18F-FDG PET/CT images in primary adrenal lymphoma

Primary adrenal lymphoma (PAL) is an extremely rare entity and primary adrenal insufficiency (PAI) is a common complication. The majority of cases reported previously were of B-cell origin. Here, we describe an additional PAL of B-cell origin with 18F-FDG PET/CT images. The patient was a 74-year-old man who presented with clinical and laboratory features of PAI. Abdominal ultrasonography (US) showed bilateral adrenal masses. Whole-body 18F-FDG PET/CT showed intensely increased glucose metabolism in bilateral bulky adrenal masses. Pathological diagnosis was non-Hodgkin lymphoma of B-cell origin. Combination chemotherapy was unsuccessful and our patient died of CNS involvement 6 months later. The present case indicated that PAL should be included in the differential diagnosis of bilateral adrenal masses, especially in patients with PAI. We report the case and review the literature for this disease in detail.