Mainly Adrenal Gland Involving NK/T-Cell Nasal Type Lymphoma Diagnosed with Delay due to Mimicking Adrenal Hemorrhage

다국어 초록 (Multilingual Abstract)

A 29-yr-old man, presented with abdominal pain and fever, had an initial computed tomography (CT) scan revealing low attenuation of both adrenal glands. The initial concern was for tuberculous adrenalitis or autoimmune adrenalitis combined with adrenal hemorrhage. The patient started empirical anti-tuberculous medication, but there was no improvement. Enlargement of cervical lymph nodes were developed after that and excisional biopsy of cervical lymph nodes was performed. Pathological finding of excised lymph nodes was compatible to NK/T-cell lymphoma. The patient died due to the progression of the disease even after undergoing therapeutic trials including chemotherapy. Lymphoma mainly involving adrenal gland in the early stage of the disease is rare and the vast majority of cases that have been reported were of B-cell origin. From this case it is suggested that extra-nodal NK/T-cell lymphoma should be considered as a cause of bilateral adrenal masses although it is rare.

참고문헌 (Reference)

1 Porcel JM, "Tuberculous pleural effusion" 187 : 263-270, 2009

2 Thompson MA, "Primary adrenal natural killer/T-cell nasal type lymphoma: first case report in adults" 82 : 299-303, 2007

3 Mantzios G, "Primary adrenal lymphoma presenting as Addison’s disease: case report and review of the literature" 83 : 460-463, 2004

4 Wang FF, "Primary adrenal lymphoma manifestating as adrenal incidentaloma" 66 : 67-71, 2003

5 Grigg AP, "Primary adrenal lymphoma" 4 : 154-160, 2003

6 Tomoyose T, "Primary adrenal adult T-cell leukemia/lymphoma: a case report and review of the literature" 82 : 748-752, 2007

7 Kwong YL, "Natural killer-cell malignancies: diagnosis and treatment" 19 : 2186-2194, 2005

8 Lee J, "Nasal-type NK/T cell lymphoma: clinical features and treatment outcome" 92 : 1226-1230, 2005

9 Rosenberg SA, "Lymphosarcoma: a review of 1269 cases" 40 : 31-84, 1961

10 Kohrt H, "Extranodal natural killer/T-cell lymphoma: current concepts in biology and treatment" 50 : 1773-1784, 2009

11 AlShemmari SH, "Extranodal lymphoma: a comparative study" 13 : 163-169, 2008

12 Gopi A, "Diagnosis and treatment of tuberculous pleural effusion in 2006" 131 : 880-889, 2007

13 Arora S, "Computed tomography appearance of spontaneous adrenal hemorrhage in a pheochromocytoma" 33 : 314-317, 2009

14 Ko YH, "Clinicopathologic and genotypic study of extranodal nasal-type natural killer/T-cell lymphoma and natural killer precursor lymphoma among Koreans" 89 : 2106-2116, 2000

15 Wang J, "Clinically silent primary adrenal lymphoma: a case report and review of the literature" 58 : 130-136, 1998

16 van den Heiligenberg SM, "Bilateral adrenal enlargement with an unexpected diagnosis" 18 : 249-250, 2007

17 Levy NT, "Adrenal insufficiency as a manifestation of disseminated non-Hodgkin’s lymphoma" 72 : 818-822, 1997

18 Nawar R, "Adrenal incidentalomas: a continuing management dilemma" 12 : 585-598, 2005

19 Dunning KK, "Adrenal extranodal NK/T-cell lymphoma diagnosed by fineneedle aspiration and cerebrospinal fluid cytology and immunophenotyping: a case report" 37 : 686-695, 2009

20 Mizoguchi Y, "A case of adolescent primary adrenal natural killer cell lymphoma" 81 : 330-334, 2005