PMC9079230_01
A: Contrast-enhanced adrenal CT: comparisons of adrenal masses before and after treatment. i: bilateral ill defined adrenal masses of 6.7 cm on the right and of 3.7 cm on the left adrenal and ii: significant bilateral masses' regression post-treatment. B: Cardiac MRI (balanced SSFP sequences): Comparisons of cardiac mass before and after treatment i: mass of 4.6 x 5.5 cm of reduced signal surrounding the right atrium and ii: significant mass regression post-treatment C: PET-CT scan. i: High accumulation of FDG in both the cardiac atrium (SUVmax 21.2) and adrenals tumors (SUVmax 20.5). ii: The abnormal uptake disappeared after 6 cycles of immunochemotherapy.
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On admission, a repeated adrenal CT scan showed large bilateral adrenal masses of 6.7 cm on the right adrenal gland compressing the inferior vena cava and of 3.7 cm on the left adrenal gland (Fig. 1A). Subsequent cardiac magnetic resonance imaging (MRI) confirmed the previous finding (Fig. 1B). A week later, a positron emission tomography (PET-CT) scan showed hyper-metabolic infiltrative masses involving the right atrium and both adrenal glands (Fig. 1C). Three months after the completion of six cycles of immunochemotherapy, a marked decrease of lymphoma infiltration in the post-chemotherapy imaging was found (Fig. 1A,B,C).
Immunohistochemistry of adrenal neoplastic tissue establishing the diagnosis of a DLBCL. The neoplastic cells show positivity for CD20, bcl2, bcl6 and MUM1 whereas c-myc is positive in 70% of the neoplastic nuclei.
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MUM1 was positive and Ki-67 was 99% (Fig. 2).