case_images: PMC5516737_01
case_images: At the time of diagnosis. Imaging studies of patient, CT thorax, and abdomen, and pelvis show bilateral adrenal masses which are homogenous measuring 3.7 x 5.4 x 6.3 cm on the left (78.3 average HU), while the right adrenal gland measures 5.5 x 2.7 x 5.9 cm (72.7 average HU).
case_images: CRIM2017-1251950.001.jpg
case_images: PMC5516737_01_CRIM2017-1251950.001.jpg
case_images: fig1
case_images: A computed tomography scan of the thorax abdomen and pelvis was performed, and it showed bilateral homogenous adrenal masses measuring 3.7 x 5.4 x 6.4 cm on the left and 5.5 x 2.7 x 5.9 cm on the right (Figures 1 and 2).
case_images: At the time of diagnosis. Imaging studies of patient, CT thorax, and abdomen and pelvis show bilateral adrenal masses which are homogenous measuring 3.7 x 5.4 x 6.3 cm on the left (78.3 average HU), while the right adrenal gland measures 5.5 x 2.7 x 5.9 cm (72.7 average HU).
case_images: CRIM2017-1251950.002.jpg
case_images: PMC5516737_01_CRIM2017-1251950.002.jpg
case_images: fig2
case_images: A computed tomography scan of the thorax abdomen and pelvis was performed, and it showed bilateral homogenous adrenal masses measuring 3.7 x 5.4 x 6.4 cm on the left and 5.5 x 2.7 x 5.9 cm on the right (Figures 1 and 2).
case_images: At the end of treatment. Imaging studies of the patient after having chemotherapy show interval regression of bilateral adrenal glands with both adrenal glands returning to normal size.
case_images: CRIM2017-1251950.003.jpg
case_images: PMC5516737_01_CRIM2017-1251950.003.jpg
case_images: fig3
case_images: Remarkably, repeat computer tomography scan after four cycles of R-CHOP chemotherapy showed interval regression of bilateral adrenal masses with nearly normal adrenal glands (Figure 3).
case_images: At the end of treatment. Posttreatment PET-CT scan showing normal sized adrenal glands (white arrows) with no significant FDG activity.
case_images: CRIM2017-1251950.004.jpg
case_images: PMC5516737_01_CRIM2017-1251950.004.jpg
case_images: fig4
case_images: Tomography (PET) scan six weeks after completion of both R-CHOP and intrathecal methotrexate revealed no fluorodeoxyglucose (FDG) update in the chest, abdomen, or pelvis and the enlarged left supraclavicular lymph node showed mild-FDG avidity that was smaller in size compared to previous computed tomography scans. This was discussed in a multidisciplinary tumour board, and it was decided to consider this as a reactive lymph node (please see Figures 4 and 5).
case_images: At the end of treatment. Posttreatment PET-CT scan showing a borderline enlarged left supraclavicular lymph node (white arrow) with moderate to intense FDG activity (SUVmax 8.4). In the absence of any significant adenopathy elsewhere in the body, this was deemed to be of reactive nature.
case_images: CRIM2017-1251950.005.jpg
case_images: PMC5516737_01_CRIM2017-1251950.005.jpg
case_images: fig5
case_images: Tomography (PET) scan six weeks after completion of both R-CHOP and intrathecal methotrexate revealed no fluorodeoxyglucose (FDG) update in the chest, abdomen, or pelvis and the enlarged left supraclavicular lymph node showed mild-FDG avidity that was smaller in size compared to previous computed tomography scans. This was discussed in a multidisciplinary tumour board, and it was decided to consider this as a reactive lymph node (please see Figures 4 and 5).
case_images: Histology images. The neoplastic lymphoid cells showed large vesicular nuclei ((a) H&E, original magnification x600) and prominent intravascular growth pattern ((b) original magnification x400). They were positive for CD20 ((c) original magnification x600). CD34 stain ((d) original magnification x400) highlighted vascular channels containing neoplastic lymphoid cells, confirming the intravascular growth pattern.
case_images: CRIM2017-1251950.006.jpg
case_images: PMC5516737_01_CRIM2017-1251950.006.jpg
case_images: fig6
case_images: Bone marrow biopsy did not show any marrow involvement (Figure 6).