PDF(Pubmed)
Abstract：
BACKGROUND: Most adrenal tumors are benign and primary adrenal malignancies are relatively rare. Primary adrenal lymphoma (PAL) is a very rare and highly aggressive malignant tumor with unknown etiology, atypical clinical symptoms, nonspecific imaging manifestations, difficult disease diagnosis and poor prognosis.
METHODS: This case report details a 42-year-old woman who was admitted to the hospital with a 1-year-old bilateral adrenal mass and 1-month-old left upper abdominal pain. Enhanced CT of the abdomen showed a right adrenal nodule and a large occupying lesion in the left adrenal region, with a high probability of pheochromocytoma. Intraoperatively, a huge tumor measuring about 12*12*10 cm was found in the left adrenal region, infiltrating the left kidney, spleen and pancreatic tail. Postoperative pathology: lymphocytes were found in the renal capsule and subcapsule, lymphocytes were found in the pancreas; lymphocytes were found in the spleen. Consider a tumor of the lymphohematopoietic system, possibly lymphoma.
CONCLUSIONS: This case demonstrates that primary adrenal diffuse large B-cell lymphoma (PADLBCL) is highly aggressive, has a poor prognosis, is prone to recurrence, has poor therapeutic outcomes, and is difficult to diagnose. Clinicians should consider the possibility of PADLBCL when encountering huge adrenal-occupying lesions and consider chemotherapy before surgery. Reducing the tumor size before surgery is a more favorable therapeutic approach, thus prolonging the patient life and improving the quality of survival.
METHODS: This case report details a 42-year-old woman who was admitted to the hospital with a 1-year-old bilateral adrenal mass and 1-month-old left upper abdominal pain. Enhanced CT of the abdomen showed a right adrenal nodule and a large occupying lesion in the left adrenal region, with a high probability of pheochromocytoma. Intraoperatively, a huge tumor measuring about 12*12*10 cm was found in the left adrenal region, infiltrating the left kidney, spleen and pancreatic tail. Postoperative pathology: lymphocytes were found in the renal capsule and subcapsule, lymphocytes were found in the pancreas; lymphocytes were found in the spleen. Consider a tumor of the lymphohematopoietic system, possibly lymphoma.
CONCLUSIONS: This case demonstrates that primary adrenal diffuse large B-cell lymphoma (PADLBCL) is highly aggressive, has a poor prognosis, is prone to recurrence, has poor therapeutic outcomes, and is difficult to diagnose. Clinicians should consider the possibility of PADLBCL when encountering huge adrenal-occupying lesions and consider chemotherapy before surgery. Reducing the tumor size before surgery is a more favorable therapeutic approach, thus prolonging the patient life and improving the quality of survival.
摘要：
背景：大多数肾上腺肿瘤是良性的，原发性肾上腺恶性肿瘤相对罕见。原发性肾上腺淋巴瘤(PAL)是一种非常罕见且高度侵袭性的恶性肿瘤，病因不明，不典型的临床症状，非特异性影像学表现，疾病诊断困难，预后差。
方法：本病例报道了一名42岁女性，因1岁双侧肾上腺肿块和1个月大的左上腹痛入院。腹部增强CT示：右侧肾上腺结节，左侧肾上腺区大面积占位，嗜铬细胞瘤的可能性很高。术中,在左肾上腺区发现了一个约12*12*10厘米的巨大肿瘤，浸润左肾,脾脏和胰尾。术后病理：肾包膜及包膜下可见淋巴细胞，在胰腺中发现淋巴细胞；在脾脏中发现淋巴细胞。考虑淋巴造血系统的肿瘤，可能是淋巴瘤.
结论：该病例表明原发性肾上腺弥漫性大B细胞淋巴瘤（PADLBCL）具有高度侵袭性，预后不良,容易复发，治疗效果不佳，而且很难诊断.临床医生在遇到巨大的肾上腺占位性病变时应考虑PADLBCL的可能性，并在手术前考虑化疗。手术前缩小肿瘤大小是一种更有利的治疗方法，从而延长患者生命,提高生存质量。
方法：本病例报道了一名42岁女性，因1岁双侧肾上腺肿块和1个月大的左上腹痛入院。腹部增强CT示：右侧肾上腺结节，左侧肾上腺区大面积占位，嗜铬细胞瘤的可能性很高。术中,在左肾上腺区发现了一个约12*12*10厘米的巨大肿瘤，浸润左肾,脾脏和胰尾。术后病理：肾包膜及包膜下可见淋巴细胞，在胰腺中发现淋巴细胞；在脾脏中发现淋巴细胞。考虑淋巴造血系统的肿瘤，可能是淋巴瘤.
结论：该病例表明原发性肾上腺弥漫性大B细胞淋巴瘤（PADLBCL）具有高度侵袭性，预后不良,容易复发，治疗效果不佳，而且很难诊断.临床医生在遇到巨大的肾上腺占位性病变时应考虑PADLBCL的可能性，并在手术前考虑化疗。手术前缩小肿瘤大小是一种更有利的治疗方法，从而延长患者生命,提高生存质量。
