Diagnosis And Treatment Of Primary Non-Hodgkin’s Lymphoma Of The Adrenal Gland

Objective:To improve the understanding of primary adrenal lymphoma (PAL). To explore the diagnosis and treatment of this disease.Methods:Two patients were diagnosed with PAL from June2001to January2011in Qilu Hospital of Shandong University. The tow patients were male and the one was73years old, the other was87years old, mean age80years. One for "anal ache with defecate carries blood more than50years, increasing more than half month" admitted to hospital, then CT and MRI found the left adrenal tumor. The other one for "health screening found the left adrenal tumor". The disease was found by physical examination, without specific clinical manifestation. Tumors were located on the left, average diameter of5.7(5.5-6) cm. The tow patients were treated by surgical operation. The one was made the left adrenal tumor resection by laparoscopic. We saw that tumor was gray, rough surface, cut surface gray, yellowish gray and soft. The other was made by routine open operation. The tumor was4*5cm size, irregular, ill-defined with the surrounding tissue.Results:After operation the tumor tissue was sent to pathological testing. In the light microscope, the tumor cells showed diffuse distribution or sheet distribution, tumor cells rounded, polygonal, less cytoplasm, nucleus round or oval, cellular atypia obvious, mitotic figures visible, then more small vessels were between them. The pathological diagnosis was diffuse large B cell lymphoma of left adrenal gland. Immunohistochemistry:LCA positive, CD20positive, CD10positive, CD79a positive, CD2, CD3, CD56, ALK, CgA, Syn, EMA, melan-A, CK all negative. They were performed with R-CHOP (Rituximab+cyclophosphamide+doxorubicin+vincristine+prednisone) regimen after surgical operation. So far, the tow patients are alive. The one has been followed up for20months, and the other for6months.Conclusions:PAL is an extremely rare malignant tumor. The disease was usually occurred in old man without the special clinical manifestation, so its diagnosis dependent on pathological examination. PAL is a disease which is highly malignant, not sensitive to treatment and poor prognosis.