Safi S, Kassmaoui H, Hassikou H, Alami M, Homadi A, Tabache F, Baaj M, Hadri L
Service de médecine interne, hôpital militaire Moulay-Ismail, BP S15, Meknès, Maroc.
Ann Endocrinol (Paris). 2007 Jun;68(2-3):208-11. doi: 10.1016/j.ando.2007.02.008. Epub 2007 May 24.
Bilateral primary non-Hodgkin's lymphoma (NHL) of the adrenals is uncommon. Less than 70 cases have been described in the literature. The symptoms of disease are variable and depend on the tumor size and the presence of adrenal insufficiency . We report a case of large diffuse B-cell adrenal lymphoma discovered in a 40-year-old woman presenting bilateral lumbar pain. Hormonal exploration demonstrated adrenal insufficiency. Imaging explorations showed a large and bilateral adrenal mass. Percutaneous CT-guided biopsy of the adrenal and search for extension revealed primary bilateral adrenal lymphoma. After glucocorticoid substitution, treatment was based on a CHOP regimen chemotherapy; outcome was unfavourable after the second cure; the patient died from septic shock. The diagnosis of primary adrenal non-Hodgkin lymphoma should be investigated in patients with a rapidly growing bilateral adrenal mass associated with adrenal insufficiency.
双侧原发性肾上腺非霍奇金淋巴瘤(NHL)并不常见。文献中报道的病例少于70例。该病症状多样,取决于肿瘤大小及肾上腺功能不全的情况。我们报告一例40岁女性患者,因双侧腰痛发现巨大弥漫性B细胞肾上腺淋巴瘤。激素检查显示肾上腺功能不全。影像学检查发现双侧肾上腺有巨大肿块。经皮CT引导下肾上腺活检及寻找转移灶,确诊为原发性双侧肾上腺淋巴瘤。糖皮质激素替代治疗后,采用CHOP方案化疗;第二次化疗后病情不佳;患者死于感染性休克。对于双侧肾上腺肿块迅速增大且伴有肾上腺功能不全的患者,应考虑原发性肾上腺非霍奇金淋巴瘤的诊断。