18F-FDG PET/CT Imaging In Primary Bilateral Adrenal Lymphoma

Abstract

The adrenal localization of a primary non-Hodgkin lymphoma is rare. We report a case of a 51-year-old man with adrenal insufficiency, cough and elevated eritrosit sedimantation rate. Conventional imaging studies ultrasonography (US) and computed tomography (CT) demonstrated bilateral bulky adrenal masses, and whole-body F 18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) showed that the masses and peripancreatic lymphadenopathy were the unique manifestations of this disease. The patient was eventually diagnosed with a diffuse large B-cell lymphoma after a CT-guided needle adrenal biopsy. The present case indicated that primary adrenal lymphoma should be included in the differential diagnosis of bilateral adrenal masses.

Keywords

• Non-hodgkin lymphoma, adrenal gland, neoplasm, PET, CT

18F-FDG PET/CT Imaging In Primary Bilateral Adrenal Lymphoma

Öz

Adrenal kaynaklı primer non-Hodgkin lenfoma nadir görülen bir klinik durumdur. Bu vaka çalışmasında adrenal yetmezlik, öksürük ve sedimentasyon yüksekliği bulguları olan 51 yaşında bir erkek hasta sunulmaktadır. Konvansiyonel görüntüleme yöntemleri (ultrasonografi, bilgisayarlı tomografi) ve F- 18 fluorodeoksiglukoz pozitron emisyon tomografisi/ bilgisayarlı tomografi (18F-FDG PET/BT) tüm vücut görüntüleme ile büyük adrenal kitleler ve peripankreatik lenf nodları gösterilmiştir. 18F-FDG PET/BT görüntülerinde diğer vücut bölgelerinde patoloji izlenmemiştir. Bilgisayarlı tomografi eşliğinde yapılan adrenal iğne biopsisi sonrası diffüz büyük-hücreli non-Hodgkin lenfoma tanısı konuldu. Bu vaka çalışması bilateral adrenal kitlelerin ayırıcı tanısında primer adrenal lenfomanın da düşünülmesi gerektiğini göstermektedir

Anahtar Kelimeler

• Non-hodgkin lenfoma, adrenal bez, neoplazm, PET, BT

References

1. Kubo M, Koga M, Fujii T, et al. Bilateral adrenal lympho- ma with neoplastic angioendotheliosis. Intern Med 1997; 36: 47-52.
2. Inan N, Arslan A, Akansel G, Anik Y, Balci NC, Demirci A. Dynamic contrast enhanced MRI in the differential diag- nosis of adrenal adenomas and malignant adrenal masses. Eur J Radiol 2008;65:154–62.
3. Tsushima Y, Ishizaka H, Matsumoto M. Adrenal masses: differentiation with chemical shift, fast low-angle shot MR imaging. Radiology 1993;186:705–9.
4. Hahn JS, Choi HS, Suh CO, et al. A case of primary bilat- eral adrenal lymphoma (PAL) with central nervous system (CNS) involvement. Yonsei Med J 2002; 43: 385-90.
5. Salvatore JR, Ross RS. Primary bilateral adrenal lympho- ma. Leuk Lymphoma 1999; 34: 111-7.
6. Caoili EM, Korobkin M, Francis IR, et al. Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology 2002; 222: 629-33.
7. Okada M, Shimono T, Komeya Y, et al. Adrenal masses: the value of additional fluorodeoxyglucose-positron emission tomography/ computed tomography (FDG-PET/CT) in dif- ferentiating between benign and malignant lesions. Ann Nucl Med 2009; 23: 349-54.
8. Freeman C, Berg JW, Culter SJ. Occurrence and prognosis of extranodal lymphomas. Cancer 1972 ;29: 252-60.

9. Axiang Xu, Xuren Xiao, Linyang YE, Baofa Hong, Xiaoxiong- Wang. Primary adrenal lymphoma. Leuk Lymphoma 2003; 44: 739-40.
10. Rosemberg SA, Diamond HD, Jaslowitz B, Craver LF. Lymphosarcoma: a review of 1296 cases. Medicine 1961; 40: 31-84.
11. Wang J, Sun NCJ, Renslo R, et al. Clinically silent primary adrenal lymphoma: a case report and review of the lit- erature. Am J Hematol 1998; 58: 130-6.
12. Huminer D, Garty M, Lapidot M, Leiba S, Borohov H, Rosenfeld JB. Lymphoma presenting with adrenal insuf- ficiency: Adrenal enlargement on computed tomographic scanning as a clue to diagnosis. Am J Med 1988;84(1):169-72.
13. Hsu CW, Ho CL, Sheu WHH, Harn HJ, Chao TY. Adrenal insufficiency caused by primary aggressive non-Hodgkin's lymphoma of bilateral adrenal glands: report of a case and literature review. Ann Hematol 1999; 58: 130-6.
14. Case Records of the Massachusetts General Hospital. Weekly Clinicopathological Exercises. Case 35-2000. An 82-year old woman with bilateral adrenal masses and a low-grade fever. N Engl J Med 2000; 343: 1477-83.
15. Pimentel M, Johnston JB, Allan DR, Greenberg H, Bernstein CN. Primary adrenal lymphoma associated with adrenal insufficiency: a distinct clinical entity. Leuk Lymphoma 1997; 24: 363-7.
16. Mansmann G, Lau J, Balk E, et al. The clinically inappar- ent adrenal mass: update in diagnosis and management. Endocrine Rev 2004; 25: 309-40.
17. Pacak K, Eisenhofer G, Goldstein DS. Functional imaging of endocrine tumors: role of positron emission tomogra- phy. Endocrine Rev 2004; 25: 568-80.
18. Maurea S, Klain M, Mainolfi C, et al. The diagnostic role of radionuclide imaging in evaluation of patients with nonhypersecreting adrenal masses. J Nucl Med 2001; 42; 884-92.
19. Horiguchi K, Hashimoto K, Hashizume M, et al. Primary bilateral adrenal diffuse large B-cell lymphoma demon- strating adrenal failure. Intern Med 2010; 49: 2241-6.
20. Kumar R, Bhargava P, Bozkurt MF, et al. Positron emission tomography imaging in evaluation of cancer patients. Indian J Cancer 2003; 40: 87-100.