J Korean Med Sci.  2009 Jun;24(3):525-528. 10.3346/jkms.2009.24.3.525.

A Case of Primary Adrenal Diffuse Large B-cell Lymphoma Achieving Complete Remission with Rituximab-CHOP Chemotherapy

• Kim KM
• Yoon DH
• Lee SG
• Lim SN
• Sug LJ
• Huh J
• Suh C

• KMID: 1779176
• DOI: http://doi.org/10.3346/jkms.2009.24.3.525

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 lyphoma 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.

Keyword

Primary Adrenal Lymphoma; Lymphoma, Large B-Cell, Diffuse; R-CHOP; Complete Remission

MeSH Terms

Adrenal Gland Neoplasms/*drug therapy/pathology/radiography
Antibodies, Monoclonal/*therapeutic use
Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
Cyclophosphamide/therapeutic use
Doxorubicin/therapeutic use
Drug Therapy, Combination
Humans
Lymphoma, Large B-Cell, Diffuse/*drug therapy/pathology/radiography
Male
Middle Aged
Positron-Emission Tomography
Prednisone/therapeutic use
Tomography, X-Ray Computed
Vincristine/therapeutic use

Figure

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  Fig. 1 Abdominal pelvic CT scan showing bilateral adrenal masses.

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  Fig. 2 CT-guided core needle biopsy of the left adrenal mass showing a tumor comprised of large cells, immunohistochemically positive for CD20 but negative for CD3 and CD30. The Ki-67 labeling index was about 90%. The tumor was diagnosed as a diffuse large B-cell lymphoma.

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  Fig. 3 F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) scan showing intense FDG accumulation in both adrenal glands. There was no abnormal FDG uptake in the rest of the body.

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  Fig. 4 Follow-up CT and FDG-PET scans after 6 cycles of R-CHOP chemotherapy showing no evidence of tumor.

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