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Adrenal relapse of primary central nervous system diffuse large B-cell lymphoma: A case report
RATIONALE: Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin lymphoma with a dismal outcome. Most patients relapse in intracranial sites and <5% of patients relapse in extracranial sites. Here, we present the first case of PCNSL with an adrenal relapse. PATIENT CONCERN...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6160128/ https://www.ncbi.nlm.nih.gov/pubmed/30235749 http://dx.doi.org/10.1097/MD.0000000000012482 |
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author | Ma, Shuang Sen, Siddhartha Sen Jug, Rachel Zhang, Xuefeng Zhang, Wan-Lin Shen, Shuai Yu, Cheng-Qian Xu, Hong-Tao Yang, Lian-He Wang, Endi |
author_facet | Ma, Shuang Sen, Siddhartha Sen Jug, Rachel Zhang, Xuefeng Zhang, Wan-Lin Shen, Shuai Yu, Cheng-Qian Xu, Hong-Tao Yang, Lian-He Wang, Endi |
author_sort | Ma, Shuang |
collection | PubMed |
description | RATIONALE: Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin lymphoma with a dismal outcome. Most patients relapse in intracranial sites and <5% of patients relapse in extracranial sites. Here, we present the first case of PCNSL with an adrenal relapse. PATIENT CONCERNS: A 72-year-old woman, first presented 7 years ago with complaints of headache and dizziness. DIAGNOSES: Enhanced magnetic resonance imaging revealed the mass within the splenium of the corpus callosum. On histological examination, there was a diffuse growth pattern of neoplastic cells in the brain biopsy. Immunohistochemistry and flow cytometric analysis demonstrated that the neoplastic cells were of B-cell lineage. INTERVENTIONS: The patient underwent methotrexate-based chemotherapy and whole-brain radiotherapy after the initial diagnosis of primary central nervous system-large B-cell lymphoma (CNS-DLBCL). OUTCOMES: After 4 years of clinical remission, the patient was diagnosed with endometrial cancer. Interestingly, a radiological study following the treatment of endometrial cancer demonstrated a right adrenal mass, which was suspicious for malignancy. Morphologic examination and immunohistochemistry studies confirmed the diagnosis of diffuse large B-cell lymphoma. A fluorescent in situ hybridization panel for lymphoma showed rearrangement of Immunoglobulin heavy chain (IGH) and B-cell lymphoma 6 (BCL6), respectively, suggesting fusion of BCL6/IGH. Immunoglobulin kappa analysis demonstrated a common origin for the brain and adrenal lesions, which led to the final diagnosis of an adrenal relapse of CNS-DLBCL. LESSONS: PCNSL is a highly infiltrative neoplasm, particularly at relapse. To the best of our knowledge, this is the first case of CNS-DLBCL with adrenal relapse. Considering the poor outcome of CNS-DLBCL, molecular genetic studies should be done to identify a common origin for the primary and secondary lesion. |
format | Online Article Text |
id | pubmed-6160128 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-61601282018-10-12 Adrenal relapse of primary central nervous system diffuse large B-cell lymphoma: A case report Ma, Shuang Sen, Siddhartha Sen Jug, Rachel Zhang, Xuefeng Zhang, Wan-Lin Shen, Shuai Yu, Cheng-Qian Xu, Hong-Tao Yang, Lian-He Wang, Endi Medicine (Baltimore) Research Article RATIONALE: Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin lymphoma with a dismal outcome. Most patients relapse in intracranial sites and <5% of patients relapse in extracranial sites. Here, we present the first case of PCNSL with an adrenal relapse. PATIENT CONCERNS: A 72-year-old woman, first presented 7 years ago with complaints of headache and dizziness. DIAGNOSES: Enhanced magnetic resonance imaging revealed the mass within the splenium of the corpus callosum. On histological examination, there was a diffuse growth pattern of neoplastic cells in the brain biopsy. Immunohistochemistry and flow cytometric analysis demonstrated that the neoplastic cells were of B-cell lineage. INTERVENTIONS: The patient underwent methotrexate-based chemotherapy and whole-brain radiotherapy after the initial diagnosis of primary central nervous system-large B-cell lymphoma (CNS-DLBCL). OUTCOMES: After 4 years of clinical remission, the patient was diagnosed with endometrial cancer. Interestingly, a radiological study following the treatment of endometrial cancer demonstrated a right adrenal mass, which was suspicious for malignancy. Morphologic examination and immunohistochemistry studies confirmed the diagnosis of diffuse large B-cell lymphoma. A fluorescent in situ hybridization panel for lymphoma showed rearrangement of Immunoglobulin heavy chain (IGH) and B-cell lymphoma 6 (BCL6), respectively, suggesting fusion of BCL6/IGH. Immunoglobulin kappa analysis demonstrated a common origin for the brain and adrenal lesions, which led to the final diagnosis of an adrenal relapse of CNS-DLBCL. LESSONS: PCNSL is a highly infiltrative neoplasm, particularly at relapse. To the best of our knowledge, this is the first case of CNS-DLBCL with adrenal relapse. Considering the poor outcome of CNS-DLBCL, molecular genetic studies should be done to identify a common origin for the primary and secondary lesion. Wolters Kluwer Health 2018-09-21 /pmc/articles/PMC6160128/ /pubmed/30235749 http://dx.doi.org/10.1097/MD.0000000000012482 Text en Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 |
spellingShingle | Research Article Ma, Shuang Sen, Siddhartha Sen Jug, Rachel Zhang, Xuefeng Zhang, Wan-Lin Shen, Shuai Yu, Cheng-Qian Xu, Hong-Tao Yang, Lian-He Wang, Endi Adrenal relapse of primary central nervous system diffuse large B-cell lymphoma: A case report |
title | Adrenal relapse of primary central nervous system diffuse large B-cell lymphoma: A case report |
title_full | Adrenal relapse of primary central nervous system diffuse large B-cell lymphoma: A case report |
title_fullStr | Adrenal relapse of primary central nervous system diffuse large B-cell lymphoma: A case report |
title_full_unstemmed | Adrenal relapse of primary central nervous system diffuse large B-cell lymphoma: A case report |
title_short | Adrenal relapse of primary central nervous system diffuse large B-cell lymphoma: A case report |
title_sort | adrenal relapse of primary central nervous system diffuse large b-cell lymphoma: a case report |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6160128/ https://www.ncbi.nlm.nih.gov/pubmed/30235749 http://dx.doi.org/10.1097/MD.0000000000012482 |
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