Adrenal venography.
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A 20-year-old man was admitted to Kyushu University Hospital with complaints of severe headache and episodic hypertension (200/100 mmHg). Ultrasonograms and computed tomographs revealed tumors in the left adrenal region and in the right lower lobe of the thyroid gland. Total thyroidectomy and left adrenalectomy were performed. The excised thyroid tumor and adrenal tumor were pathologically diagnosed as papillary adenocarcinoma and pheochromocytoma, respectively. A chromosome analysis revealed no karyotypic abnormality. Whereas the world literature records such occurrences in women, this is the first report of a simultaneous occurrence of pheochromocytoma and papillary adenocarcinoma of the thyroid in a young man.
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A 18 years old female patient was admitted to our clinic with a diagnosis of non-Hodgkin malignant lymphoma originating from the subcutaneous tissue of the left paravertebral region. Notwithstanding cycles of polychemotherapy and radiotherapy, clinical conditions rapidly worsened with rapid appearance of an increasing number of cutaneous neoplastic infiltrations. Due to the rapid spread of the malignancy -- as shown by lung X-rays and bone marrow biopsy -- the patient died 8 months after the onset of the disease (2 months after admittance). At autopsy, tumor cell infiltrates were found not only in the bone marrow and lung but also in the liver, adrenals, gonads and spinal cord. Histological and cytochemical features -- both in bioptic and autopic tissue specimens -- were quite similar to those of Ewing's sarcoma of bone. On the whole, of these clinical and histopathological features, this can be considered a case of "extraskeletal Ewing's sarcoma" as described by Angervall and Enzinger and recently by E. H. Soule et Al.
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We report a rare case of bilateral primary adrenal non-Hodgkin's lymphoma with adrenal failure. A 66-year-old woman developed symptoms of adrenal failure. The cause of adrenal failure was suspected to be malignant lymphoma based on the high levels of serum soluble interleukin-2 receptor and LDH. Bilateral adrenalectomy was performed and pathological examination showed intravascular large B-cell lymphoma (IVL). Although complete remission was achieved, recurrence occurred three months later with brain metastases. IVL should be suspected in patients with bilateral adrenal tumors who present with rapidly progressive adrenal failure.
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