Primary bilateral adrenal lymphoma

When abdominal imaging reveals the existence of unsuspected adrenal masses, a diagnostic strategy is necessary. We report the case of a woman presenti ng with pulmonary embolism, in whom abdominal ultrasound revealed voluminou s masses in both adrenals without clinical or biological signs of hormone h ypersecretion, but with mild primary adrenal failure. From a CT scan-direct ed needle biopsy of the right adrenal mass and subsequent staging we were a ble to diagnose a primary bilateral adrenal lymphoma, diffuse large B-cell type (REAL/WHO). On CHOP chemotherapy both adrenal masses decreased dramati cally and the patient is in remission 18 months later. Primary adrenal lymp homa is a rare condition, since 65 cases have been reported to date. Histol ogical diagnosis is nevertheless important, in view of the excellent respon se to specific therapy observed in some cases.