Involvement of one adrenal gland by lymphoma as the sole manifestation of lymphoma is very rare, with only three cases reported in the literat~re.'-~ Adrenal glands are involved in diffuse, non-Hodgkin's lymphoma approximately 4% of the time ra-di~graphically,~ although involvement at autopsy occurs 24% of the time.5 Usually, adrenal involvement at the time of presentation occurs with evidence of disease elsewhere (especially with evidence of retroperitoneal adenopathy or ipsilateral renal involvement)6 or as a site of tumor recurrence following therapy. Often adrenal involvement is bilateral.7
We present an interesting case in which a large adrenal mass found incidentally was the only focus of diffuse histiocytic lymphoma (B-immunoblastic lymphoma) on initial presentation. The CT and ultrasonic appearances are discussed.
CASE REPORT
H.F. is a 68-year-old white male admitted to another hospital for rehabilitation. He was noticed to be jaundiced on admission (BR = 2.3; SGOT = 75; alk. phos. = 848). Evaluation of the jaundice included a livedspleen scan showing diffuse parenchymal disease. An abdominal ultrasound showed no evidence of biliary dilatation, but a large 8 cm x 10 cm complex mass with solid and cystic components was seen in the region of the right adrenal gland. This was separate from the liver and right kidney. Abdominal CT showed a complex mass with a solid component and a large high-density component superior to the right kidney. The high-density component was felt to represent possible hemorrhage. No adrenal gland was From the Departments of *Radiology, tSurgery, and SPathology, The