Fig. 1(a) re-contrast APCT scan shows large, homogeneous soft tissue masses in bilateral adrenal glands (asterisks)(b,c,d) ontrast-enhanced APCT scan shows adjacent lymph node enlargement (straight arrow), retroperitoneal enlarged lymph nodes involving internal necrosis (dotted arrow), adjacent liver (double-lined arrow) and crural invasion (curved arrow).
Fig. 2(a) Baseline F-18 FDG PET/CT (maximal intensity projection (MIP), axial images) and post-contrast APCT scanshow intense FDG accumulation in bilateral adrenal glands, right hepatic invasionand adjacent left gastric lymph node involvement. (b) After cycles of R-CHOP, no definite residual hypermetabolism is noted on F-18 FDG PET/CTand marked decreasesize of both adrenal glands is demonstrated on post-contrast APCT. (c) After cycles of R-CHOP, F-18 FDG PET/CT shows metabolically complete remission, and post-contrast APCT showsize of both adrenal glands compared with interim post-contrast APCT.
Fig. 3(a) The biopsy specimen of adrenal mass shows diffuse atypical lymphoid cellinfiltration replacing normal adrenal gland. The tumor consists of medium-to-large polymorphic cells (H&E Original magnifications, ×400)(b, c) he atypical cells are positive for CD20 immunohistochemical staining and the Ki-67 labeling index is about 90% (×200).