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Patología Revista Latinoamericana

2011, Number S1

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Patol Rev Latinoam 2011; 49 (S1)

Adrenal bilateral primary lymphoma: a case report and immunohistochemical criteria review

Sierra AJA, Núñez PHL, Bonilla TLJ, Puentes MCA, García AE

Language: Spanish
References: 44
Page: s18-s25
PDF size: 536.50 Kb.


ABSTRACT

Primary adrenal bilateral lymphoma is an uncommon extranodal lymphoproliferative clinico-pathological entity with less than 100 reported cases in the worldwide literature, related with a poor prognosis. Adrenal failure is a frequent finding, established according to the infiltration grade. Immunohistochemical criteria are important to figure out the suitable diagnosis, prognosis and therapeutic management. This paper reports the case of a female 74-year-old patient with antecedent of diabetes mellitus type 2, neurodegenerative disease and arterial hypertension, presents at the emergency department for syncope. Then she developed nosocomial pneumonia, metabolic encephalopathy, and multiple system failure and then she died. In the medical-scientific autopsy were found: bilateral adrenal masses with increased weight and height, generalized edema, microthrombi into systemic circulation and hypoxic-isquemic encephalic infarctations with diffuse distribution. Immunohistochemical essays were done with the markers CD3, CD10, CD20, MUM-1, Bcl-2, Bcl-6, Ki67 and cycline D1, showing a diffuse large B cell non-Hodgkin lymphoma with a germinal center phenotype, a proliferation rate of 40% and tumoral microthrombi distributed systemically. Diffuse large B-cell lymphoma frequently impairs organs of the reticular endothelial system and bone marrow, both absent findings in this case just like the clinical criteria of adrenal insufficiency despite the wide impairment of adrenal tissue. The findings differ from previous studies which had reported a high frequency of non-germinal center B-cell phenotype. This work confirms to use eight immunohistochemical markers for the clinical/therapeutic orientation and the prognosis approaching in the cases of extranodal lymphoma.


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