomography (CT) in order to maximize patient survival. Adrenal function testing was normal. Repeat CT imaging revealed rapidly growing lesions with high attenuations; both masses >10 HU. Histological examination of core biopsies discovered malignant lymphoma with no known past history of lymphoma. Our case coincides with the literature, which states that a mass with attenuation >10 HU in the adrenal glands has a high risk of malignancy.

No MeSH data available.


Related in: MedlinePlus

Nonenhanced computed tomography scan from 7/12/13 showing bilateral adrenal masses measuring 6.5 cm and 5 cm
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Figure 1: Nonenhanced computed tomography scan from 7/12/13 showing bilateral adrenal masses measuring 6.5 cm and 5 cm

Mentions: The original Helical Transverse CTA of the abdomen showed a 6.5 cm right adrenal mass and a 5 cm left adrenal mass; both with homogeneous attenuation throughout and no calcifications [Figure 1]. A repeat CT with contrast in 5 mm slices was conducted 2 months later and showed a substantial increase in the size of both adrenal masses. The left adrenal mass measured 7.3 × 7.3 × 7.8 cm, while the right adrenal mass increased to 12.3 × 7.6 × 11.2 cm in size [Figure 2]. The repeat CT also showed encasement of the right renal artery and anterior displacement of the inferior vena cava and bilateral renal veins by the right adrenal mass; consequentially causing a mass effect on the porta hepatis. A 1 mg dexamethasone suppression test produced a cortisol level of 2.8 mcg/dL (normal range <5 mcg/dL). 24 h urinary free-cortisol level was 35 mcg/24 h (normal range: 3.5-45 mcg/24 h). ACTH levels were 44.1 pg/mL (normal range: 7.2-63.3 pg/mL). 24 h urine fractionated metanephrines was 10 mcg/24 h (normal range <20 mcg/24 h). Serum aldosterone levels were <1 ng/dL (normal range: 0.0-30.0 ng/dL) and serum dehydroepiandrosterone sulfate levels were 38.4 ug/dL (normal range: 20.8-226.4 ug/dL).


Bilateral primary adrenal non-Hodgkin's lymphoma without adrenal insufficiency.

Simpson WG, Babbar P, Payne LF - Urol Ann (2015 Apr-Jun)

Nonenhanced computed tomography scan from 7/12/13 showing bilateral adrenal masses measuring 6.5 cm and 5 cm
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374272&req=5

Figure 1: Nonenhanced computed tomography scan from 7/12/13 showing bilateral adrenal masses measuring 6.5 cm and 5 cm
Mentions: The original Helical Transverse CTA of the abdomen showed a 6.5 cm right adrenal mass and a 5 cm left adrenal mass; both with homogeneous attenuation throughout and no calcifications [Figure 1]. A repeat CT with contrast in 5 mm slices was conducted 2 months later and showed a substantial increase in the size of both adrenal masses. The left adrenal mass measured 7.3 × 7.3 × 7.8 cm, while the right adrenal mass increased to 12.3 × 7.6 × 11.2 cm in size [Figure 2]. The repeat CT also showed encasement of the right renal artery and anterior displacement of the inferior vena cava and bilateral renal veins by the right adrenal mass; consequentially causing a mass effect on the porta hepatis. A 1 mg dexamethasone suppression test produced a cortisol level of 2.8 mcg/dL (normal range <5 mcg/dL). 24 h urinary free-cortisol level was 35 mcg/24 h (normal range: 3.5-45 mcg/24 h). ACTH levels were 44.1 pg/mL (normal range: 7.2-63.3 pg/mL). 24 h urine fractionated metanephrines was 10 mcg/24 h (normal range <20 mcg/24 h). Serum aldosterone levels were <1 ng/dL (normal range: 0.0-30.0 ng/dL) and serum dehydroepiandrosterone sulfate levels were 38.4 ug/dL (normal range: 20.8-226.4 ug/dL).

Bottom Line: Adrenal function testing was normal.Repeat CT imaging revealed rapidly growing lesions with high attenuations; both masses >10 HU.Histological examination of core biopsies discovered malignant lymphoma with no known past history of lymphoma.

View Article: PubMed Central - PubMed

Affiliation: West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901, USA.

ABSTRACT
We are presenting a rare case of bilateral adrenal non-Hodgkin's lymphoma (NHL) that presented as a primary malignancy. An 83-year-old man presented with newly discovered bilateral adrenal incidentalomas, fatigue, and 30 pound weight loss. Of the 116 cases of primary adrenal NHL reported, over half have presented bilaterally and occur with adrenal insufficiency. Therefore, the finding of bilateral adrenal masses requires an urgent work-up of the functional status of the adrenal gland as well as a thorough analysis of the imaging characteristics seen on noncontrast computed tomography (CT) in order to maximize patient survival. Adrenal function testing was normal. Repeat CT imaging revealed rapidly growing lesions with high attenuations; both masses >10 HU. Histological examination of core biopsies discovered malignant lymphoma with no known past history of lymphoma. Our case coincides with the literature, which states that a mass with attenuation >10 HU in the adrenal glands has a high risk of malignancy.

No MeSH data available.


Related in: MedlinePlus