Transient spontaneous regression of aggressive non-Hodgkin's lymphoma confined to the adrenal glands

Case Details

Disease Location

Adrenal glands

Personal Characteristics

72 -year-old male august 1997

Clinical Characteristics

Was initially hospitalized with a 4 month history of night sweats and a low-grade fever abdominal CT scan found the right and left adrenal glands to be diffusely enlarged (right 2.7x1.5cm, left 3.0x2.4cm) blood pressure was 150/90 mmhg, pulse rate 60bpm, temperature of 37.3c. No lymph nodes were palpably enlarged, and no evident hepatosplenomegaly serum c-reactive protein (crp) concentration was slightly increased (1.5 mg/dl), serum lactate dehydrogenase was elevated (486 u/l). Hemoglobin, total protein, alkaline phosphate, creatinine, and serum electrolytes were normal, as was basal plasma cortisol concentration; but adrenocorticotrophic hormones was slightly elevated (18 pmol/l) rapid acth stimulation test was performed and peak cortisol value was a normal response, however adrenal insufficiency was still suspected because of elevated plasma acth concentration other than the enlarged adrenal glands, no other abnormalities or lymphadenopathy was seen on CT scan of neck, thorax, pelvis, and abdomen, gallium-67 scintigraphy, and barium and endoscopic gi studies...primary adrenal lymphoma was suspected but the patient declined further evaluation and was discharged in october 1997 in june 1998, night sweats reappeared, when readmitted the patient was afebrile, blood pressure was 100/60 mmhg, had mild hyperpigmentation of the hands, but no abnormalities were found on a physical exam. Low serum cortisol (53 nmol/l) associated with an increased plasma acth (162 pmol/l) indicated primary adrenal insufficiency. Ebv was negative in serum, abdominal CT scan showed enlarged adrenal glands (right 5.2x2.0cm, left 5.5x2.6cm), no other lesions or malignant cells were seen on microscopic exam of bone marrow. Right adrenal gland was laparoscopically resected, the tumor was confirmed histopathologically to be a nhl of diffuse large cell type, immunohistochemical study indicated b cell origin with staining present for l26 (CD20) and mb1 (cd79a) but not uchl1 (cd45ro) or mt1 (CD43) contralateral laparoscopic adrenalectomy was performed, no evidence of tumor extension beyond adrenal regions in both procedures, the tumor was completely resected

Remission Characteristics

In october, night sweats and fever gradually decreased and the ldh and crp became normal without treatment. One months after discharge, CT indicated a decrease in size of both adrenals (right 2.1x0.6cm, left 1.4x1.0cm) and patient remained asymptomatic after complete resection surgery, chop regimen was started and hydrocortisone treatment was continued, 26 months after discharge, there has been no recurrence

Treatment & Mechanisms

Proposed Remission Mechanisms

Apoptotic mechanism, although unlikely, but cannot be ruled out surgery plus chemo

Clinical Treatment

Acth stimulation test (intravenous injection of 250 micrograms of cosyntropin) in june 1998, given hydrocortisone replacement therapy following the surgery, the patient was treated with chop regimen for 5 cycles, hydrocortisone treatment continued

Non-Clinical Treatment

None reported