P-13 EXTRANODAL LYMPHOMA WITH ENDOCRINE ORGAN INVOLVEMENT: CASE REPORTS
Authors: Demirtaş Ezgi , Nur Kebapçı Medine , Akalın Aysen , Kalkan Ahmet Toygar 
Published: January 2025

Abstract

Introduction
The incidence of extranodal lymphomas has increased in the last decade, most commonly occurring in the gastrointestinal tract, head and neck, skin/soft tissue and central nervous system. We report two cases of extranodal lymphoma in the thyroid and adrenal gland.

Clinical Cases
A 61-year-old male patient diagnosed with Small Lymphocytic Lymphoma (CLL) was referred to us after his follow-up at the Hematology Clinic. Thyroid ultrasonography (USG) revealed a nodular ovoid lesion, that has a semisolid structure of 36x12 mm in size, with a cystic component in the center, located at the right lobe - isthmus junction, and with increased vascularity. Laboratory tests were as in Table 1. It was learned that the patient had received chemotherapy for CLL in 2009 and was in remission, and there was no family history of thyroid cancer. Since the fine needle aspiration biopsy (FNAB) was suspicious for lymphoid neoplasia, a tru-cut biopsy was performed. The flow cytometry result was found to be compatible with B-cell clonality, and the pathology result revealed mature B-cell neoplasia infiltration. Immunohistochemically, dense plasma cells were observed with CD138. Thyroidectomy was recommended to the patient, but he refused and was followed up.
A 73-year-old female patient was referred to our clinic with the suspicion of adrenal insufficiency due to ongoing nausea, vomiting, and hypotension symptoms. Laboratory tests at presentation were as shown in Table 2. The patient was started on 80 mg/day methylprednisolone, which was thought to be acute adrenal insufficiency biochemically and clinically, and since hyperkalemia persisted, 0.05 mg/day fludrocortisone was added to the treatment. It was learned that the patient had been examined for abdominal pain for 6 months, and 15 mm nodular lesions were observed in both adrenal glands in the abdominal CT, but no further examination was performed. In adrenal CT, lesions measuring 41x30 mm on the right and 30x22 mm on the left at the body-medial crus level were observed in both adrenal glands, with a density higher than expected for adenoma (Figure 1). The findings were evaluated as significant in favor of nonadenomatous lesions, and due to progression in lesion sizes and high suspicion of malignancy, pheochromocytoma was excluded by checking urine catecholamines from the lesion in the right adrenal gland, and a tru-cut biopsy was performed. As a result of the pathology, the patient was diagnosed with high-grade B-cell neoplasia and hematological treatment was started.

Conclusion
Extranodal lymphoma involvement has been described with multiple different presentations in every tissue of the body, even within an organ system. Therefore, it should be included in the differential diagnosis of mass lesions. Tissue biopsy and immunohistochemistry are the most important methods for determining the specific subtype and cell origin.Figure 1:CT images of patientLesions in bilateral adrenal glands Table 1:Laboratory workup*Thyroid Stimulating Hormone. Table 2:Laboratory workup*Blood Urea Nitrogen,C-reactive Protein, Adrenocorticotropic hormone, Thyroid Stimulating Hormone