Adrenal Lymphoma Presenting with the CT Angiogram Sign.

The patient was a 65-year-old man who presented disturbed consciousness and hyponatremia. After salt (25 g per day) supplementation, his serum sodium level was 125 mEq/L. A laboratory analysis revealed the following findings: white blood cell count, 7,500 /μL with 5.2% eosinophils; plasma adrenocorticotropin (ACTH), 395 pg/mL; and serum cortisol, 4.3 μg/dL. An ACTH stimulation test confirmed adrenocortical insufficiency.

Contrast enhanced computed tomography (CT) revealed bilateral adrenal mass. The renal artery penetrated a left adrenal tumor without encasement (Picture 1, middle). Primary adrenal lymphoma was suspected and diffuse B cell lymphoma was confirmed by biopsy. The patient achieved complete remission after chemotherapy with rituximab (Picture 2).

Picture 1.

Picture 2.

The CT angiogram sign, vessels penetrating the tumor without encasement, can be observed in tumors such as lymphoma, which grow to surround adjacent vessels and spread without destroying the circumferential structure (1). Although adrenal lymphoma is typically revealed as a low density homogeneous mass with mild enhancement on contrast-enhanced CT (2), recognition of the CT angiogram sign could be another clue to differentiate adrenal lymphoma from other adrenal tumors.

The authors state that they have no Conflict of Interest (COI).