内容紹介
Combined Modality Therapy for a Patient with Primary Adrenal Lymphoma
Summary
A 71-year-old man with malaise, anorexia, and weight loss was referred to our hospital from a clinic. Abdominal computed tomography(CT)revealed bilateral adrenal masses. An ultrasound-guided percutaneous needle biopsy of the adrenal grand indicated diffuse large B-cell lymphoma. A rapid adrenocorticotropic hormone(ACTH)test revealed primary adrenal failure. Rituximab-cyclophosphamide/doxorubicin/vincristine/prednisolone(common name, R-CHOP)therapy accompanied by intrathecal treatment was initiated along with steroid replacement therapy. After the fourth courses, a CT scan showed a reduction of the adrenal masses, and there was no[18F]-fluorodeoxyglucose(FDG)uptake in the adrenal masses. The patient has remained in metabolic complete remission. Subsequently, both adrenal lymphomas were irradiated. The patient has been disease-free for 6 months after the diagnosis of primary adrenal lymphoma. The combined modality of chemoradiation therapy plus intrathecal treatment could be effective for primary adrenal lymphoma with a poor prognosis.
要旨
症例は71歳,男性。全身倦怠感,食欲不振,体重減少のため前医より当院に紹介入院となった。CT検査で両側副腎腫脹を認め,超音波ガイド下副腎腫瘍生検を施行し,びまん性大細胞型B細胞リンパ腫と診断した。迅速ACTH負荷試験で副腎機能不全を認めたため,副腎皮質ステロイドを補充して抗癌剤髄注併用rituximab-cyclophosphamide/doxorubicin/vincristine/prednisolone(R-CHOP)療法を開始した。4コース終了後にはCTで副腎病変は縮小し,FDG-PETでは異常集積を認めずmetabolic CRが得られた。その後,両側副腎に対して放射線照射を施行し,診断後6か月経過した現在も再発を認めていない。予後不良な副腎原発悪性リンパ腫において,予防的髄注を併用した化学放射線療法の有効性が示唆された。
目次
Summary
A 71-year-old man with malaise, anorexia, and weight loss was referred to our hospital from a clinic. Abdominal computed tomography(CT)revealed bilateral adrenal masses. An ultrasound-guided percutaneous needle biopsy of the adrenal grand indicated diffuse large B-cell lymphoma. A rapid adrenocorticotropic hormone(ACTH)test revealed primary adrenal failure. Rituximab-cyclophosphamide/doxorubicin/vincristine/prednisolone(common name, R-CHOP)therapy accompanied by intrathecal treatment was initiated along with steroid replacement therapy. After the fourth courses, a CT scan showed a reduction of the adrenal masses, and there was no[18F]-fluorodeoxyglucose(FDG)uptake in the adrenal masses. The patient has remained in metabolic complete remission. Subsequently, both adrenal lymphomas were irradiated. The patient has been disease-free for 6 months after the diagnosis of primary adrenal lymphoma. The combined modality of chemoradiation therapy plus intrathecal treatment could be effective for primary adrenal lymphoma with a poor prognosis.
要旨
症例は71歳,男性。全身倦怠感,食欲不振,体重減少のため前医より当院に紹介入院となった。CT検査で両側副腎腫脹を認め,超音波ガイド下副腎腫瘍生検を施行し,びまん性大細胞型B細胞リンパ腫と診断した。迅速ACTH負荷試験で副腎機能不全を認めたため,副腎皮質ステロイドを補充して抗癌剤髄注併用rituximab-cyclophosphamide/doxorubicin/vincristine/prednisolone(R-CHOP)療法を開始した。4コース終了後にはCTで副腎病変は縮小し,FDG-PETでは異常集積を認めずmetabolic CRが得られた。その後,両側副腎に対して放射線照射を施行し,診断後6か月経過した現在も再発を認めていない。予後不良な副腎原発悪性リンパ腫において,予防的髄注を併用した化学放射線療法の有効性が示唆された。