PRIMARY ADRENAL LYMPHOMA (PAL) ON 18FDG PET/CT IMAGING: RARE CASE

Abstract

Primary adrenal lymphoma (PAL) is a rare entity (<250 cases reported in literature) which should be considered in the differential diagnosis of bilateral adrenal lesions with or without associated adrenal insufficiency (AI). We present a case of 63-year-old man having 6 month’s history of weakness, weight loss and bilateral dull lumbar aches.  Contrast enhanced CT of abdomen and pelvis revealed isolated bilateral adrenal masses. His serum metanephrine, normetanephrine and cortisol levels were normal but serum aldosterone level was significantly low (<0.97 ngm/ml; Normal <46 ngm/ml). CT-guided biopsy of the right adrenal gland was consistent with high grade B-cell lymphoma. ¹⁸F-fluorodeoxyglucose (¹⁸FDG) positron emission tomography (PET/CT) done as part of staging revealed isolated hypermetabolic adrenal masses but no other lesion and a diagnosis of PAL was concluded.

Key Words: Lymphoma; primary adrenal lymphoma; adrenal insufficiency; ¹⁸FDGPET/CT