Large B-cell lymphoma mimicking adrenal pheochromocytoma

A 70-year old woman presented to Haydarpaşa Numune Training and Research Hospital, Urology Department, Istanbul, Turkey, in March 2012, with haematuria and 10 kg weight loss during the last three months. There was no abnormality seen in the physical examination. Complete blood count was normal, serum biochemistry profile was within normal limits. Urine (24 h) normetanephrine level was 1160 μg (normal range 92-604 μg). Computered tomography (CT) and magnetic resonance imaging (MRI) revealed right adrenal 11 × 11 × 10 cm sized mass (Figs 1 and 2). An adrenal pheochromocytoma was suspected in endocrinological examination. Adrenalectomy was planned for definitive diagnosis and treatment. The patient was treated with open transperitoneal adrenalectomy in urology clinics. Pathological examination of adrenal revealed diffuse proliferation of atypical cells with large hyperchromatic nuclei and narrow eosinophilic cytoplasm. In the immunohistochemical study, tumour cells were positive for CD 20, while CD 5, cyclin D1 and CD 10 were negative. The patient was treated with six cycles of chemotherapy after operation in the oncology department. She had no recurrence and metastasis now.

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Fig. 1

MRI image of right adrenal tumour the patient.

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Fig. 2

CT image of adrenal mass the patient.

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Adrenal lesions are usually metastases from distant organ malignites1. The most common metastases arise from bronchial carcinomas. Primary adrenal lymphoma is rare2 and adrenal lymphomas are usually bilateral3.