TCL-297: A Rare Case of Bilateral Adrenal T Cell Lymphoma

Abstract

Introduction: Primary adrenal lymphoma is a very rare and aggressive disease. B cell lymphoma is considered to be more common than T cell lymphoma, which is extremely rare. Very few cases were reported in the literature. The disease process usually affects bilateral glands. Case Presentation: A 53-year-old female, experienced typical signs of weight loss, dyspnea, and diffuse abdominal pain. Following an extended workup, she was reported having significant pericardial effusion, left pleural effusion, and bilateral heterogeneous adrenal masses of 90×56 mm and 100×67 mm at the right and left adrenal glands, respectively. An emergent pericardiocentesis was performed that showed atypical cells compatible with lymphoma, with immunochemistry positive for anti-LCA antibodies (anti-CD45) compatible with lymphoid origin. Subsequently, she underwent a PET-CT scan that showed increase signal in both adrenal glands with excessive retroperitoneal and mediastinal lymph nodes in addition to the suspected areas of involvement of the pericardium and pleural spaces previously described. The findings were compatible with lymphoma. The definitive diagnosis was made by an image guided percutaneous biopsy of the adrenal mass that confirmed peripheral T cell lymphoma of bilateral adrenal glands and treatment with CHOEP was planned (cyclophosphamide, oncovin, etoposide). Doxorubicin was not given due to her coronary artery disease and heart failure. Following her first cycle, she was admitted to the intensive care unit due to general status alteration and febrile neutropenia for which she received the proper treatment and was discharged home few days later. The patient then received her second cycle of CHOEP without any complications as of now. Conclusions: Although extremely rare, lymphoma of the adrenal glands should be considered in patients presenting with adrenal masses, mainly when multiple systems are involved due to metastatic spread. PET-CT is an excellent tool for diagnosis and follow up, while biopsy is useful to determine histology.