Adrenal Hodgkin lymphoma

Abstract

A 76-year-old woman presented with a history of right-sided sciatic pain accompanied by hot flushes and a 4AE5 kg unintentional weight loss. A computed tomography (CT) scan revealed the presence of a large right adrenal mass measuring 4AE7 · 2AE3 cm. Mediastinal lymphadenopathy, para-aortic lymphadenopathy and right hydronephrosis were identified on a CT positron emission tomography scan. The patient subsequently underwent a right adrenalectomy. Microscopic examination showed a portion of normal adrenal gland and an infiltrate containing mononuclear and multinuclear Hodgkin and Reed-Sternberg (HRS) cells (top left) in a background of lymphocytes, histiocytes and plasma cells, with fibrosis and focal necrosis. Immunohistochemical studies showed that the HRS cells were positive for CD30 (top centre), CD15 (top right) and PAX5 (weak) (bottom left) and were variably positive for CD20. The background contained numerous CD3-positive T cells. HRS cells were positive for Epstein–Barr virus (EBV) by in situ hybridization for EBV early RNA (EBER) (bottom centre) and latent membrane protein 1 (LMP1) was positive by immunohistochemistry (bottom right). Polymerase chain reaction studies for rearrangements of TCRG@ and IGH@ were negative for a clonal process. These findings were consistent with classical Hodgkin lymphoma, mixed cellularity subtype. Adrenal glands are very rarely involved by Hodgkin or non-Hodgkin lymphoma. A bone marrow biopsy was subsequently performed and did not show infiltration.