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J Surg Case Rep. 2019 Feb 19;2019(2):rjz048. doi: 10.1093/jscr/rjz048. eCollection 2019 Feb.

Intravascular B-large cell lymphoma: an unexpected diagnosis of an incidental adrenal mass.

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1
Department of Surgery, 5th Surgical Clinic, Evgenidion Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.

Abstract

Adrenal incidentalomas originally defined as tumors discovered serendipitously in the course of diagnostic evaluation or follow-up of unrelated disorders, may occasionally pose serious diagnostic challenges. Intravascular large B-cell lymphoma (IVLBCL) may be a rare example of such a case. We present an IVLBCL confined to the adrenal gland in a 52-year-old man focusing on its diagnostic and therapeutic aspects. On endocrine work up, the tumor was hormonally inactive and exhibited inconclusive imaging characteristics without signs of locoregional spread. After a left laparoscopic adrenalectomy, histologic sections revealed the presence of tumor cells inside dilated, thin-walled vascular spaces. Immunohistochemical stains confirmed the diagnosis of IVLBCL. The patient was then referred to a Hematology Unit for further staging and treatment and received six cycles of R-CHOP. Despite the fact that IVLBCL carries a dismal prognosis our patient remains alive and in complete remission 6 years after the initial diagnosis.

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