title: A case of primary bilateral adrenal lymphoma (PAL) with central nervous system (CNS) involvement.
abstract: Primary adrenal lymphoma (PAL) is a very rare disease and usually does not have disease elsewhere, and if present, it is frequently extranodal. Several cases of PALs, with central nervous system (CNS) involvement, gastrointestinal tract or other endocrine organs involvement, have been reported in Western literature. We experienced a case of PAL with CNS involvement, which was previously unreported in Korea. The patient, a 61 year-old male, was admitted with left abdominal pain. After imaging study and needle aspiration biopsy (NAB), a bilateral primary adrenal lymphoma (large B-cell type), with bilateral hemorrhage, was confirmed. Combination chemotherapy, with CEOP regimen, was used. A follow-up abdomino- pelvic CT scan, after the second CEOP chemotherapy, showed the previous adrenal masses had nearly disappeared. However, about 2 months after diagnosis (day 52), he showed recent memory loss, obtundation, disorientation and drowsy mental status. The brain MRI revealed multifocal scattered lesions with increased signal intensity. The result of a brain biopsy was diffuse large B-cell lymphoma. After 5(1/2) cycles of chemotherapy, with CEOP regimen, and whole brain radiotherapy, he is still surviving 6 months later, and has become alert with nearly normalized cognitive function.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, C.P.O. Box 8044, Seoul 120-752, Korea. teodoro@chollian.net
authors.forename: Jee Sook
authors.initials: JS
authors.lastname: Hahn
authors.forename: Han Seok
authors.initials: HS
authors.lastname: Choi
authors.forename: Chang Ok
authors.initials: CO
authors.lastname: Suh
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Lee
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis*; D001932:Brain Neoplasms / Q000175:diagnosis*; D006801:Humans; D016393:Lymphoma, B-Cell / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis*; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed