Presentation
Complaints of cough with expectoration, generalized weakness and low grade intermittent fever since 1 month. CRP is positive and ultrasound abdomen and pelvis revealed hypoechoic lesions in bilateral suprarenal regions.
Patient Data
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Large lobulated hypodense lesions noted in bilateral suprarenal regions, showing no significant contrast enhancement. No calcifications or necrosis noted. This is seen indenting on superior poles of bilateral kidneys. Hepatosplenomegaly noted.
Patient also complained of difficulty in walking and right sided weakness since 1 week, for which MRI brain with contrast was performed.
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Well defined intensely enhancing lesion in left frontal lobe with gross perilesional edema, causing mass effect and midline shift.
Case Discussion
Patient underwent ultrasound-guided biopsy of the left suprarenal lesion.
Microscopic sections showed linear cores of tumor tissue composed of loose sheets of monomorphous population of atypical lymphoid cells. The cells exhibit high N:C ratio. The nuclei are large and show irregular nuclear membrane, distinct nucleoli and coarse chromatin. The tumor tissue is intersected by bands of sclerosis.
Features suggestive of Non Hodgkin's lymphoma (DLBCL).
Patient underwent 8 cycles of chemotherapy.
Followup CECT abdomen and pelvis and MRI brain showed significant reduction in size of bilateral adrenal lesions and brain lesion respectively.
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