Spontaneously reversible adrenal nodules in primary diffuse large B-cell testicular lymphoma mimicking an extranodal involvement: A case report
In the staging of cancer patients, transient and spontaneously reversible bilateral adrenal hypertrophy may mimic a secondary localization of the disease. We discuss the case of an 82-year-old male patient with suspected testicular neoplasia in which abdominal CT examination reveals the onset of a b...
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doaj-05ca12942a8a40c589f9a2bfe1713ede2021-06-29T04:12:22ZengElsevierRadiology Case Reports1930-04332021-08-0116821682173Spontaneously reversible adrenal nodules in primary diffuse large B-cell testicular lymphoma mimicking an extranodal involvement: A case reportFabio Pellegrino, MD0Francesca Scabbia, MD1Annalisa Merlo, MD2Luca Perrucci, MD3Ludovica Aliberti, MD4Antonio Urso, MD5Maria Rosaria Ambrosio, MD6Antonio Cuneo, MD7Roberto Galeotti, MD8Melchiore Giganti, MD9Radiology Division, S. Bonifacio Hospital, Verona, Italy; Corresponding author.Department of Morphology, Section of Diagnostic Imaging, Surgery and Experimental Medicine, University of Ferrara, ItalyDepartment of Morphology, Section of Diagnostic Imaging, Surgery and Experimental Medicine, University of Ferrara, ItalyFerrara Department of Interventional and Diagnostic Radiology, Ospedale di Lagosanto, Azienda AUSL, Ferrara, ItalyDepartment of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, ItalySection of Hematology, St. Anna University Hospital, Ferrara, ItalyDepartment of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, ItalySection of Hematology, St. Anna University Hospital, Ferrara, ItalyDepartment of Morphology, Section of Diagnostic Imaging, Surgery and Experimental Medicine, University of Ferrara, ItalyDepartment of Morphology, Section of Diagnostic Imaging, Surgery and Experimental Medicine, University of Ferrara, ItalyIn the staging of cancer patients, transient and spontaneously reversible bilateral adrenal hypertrophy may mimic a secondary localization of the disease. We discuss the case of an 82-year-old male patient with suspected testicular neoplasia in which abdominal CT examination reveals the onset of a bilateral macronodular adrenal enlargement, suggesting the diagnostic hypothesis of primary testicular neoplasia with secondary adrenal localization. The subsequent 18FDG-PET/CT study showed hyper-metabolism of the testicular mass, while the adrenal glands, surprisingly, did not show increased uptake of the radiotracer. After right orchifunicolectomy, primary testicular diffuse large B-cell lymphoma was diagnosed. The subsequent staging PET/CT study with iodine contrast medium, three months after the first CT examination, showed spontaneous complete regression of the adrenal hypertrophy without any use of drug therapy. The differential diagnosis of this finding considered the lack of hypermetabolism and the densitometric characteristics of the adrenal glands, the absence of possible pharmacological interactions throughout the time of the diagnostic procedures, and the available clinical-laboratory data. By excluding the main causes of adrenal hypertrophy, the most likely diagnostic hypothesis was transient adrenal hypertrophy due to stress induced by testicular lymphoma, meaning by stress a disturbance not only emotional but also an alteration of organic homeostasis. Our case suggests that the analysis of adrenal lesions appeared in cancer patients should take into account non-metastatic conditions that must be studied with a multimodal approach and with serial investigations.http://www.sciencedirect.com/science/article/pii/S1930043321003290Adrenal hyperplasiaLymphomaIncidentalomaTesticularReversible |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Fabio Pellegrino, MD Francesca Scabbia, MD Annalisa Merlo, MD Luca Perrucci, MD Ludovica Aliberti, MD Antonio Urso, MD Maria Rosaria Ambrosio, MD Antonio Cuneo, MD Roberto Galeotti, MD Melchiore Giganti, MD |
spellingShingle |
Fabio Pellegrino, MD Francesca Scabbia, MD Annalisa Merlo, MD Luca Perrucci, MD Ludovica Aliberti, MD Antonio Urso, MD Maria Rosaria Ambrosio, MD Antonio Cuneo, MD Roberto Galeotti, MD Melchiore Giganti, MD Spontaneously reversible adrenal nodules in primary diffuse large B-cell testicular lymphoma mimicking an extranodal involvement: A case report Radiology Case Reports Adrenal hyperplasia Lymphoma Incidentaloma Testicular Reversible |
author_facet |
Fabio Pellegrino, MD Francesca Scabbia, MD Annalisa Merlo, MD Luca Perrucci, MD Ludovica Aliberti, MD Antonio Urso, MD Maria Rosaria Ambrosio, MD Antonio Cuneo, MD Roberto Galeotti, MD Melchiore Giganti, MD |
author_sort |
Fabio Pellegrino, MD |
title |
Spontaneously reversible adrenal nodules in primary diffuse large B-cell testicular lymphoma mimicking an extranodal involvement: A case report |
title_short |
Spontaneously reversible adrenal nodules in primary diffuse large B-cell testicular lymphoma mimicking an extranodal involvement: A case report |
title_full |
Spontaneously reversible adrenal nodules in primary diffuse large B-cell testicular lymphoma mimicking an extranodal involvement: A case report |
title_fullStr |
Spontaneously reversible adrenal nodules in primary diffuse large B-cell testicular lymphoma mimicking an extranodal involvement: A case report |
title_full_unstemmed |
Spontaneously reversible adrenal nodules in primary diffuse large B-cell testicular lymphoma mimicking an extranodal involvement: A case report |
title_sort |
spontaneously reversible adrenal nodules in primary diffuse large b-cell testicular lymphoma mimicking an extranodal involvement: a case report |
publisher |
Elsevier |
series |
Radiology Case Reports |
issn |
1930-0433 |
publishDate |
2021-08-01 |
description |
In the staging of cancer patients, transient and spontaneously reversible bilateral adrenal hypertrophy may mimic a secondary localization of the disease. We discuss the case of an 82-year-old male patient with suspected testicular neoplasia in which abdominal CT examination reveals the onset of a bilateral macronodular adrenal enlargement, suggesting the diagnostic hypothesis of primary testicular neoplasia with secondary adrenal localization. The subsequent 18FDG-PET/CT study showed hyper-metabolism of the testicular mass, while the adrenal glands, surprisingly, did not show increased uptake of the radiotracer. After right orchifunicolectomy, primary testicular diffuse large B-cell lymphoma was diagnosed. The subsequent staging PET/CT study with iodine contrast medium, three months after the first CT examination, showed spontaneous complete regression of the adrenal hypertrophy without any use of drug therapy. The differential diagnosis of this finding considered the lack of hypermetabolism and the densitometric characteristics of the adrenal glands, the absence of possible pharmacological interactions throughout the time of the diagnostic procedures, and the available clinical-laboratory data. By excluding the main causes of adrenal hypertrophy, the most likely diagnostic hypothesis was transient adrenal hypertrophy due to stress induced by testicular lymphoma, meaning by stress a disturbance not only emotional but also an alteration of organic homeostasis. Our case suggests that the analysis of adrenal lesions appeared in cancer patients should take into account non-metastatic conditions that must be studied with a multimodal approach and with serial investigations. |
topic |
Adrenal hyperplasia Lymphoma Incidentaloma Testicular Reversible |
url |
http://www.sciencedirect.com/science/article/pii/S1930043321003290 |
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