Lymphomatous Involvement of the Adrenal Glands

Lymphomatous involvement of the adrenal glands occurs in less than 5% of patients with non-Hodgkin lymphoma. 50% of these patients have bilateral involvement. Other types of lymphoma involve the adrenal glands even less frequently. Involvement is most commonly secondary.

Patients may present with adrenal insufficiency.

The most common imaging finding is nonspecific unilateral or bilateral enlargement of the adrenal glands. Adenopathy in the abdomen and elsewhere may suggest the diagnoosis. Early on, the shape of the adrenal gland may be preserved, mimicking adrenal hypertrophy or hyperplasia. Washout characteristics are similar to those of other adrenal malignancies.

FDG avidity of the adrenal glands on PET imaging tends to follow that of other involved areas. FDG upatke, however, may not be a reliable indicator of disease activity in certain types of lymphoma (e.g., marginal zone and peripheral T-cell lymphomas) and may be low in low-grade lymphomas.

On MRI, the lesions are heterogeneously T1-hypointense and T2-hyperintense and demonstrate progressive contrast enhancement.

The images above are from a patient with diffuse large B-cell lymphoma and show multiple adrenal lesions bilaterally. The lesions are FDG avid. Biopsy showed lymphomatous involvement.

References

• Blake MA, Cronin CG, Boland GW. Adrenal imaging. AJR Am J Roentgenol. 2010 Jun;194(6):1450-60.
• Leite NP, Kased N, Hanna RF, Brown MA, Pereira JM, Cunha R, Sirlin CB. Cross-sectional imaging of extranodal involvement in abdominopelvic lymphoproliferative malignancies. Radiographics. 2007 Nov-Dec;27(6):1613-34.