title: Diffuse large B-cell lymphoma solely involving bilateral adrenal glands and stomach: report of an extremely rare case with review of the literature.
abstract: A 60-year-old man complained of nausea, vomiting, decreased appetite, and a feeling of abdominal fullness in August 2013. Based on biopsy findings from an upper gastrointestinal endoscopy examination, a diagnosis of non-Hodgkin's lymphoma (NHL), diffuse large B-cell lymphoma (DLBCL), non-GC type, was made. F18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) revealed abnormal accumulations solely in the gastric wall (SUVmax = 14.5), the left adrenal gland (SUVmax = 14.3), and the right adrenal gland (SUVmax = 8.5). The clinical stage (Ann Arbor) was IVA, the serum LDH level was within the reference range, and the International Prognostic Index (IPI) was low-intermediate. The serum soluble IL-2 receptor level was within the reference range, and there was no evidence of HIV, EB virus, or autoimmune disease. After the completion of 4 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) and 2 parallel cycles of prophylactic intrathecal (I.T.), an upper gastrointestinal endoscopy and a FDG-PET/CT examination showed complete remission (CR). The patient received 8 cycles of ritsuximab therapy, 6 cycles of CHOP, and 3 cycles of I.T. The patient has maintained a CR for about 14 months. A literature search revealed that malignant lymphoma with involvement confined to the adrenal gland and gastrointestinal tract is exceedingly rare, and only 3 cases of malignant lymphoma have been reported, with involvement of the stomach in 2 cases and the duodenum in 1 case. All of the cases were diagnosed as DLBCL. The case described herein represents the third case with involvement of the stomach.
authors.affiliation: Department of Hematology, Juntendo University Urayasu Hospital Japan.
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Wakabayashi
authors.affiliation: Department of Hematology, Juntendo University Urayasu Hospital Japan.
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Sekiguchi
authors.affiliation: Department of Hematology, Juntendo University Urayasu Hospital Japan ; Department of Hematology, Juntendo University Hospital Japan.
authors.forename: Asami
authors.initials: A
authors.lastname: Shimada
authors.affiliation: Department of Hematology, Juntendo University Urayasu Hospital Japan ; Department of Hematology, Juntendo University Hospital Japan.
authors.forename: Kunimoto
authors.initials: K
authors.lastname: Ichikawa
authors.affiliation: Department of Hematology, Juntendo University Urayasu Hospital Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Sugimoto
authors.affiliation: Department of Pathology, Juntendo University Urayasu Hospital Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Tomita
authors.affiliation: Department of Pathology, Juntendo University Urayasu Hospital Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Izumi
authors.affiliation: Department of Clinical Laboratory, Juntendo University Urayasu Hospital Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Nakamura
authors.affiliation: Department of Clinical Laboratory, Juntendo University Urayasu Hospital Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Sawada
authors.affiliation: Department of Pathology, Research Hospital, The Institute of Medical Science, The University of Tokyo Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Ohta
authors.affiliation: Department of Hematology, Juntendo University Hospital Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Komatsu
authors.affiliation: Department of Hematology, Juntendo University Urayasu Hospital Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Noguchi
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000188:drug therapy / Q000473:pathology*; D000971:Antineoplastic Combined Chemotherapy Protocols; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology*
keywords: Diffuse large B-cell lymphoma (DLBCL); adrenal gland; stomach