Synchronous gastric cancer and primary lymphoma of right adrenal gland: a case report

Shuichi Fukuda,Kotaro Kitani,Yutaka Kimura,Tomoko Wakasa,Yoshio Ohta,Hitoshi Hanamoto,Daisuke Terashita,Kazuhiko Hashimoto,Jin-Ichi Hida,Hideo Tomihara,Hajime Ishikawa,Atsushi Gakuhara,Taichi Koyama,Masatoshi Inoue,Katsuya Ohta

doi:10.1007/s12328-021-01482-8

Abstract

This report presents an extremely rare case of synchronous gastric cancer and primary adrenal diffuse large B-cell lymphoma (DLBCL). An 82-year-old man underwent computed tomography, which revealed a heterogeneous appearing and hypodense adrenal mass and a gastric mass with no enlarged lymph nodes in the neck, mediastinum, abdomen, and inguinal region. Upper gastrointestinal endoscopy revealed a protruding gastric tumor. The specimens obtained from endoscopic biopsy were histologically confirmed to be adenocarcinoma. The hormonal findings eliminated functional adrenal tumor. The patient underwent distal gastrectomy with regional lymph node resection for gastric cancer and incisional biopsy of the adrenal mass. Based on the pathological findings, diagnoses of mixed mucinous and tubular adenocarcinomas of the stomach and adrenal DLBCL were confirmed. Postoperation, the patient received rituximab combined with low-dose doxorubicin, cyclophosphamide, vincristine, and prednisone (R-miniCHOP). Six courses of R-miniCHOP were planned, but were completed in only one course at the patient’s request. The patient died 2 months after surgery.

Highlights

Gastric cancer is one of the most common gastrointestinal tract carcinomas
Primary adrenal lymphoma requires a significant dominance of adrenal lesions when other organs or lymph nodes are involved by lymphoma concurrently with the adrenal glands [2]
We report an extremely rare case of synchronous gastric cancer and primary adrenal Diffuse large B-cell lymphoma (DLBCL)

Summary

Introduction

Gastric cancer is one of the most common gastrointestinal tract carcinomas. Alternatively, primary adrenal lymphoma is extremely rare, accounting for less than 1% of all nonHodgkin’s lymphomas [1]. We report an extremely rare case of synchronous gastric cancer and primary adrenal DLBCL. Distal gastrectomy with regional lymph node resection was performed for gastric cancer. Immunohistochemical staining revealed that large and atypical lymphocytes were positive for CD20 (Fig. 3b), bcl-2, and leukocyte common antigen and negative for CD3 (Fig. 3c), cytokeratin AE1/AE3 (Fig. 3d), chromogranin A, synaptophysin, desmin (Fig. 3e), myeloperoxidase, CD34, and IgG4. These histopathological and immunohistochemical findings were consistent with DLBCL.

Discussion

Findings

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