Bilateral primary adrenal diffuse large B cell lymphoma: A rare presentation

Primary lymphoma of the adrenal gland is an uncommon origin of adrenal tumors; it must be explicitly invoked anytime bilateral adrenal affections are revealed. We report a case of bilateral primary adrenal diffuse large B cell lymphoma and perform a review of the literature. Our patient was a 55-year-old man who presented night sweats and a feeling of cardiac palpitations all evolving in a context of deterioration of his general condition. An ultrasound study was requested reporting a bilateral mass corresponding to the adrenal region. A thoraco-abdominopelvic CT scan was requested and revealed bilateral homogenous, polylobed, adrenal masses, discreetly enhanced after injection of contrast product. These masses were associated with multiple retroperitoneal, para-aortic, and celio-mesenteric adenopathies. Anatomopathologic examination of the percutaneous CT-guided biopsy specimen of the adrenal tumor revealed the presence of diffuse large B cell lymphoma grade IIIB according to the Ann Arbor system. Primary adrenal lymphoma PAL on its own is an extremely rare disease entity and less than 100 cases have been reported in the last 40 years. A large proportion of PAL case reports showed that this disease usually has no excretory endocrine function and the symptoms are due to the pressure effect of the mass, whereas adrenal insufficiency usually exists. Our patient presented symptoms of indrenal insufficiency which seems to be the reason for the early diagnosis. Primary bilateral adrenal lymphoma is very rare entity that should be kept in mind whenever bilateral adrenal masses are assessed in the CT scan images.