Kosin Med J.  2017 Dec;32(2):269-276. 10.7180/kmj.2017.32.2.269.

Imaging of F-18 FDG PET/CT and follow up of bilateral invasive adrenal diffuse large B cell lymphoma mimicking adrenocortical carcinoma

• Shim HK
• Kim SW

• KMID: 2400273
• DOI: http://doi.org/10.7180/kmj.2017.32.2.269

Abstract

The incidence of malignant adrenal tumors, including primary adrenal lymphoma (PAL) and adrenocortical carcinoma (ACC), is rather low. Early differentiation between ACC and PAL is necessary because the therapeutic strategies for the two differ and the prognosis of each disease is poor. Unfortunately, there is no pathognomonic characteristic of PAL, so radiologists have difficulty in differentiating it from ACC. To our knowledge, there have been only two case reports on ACC that was evaluated and followed up using F-18 FDG PET/CT. The previously reported cases were simple, involving only the bilateral adrenal glands. Here, we report on a 52-year-old man diagnosed with PAL that radiologically mimicked ACC. He had findings of heterogeneous enhancement on CT, several adjacent lymphadenopathies with internal necrosis, and abutting hepatic and bilateral crural invasion. After pathological confirmation, we monitored his prognosis using F-18 FDG PET/CT after three cycles of rituximab-CHOP and again after six cycles of treatment.

Keyword

Adrenocortical carcinoma; Non-Hodgkin's lymphoma; Primary adrenal lymphoma

MeSH Terms

Adrenal Glands
Adrenocortical Carcinoma*
Follow-Up Studies*
Humans
Incidence
Lymphoma
Lymphoma, B-Cell*
Lymphoma, Non-Hodgkin
Middle Aged
Necrosis
Positron-Emission Tomography and Computed Tomography*
Prognosis

Figure

• 

  Fig. 1 (a) re-contrast APCT scan shows large, homogeneous soft tissue masses in bilateral adrenal glands (asterisks)(b,c,d) ontrast-enhanced APCT scan shows adjacent lymph node enlargement (straight arrow), retroperitoneal enlarged lymph nodes involving internal necrosis (dotted arrow), adjacent liver (double-lined arrow) and crural invasion (curved arrow).

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  Fig. 2 (a) Baseline F-18 FDG PET/CT (maximal intensity projection (MIP), axial images) and post-contrast APCT scanshow intense FDG accumulation in bilateral adrenal glands, right hepatic invasionand adjacent left gastric lymph node involvement. (b) After cycles of R-CHOP, no definite residual hypermetabolism is noted on F-18 FDG PET/CTand marked decreasesize of both adrenal glands is demonstrated on post-contrast APCT. (c) After cycles of R-CHOP, F-18 FDG PET/CT shows metabolically complete remission, and post-contrast APCT showsize of both adrenal glands compared with interim post-contrast APCT.

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  Fig. 3 (a) The biopsy specimen of adrenal mass shows diffuse atypical lymphoid cellinfiltration replacing normal adrenal gland. The tumor consists of medium-to-large polymorphic cells (H&E Original magnifications, ×400)(b, c) he atypical cells are positive for CD20 immunohistochemical staining and the Ki-67 labeling index is about 90% (×200).

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