Gastric diffuse large B-cell lymphoma with bilateral adrenal metastasis

Extranodal adrenal involvement in non-Hodgkin’s lymphoma is very rare, estimated to be around less than 0.2%. Most common sites involved are stomach, intestine and testis. It is very rare for adrenal tumours to present as primary adrenal insufficiency, with an incidence of around 1.2% in patients di...

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Published inBMJ case reports Vol. 12; no. 7; p. e229758
Main Authors Hassan, Muhammad, Mandal, Amrendra Kumar, Sidhu, Jasdeep Singh, Cardenas, Luz Maria
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 01.07.2019
BMJ Publishing Group
SeriesCase Report
Subjects
Abdomen
Acidosis
Adrenal Gland Neoplasms - secondary
Adrenal glands
Adrenal Glands - pathology
Biopsy
Cancer
Case reports
Family medical history
Fatal Outcome
Gastric cancer
Hepatitis
Hormones
Humans
Laboratories
Lymphoma
Lymphoma, Large B-Cell, Diffuse - pathology
Lymphoma, Non-Hodgkin - pathology
Male
Metabolism
Metastasis
Middle Aged
Neuroendocrine tumors
Pain
Patients
Respiratory failure
Stomach
Stomach Neoplasms - pathology
Tumors
Ulcers
Unusual Presentation of More Common Disease/Injury
Urine
Vomiting
endocrine system
endocrine cancer
gastroenterology
gastric cancer
oncology
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Summary:Extranodal adrenal involvement in non-Hodgkin’s lymphoma is very rare, estimated to be around less than 0.2%. Most common sites involved are stomach, intestine and testis. It is very rare for adrenal tumours to present as primary adrenal insufficiency, with an incidence of around 1.2% in patients diagnosed with adrenal masses. Diffuse large B cell lymphoma (DLBL) originating from the stomach and metastasizing to bilateral adrenal glands is an extremely uncommon occurrence with only three cases found on review of the literature. We present a case of a 62-year-old African–American man who presented with nausea, vomiting, abdominal pain and hypotension, later being diagnosed as DLBL of the gastric antrum metastasized to bilateral adrenal glands. Initial laboratory workup revealed including hormonal analysis and cosyntropin test revealed adrenal insufficiency. The patient later died during the hospitalisation after developing respiratory failure, severe hypotension refractory to vasopressors and severe metabolic acidosis.
Bibliography:ObjectType-Case Study-2
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ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2019-229758