ADRENAL PRIMARY LYMPHOMA - A CASE-REPORT

The adrenal gland is affected in about 25% of patients with diffuse ly mphoma. Conversely, primary lymphoma is a rare cause of non secreting adrenal tumour. We observed a recent case with exclusive right adrenal localization. An 84 year old woman was hospitalized for asthenia, ano rexia and a 3-kg weight loss. The past history included coronary heart disease. Physical examination was normal and the haemogramme revealed pancytopenia. No lymphomatous infiltration was seen on the myelogramm e or the bone marrow biopsy. Echography of the abdomen showed a well-l imited 10 cm mass above the right adrenal gland, distinct from the liv er; the left gland had a normal aspect. Hormone assays were within nor mal limits. The right adrenal gland was removed surgically and histolo gy revealed diffuse proliferation of medium to large sized lymphoid ce lls invading the entire gland. Immunohistochemistry suggested lymphoid B origin. No curative treatment was begun, but 2 months after surgery local invasion required polychemotherapy. The patient died of septic shock 5 days later. Serum cortisol measured during the septic shock el iminated adrenal gland failure. Malignant primative non-Hodgkinien lym phomas are extremely rare and usually discovered incidentally. The tum our is always large and sometimes accompanied by adrenal insufficiency when the lesion is bilateral. In spite of suggestive imagery the diag nosis is based on the pathology examination. The lesion is usually a h igh-grade malignant phenotype B lymphoma. Treatment relies on chemothe rapy but is disappointing.