Adrenal lymphoma with hypertension: A report of three cases

Adrenal lymphoma is a rare clinical entity, classified as either primary adrenal lymphoma (PAL) or secondary adrenal lymphoma. PAL is a highly aggressive malignancy with an extremely low incidence rate. To date, <250 cases have been reported in the English literature. The clinical manifestations of PAL are diverse and non-specific, often resulting in a delayed diagnosis or a misdiagnosis. In patients with comorbid hypertension, the differential diagnosis of an adrenal mass typically emphasizes functional tumors, such as aldosterone-producing tumors (which cause primary aldosteronism) and pheochromocytoma. Due to the usual absence of characteristic hormonal abnormalities, PAL is frequently overlooked in clinical practice. The present report describes the cases of 3 male patients with PAL, aged 83, 73 and 63 years. The first 2 patients had pre-existing hypertension prior to the confirmation of PAL. The present report summarizes the diagnostic strategies for PAL and relevant differential diagnoses, and describes the treatment responses observed in each case. Diagnosing PAL is challenging, and its prognosis is generally poor. PAL should be considered in the differential diagnosis of adrenal masses, particularly in patients with a history of hypertension. Once diagnosed, management should be guided by a multidisciplinary team specialized in adrenal and hematological disorders.