Key result
GLIDE chemotherapy and stem cell transplant achieve complete 1-year PET/CT resolution in an adrenal lymphoma case.
Why the study?
Primary adrenal nasal type extranodal NK/T cell lymphoma is rare and its imaging features and clinical course are not well characterized.
Case Report (n=1)
FDG PET/CT is useful for staging and treatment follow-up of primary adrenal extranasal NK/T cell lymphoma, a rare entity that can present with huge bilateral adrenal masses and subcutaneous involvement.
May support FDG PET/CT for response monitoring in rare adrenal NK/T-cell lymphoma; leaves open prospective validation.
RATIONALE: Primary adrenal non-Hodgkin lymphomas are predominant diffuse large B cell lymphoma with frequently bilateral adrenal involvement, but the occurrence of nasal type extranodal NK/T cell lymphoma is relatively rare. PATIENT CONCERNS: A 40-year-old woman complaining of left back pain for 2-month was admitted to our department. DIAGNOSIS: Based on the feature of enhanced computed tomography (CT) images which showed huge bilateral well-defined adrenal masses with heterogeneous enhancement, she was tentatively diagnosed as having primary adrenal malignancy. Postoperative pathology revealed the diagnosis of primary adrenal Epstein-Barr virus-associated nasal type extranodal NK/T-cell lymphoma. INTERVENTIONS: Then, she underwent F-fluoro-2-deoxy-D-glucose (F-FDG) positron emission tomography (PET)/CT examination for staging, which showed homogeneously increased FDG uptake in the right adrenal gland and left thigh subcutaneous lesion, as well as heterogeneous increased FDG uptake in the left adrenal gland region with no abnormal uptake in the nasal cavity. Subsequently, the patient has performed 7 cycles of gemcitabine, L-asparaginase, ifosfamide, dexamethasone, etoposide (GLIDE) regimen and autologous stem cell transplantation. OUTCOMES: Fortunately, the subsequent 2 follow-up FDG PET/CT scans within 1 year revealed complete resolution with no abnormal FDG uptake in the initially involved sites after 7 cycles of GLIDE chemotherapy and autologous stem cell transplantation. LESSONS: The enhanced CT and FDG PET/CT features of primary adrenal extranasal NK/T cell lymphoma are huge bilateral well-defined adrenal masses with heterogeneous enhancement, high FDG uptake, especially with subcutaneous involvement. And the awareness of this entity may help clinicians to differentiate it from other primary adrenal tumors and make reasonable therapeutic strategies. Besides, FDG PET/CT scan is very useful for the treatment follow-up of the primary adrenal extranasal NK/T cell lymphoma.
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Dong et al. (2019) conducted a case report in Primary adrenal extranasal NK/T cell lymphoma (n=1). GLIDE regimen and autologous stem cell transplantation was evaluated on Complete resolution on FDG PET/CT. In a 40-year-old woman with primary adrenal extranasal NK/T cell lymphoma, 7 cycles of GLIDE chemotherapy and autologous stem cell transplantation led to complete resolution on FDG PET/CT at 1 year.
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