[Clinical and Prognostic Analysis of Adrenal Aggressive B-cell Lymphoma]

To investigate the clinicopathological characteristics, treatment modalities, and prognosis of adrenal aggressive B-cell lymphoma.

A retrospective analysis was performed on the clinical data of 6 patients diagnosed with adrenal aggressive B-cell lymphoma in the Gansu Provincial Hospital from January 2013 to December 2024. Clinical presentations, pathological features, treatment strategies, and prognosis of the patients were analyzed, with a focus on exploring contemporary treatment approaches.

Among the 6 cases, 3 cases were male, with a median age of 62 years old. Initial clinical symptoms were often non-specific, the common manifestations included anemia, fatigue, lumbosacral and abdominal pain. Imaging revealed unilateral or bilateral adrenal space-occupying lesions. Pathological examination demonstrated a diffuse pattern of large lymphoid cells, with tumor cells exhibiting immunoblastic or centroblastic morphology, moderate cytoplasm, and eosinophilic or clear staining. Immunohistochemistry confirmed the expression of B-cell markers (CD20/CD79a) in tumor cells. Bcl-2 and Bcl-6 showed positive expression in all 6 cases, while 1 patient showed c-MYC positive expression, and 1 patient was EBER positive. In all 6 cases, the Ki-67 proliferation index exceeded 80%. Based on these findings, 5 cases were diagnosed with diffuse large B-cell lymphoma, and 1 case with EBV ⁺ large B-cell lymphoma. Among the 6 cases, 5 cases were initially treated with the R-CHOP regimen and achieved partial remission. One case underwent autologous hematopoietic stem cell transplantation after initial therapy with R-CHOP regimen, achieving complete remission. Follow-up data were available for all patients, ranging from 1 to 63 months, with a median follow-up of 32 months. The overall prognosis for these patients was favorable.

Adrenal aggressive B-cell lymphoma is a rare malignancy characterized by non-specific clinical presentations. Accurate diagnosis requires a comprehensive approach integrating pathological morphology, immunophenotyping, and molecular detection. Timely and standardized treatment significantly improves survival rate.