adrenal lymphoma
DESCRIPTION
Adrenal LymphomaTRANSCRIPT
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5/20/2018 Adrenal Lymphoma
1/23
Adrenal lymphoma
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5/20/2018 Adrenal Lymphoma
2/23
KG, 32/M, 2012090710
Referred as a case of
bilateral adrenal
masses with c/o-
Right upper abdominal
No history of-
Headache
Sweating
Palpitations
Visual blackouts
2
pain- 2 months, vague,
no shifting or migration
High grade fever- 2 days
Maximum BP recorded-140/100 mm Hg
Tremors
Weakness
Graveluria
Neck swelling
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5/20/2018 Adrenal Lymphoma
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Family History
70 yrs
Cause?
Young age
Cause ?
3
Accidental
death
70 yrs
Heart attack
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5/20/2018 Adrenal Lymphoma
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Examination
No neurocutaneous markers
P/R- 80/min, regular in rhythm
BP-
4
Supine- 140/90 mm Hg
Standing- 130/84 mm Hg
Neck- Single mobile LN in left level 2 Abdomen- NAD
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USG abdomen
Bilateral large adrenal
masses-
Left-
11.4 x 10.0 x 9.3 cm
5
Predominantly
hypoechoic
Right-
11.6 x 8.6 x 7.4 cm
Predominantly
hypoechoic
Kidneys normal
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Biochemical evaluation elsewhere
Hormone Value Normal range
24-hr urinary metanephrine 6.93 g/day 53-341
24-hr urinary metanephrine 4.01 g/gm creatinine 27-155
24-hr urinary normetanephrine 1530.84 g/day 88-444
24-hr urinary normetanephrine 885.13 g/gm creatinine 46-256
6
- r ur nary reat n ne . mg
24-hr urinary VMA 140.61 ng/dl 1.8-6.7
24-hr urinary VMA 30.98 mg/gm creatinine 1.6-4.2
S. Cortisol 83.0 ng/ml 30-150
Potassium 4.2 mmol/L 3.5-5.4
S. ACTH 64.4 pg/ml 7.9-66.1
24-hr urinary Cortisol 30.4 g/day 28.5-213.7
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Chest X-ray
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CECT abdomen
8
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CECT abdomen
9
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CECT abdomen
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CT-Angio
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MRI abdomen
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Treatment elsewhere
Diagnosis made as bilateral adrenal
Pheochromocytoma
Patient was given -blockers that were
13
-
blockers
Was planned for surgery elsewhere but
Surgeons refused; said it was inoperable
mass
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5/20/2018 Adrenal Lymphoma
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Differential Diagnosis
Bilateral adrenal masses-
?Pheochromocytoma
?? Lymphoma
14
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Course @ SGPGI
Due to confusion in diagnosis, plan was to workup again
Fever persisted despite antimalarials, antibiotics
Decreased oral intake with increasing pain
15
a omen
Plan- FNAC from neck LN
Repeat 24-hour urinary fractionated metanephrines Hematology, Biochemistry, cultures, serology,
malarial parasite (PBS)
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Investigations @ SGPGI
FNAC neck LN- Predominance of large
atypical lymphoid cells, possibility of
lymphoproliferative disorder
16
- , , -
for bacterial growth
Peripheral smear- negative for malarial
parasite
HIV, Widal- non reactive
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Investigations @ SGPGI
Hormone Value Normal range
24-hr urinary metanephrine 26.43 g/day
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Repeat CECT abdomen
Right- 11x10x8 cm
Left- 11x10.5x6 cm
Few necrotic areas
No calcification/ hge
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Encasement of celiac,
splenic and renal arteries
and veins and a focal
segment of aorta
Bilateral pleural effusion
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Histopathology from Adrenal gland
Lymphoblastic lymphoma
Bone marrow infiltration absent
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+ve- -ve- LCA, CD3 - CD20, TdT
Ki-67- 70-80%
Immunohistochemistry
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Further course
Given chemotherapy first cycle- CHOP
Partial improvement in symptoms
Fever subsided
20
Intake improved
Patient discharged in stable condition after
one week of chemotherapy
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Course @ home
Patient developed fever, vomiting and
dizziness after 10 days
Admitted at local hospital for supportive
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Further course
Patient developed fever and cough with
anemia
Admitted in shock
22
- , - , progress ve y
rising (502, 166), viral markers negative
LDH increased to 4,602 U/L
Patients condition did not improved and
succumbed 13 days after admission
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THANK YOU
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