Diffuse large B cell lymphoma with bilateral adrenal and hypothalamic involvement: A case report and literature review  

作　　者：Ping An Kang Chen Guo-Qing Yang Jing-Tao Dou Yu-Long Chen Xin-Ye Jin Xian-Ling Wang Yi-Ming Mu Quan-Shun Wang 

机构地区：[1]Department of Endocrinology,Chinese PLA General Hospital,Beijing 100853,China [2]Department of Hematology,Chinese PLA General Hospital,Beijing 100853,China

出　　处：《World Journal of Clinical Cases》2019年第23期4075-4083,共9页世界临床病例杂志

摘　　要：BACKGROUND Non-Hodgkin’s lymphoma(NHL)can involve extralymphatic organs,resulting in diverse clinical manifestations,especially if the endocrine organs are affected.This type of involvement can often be difficult to detect accurately.Until now,no patients with NHL and concomitant bilateral adrenal and hypothalamic involvement have been reported.The purpose of this article is to discuss the diagnosis and treatment of lymphoma with bilateral adrenal gland and hypothalamic involvement so as to help physicians avoid misdiagnosis and missed diagnosis.CASE SUMMARY We describe a case of a 52-years-old male patient with bilateral adrenal masses,who presented with a fever of unknown origin on admission.Subsequently,hypopituitarism of the anterior pituitary followed by posterior pituitary developed.18fluorine-fluorodeoxyglucose positron emission tomography/computed tomography(PET/CT)showed lesions with a high metabolism in both adrenal glands,hypothalamus,left supraclavicular lymph nodes,and other organs.The etiological diagnosis was determined based on a left supraclavicular lymph node biopsy.The patient,who eventually present with panhypopituitarism,was finally diagnosed with diffuse large B cell lymphoma with bilateral adrenal gland and hypothalamic involvement.After immunochemotherapy,glucocorticoids administration and desmopressin acetate replacement therapy,the symptoms of fever and panhypopituitarism improved,and all the lesions reduced in size.CONCLUSION This report demonstrates that,although synchronous involvement of two endocrine organs is rare in NHL,extra caution should be taken when dysfunction occurs in multiple endocrine organs.BACKGROUND Non-Hodgkin’s lymphoma(NHL) can involve extralymphatic organs, resulting in diverse clinical manifestations, especially if the endocrine organs are affected.This type of involvement can often be difficult to detect accurately. Until now, no patients with NHL and concomitant bilateral adrenal and hypothalamic involvement have been reported. The purpose of this article is to discuss the diagnosis and treatment of lymphoma with bilateral adrenal gland and hypothalamic involvement so as to help physicians avoid misdiagnosis and missed diagnosis.CASE SUMMARY We describe a case of a 52-years-old male patient with bilateral adrenal masses,who presented with a fever of unknown origin on admission. Subsequently,hypopituitarism of the anterior pituitary followed by posterior pituitary developed. 18 fluorine-fluorodeoxyglucose positron emission tomography/computed tomography(PET/CT) showed lesions with a high metabolism in both adrenal glands, hypothalamus, left supraclavicular lymph nodes, and other organs. The etiological diagnosis was determined based on a left supraclavicular lymph node biopsy. The patient, who eventually present with panhypopituitarism, was finally diagnosed with diffuse large B cell lymphoma with bilateral adrenal gland and hypothalamic involvement. After immunochemotherapy, glucocorticoids administration and desmopressin acetate replacement therapy, the symptoms of fever and panhypopituitarism improved,and all the lesions reduced in size.CONCLUSION This report demonstrates that, although synchronous involvement of two endocrine organs is rare in NHL, extra caution should be taken when dysfunction occurs in multiple endocrine organs.

关 键 词：Non-Hodgkin’s lymphoma BILATERAL ADRENAL GLANDS Hypothalamus PANHYPOPITUITARISM Case report 

分 类 号：R73[医药卫生—肿瘤]