Clinical characteristics of 28 cases of primary adrenal lymphoma

This study aimed to systematically characterize clinical manifestations, diagnostic findings (including imaging, endocrine laboratory evaluation, and histopathology), and clinical outcomes among patients with primary adrenal lymphoma (PAL), to refine diagnostic strategies and clinical management for this rare endocrine neoplasm.

This retrospective cohort study recruited 28 patients diagnosed with primary adrenal diffuse large B-cell lymphoma (DLBCL) at the First Affiliated Hospital of Zhengzhou University between April 2013 and December 2024. All baseline characteristics were systematically analyzed.

Twenty-eight patients were enrolled in this cohort, with a median age of 62 years; 18 patients (64%) were male. Clinical manifestations were heterogeneous, with weight loss being the most common symptom, followed by lumbar or abdominal pain and anorexia. Bilateral adrenal masses were detected in 18 of the 28 participants, and tumor diameter exceeded 4 cm in 21 cases. Morning serum adrenocorticotropin (ACTH) and cortisol concentrations were measured in 19 patients. Seven individuals displayed normal ACTH and cortisol profiles, while 6 presented with early primary adrenal insufficiency (PAI). All 28 subjects underwent adrenal pathological testing, confirming DLBCL as the definitive histological subtype. Twenty-five patients received chemotherapy.

In conclusion, PAL predominantly affects elderly male patients, who often present with bilateral adrenal masses, weight loss, and early PAI. Our cohort demonstrates substantial interindividual heterogeneity in endocrine phenotypes. High clinical suspicion and prompt adrenal biopsy are therefore vital to facilitate early intervention and optimize patient outcomes.