PMC7527573_01
Radiological findings. At diagnosis, computed tomography (CT) (a) and Positron emission tomography (PET)/CT (b) revealed the presence of bilateral bulky adrenal tumors with direct invasion toward the pancreas. The maximum standardized uptake value (SUVmax) was high (left 23.1, right 24.0). PET (c) also revealed the presence of some other lesions that were not obvious in CT. Systemic relapse was detected 2 months post transplantation (d), and was well controlled after short-term administration of l-asparaginase (e).
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A 37-year-old man suffering from fever and abdominal pain for 2 weeks was presented to our department following the detection of bulky bilateral tumors in his adrenal glands by computed tomography (CT, Fig. 1a). Positron emission tomography (PET), combined with CT, revealed bilateral bulky adrenal tumors with markedly increased uptake of fluorodeoxyglucose (FDG), appearing to directly involve the pancreas and kidney (Fig. 1b, c). Some increased FDG-uptake sites without abnormalities on CT were also observed (Fig. 1c). However, 2 months post transplantation, PET/CT showed a relapse in the liver and left adrenal gland (Fig. 1d). On day 98, PET/CT confirmed complete metabolic response (Fig. 1e), which was maintained until death.
Findings of the central nervous system (CNS) infiltration. (a) Images obtained with magnetic resonance imaging (MRI) at the time of exacerbation of hearing loss (gadolinium-enhanced T1-weighted images). Arrows show lesion sites. (b) The massive infiltration of lymphoma cells in the cerebrospinal fluid (May-Giemsa staining, x 100).
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Magnetic resonance imaging (MRI) revealed the presence of mass bilateral lesions in the internal acoustic meatuses and the fourth ventricle (Fig. 2a), which were considered relapsed lesions of ENKL. A spinal tap revealed the massive infiltration of lymphoma cells (1775 cells/muL) in the cerebrospinal fluid (CSF; Fig. 2b) with EBV-DNA being significantly increased (4.7 x 103 copies/mug DNA) in CSF, confirming a diagnosis of lymphomatous meningitis.