Primary adrenal CD20-negative diffuse large B-cell lymphoma: Diagnostic and therapeutic challenges-A case report

Mohammad Saad Salim Naviwala; Daania Shoaib; Reyan Shaikh; Romana Idress; Muhammad Afzal

doi:10.1016/j.radcr.2025.05.072

Primary adrenal CD20-negative diffuse large B-cell lymphoma: Diagnostic and therapeutic challenges-A case report

Mohammad Saad Salim Naviwala
, Daania Shoaib
, Reyan Shaikh
, Romana Idress
, Muhammad Afzal

Department of Pathology and Laboratory Medicine, Medical College, Pakistan

Research output: Other contribution

Abstract

Primary adrenal lymphoma (PAL) is a rare, aggressive malignancy, often manifesting as bilateral adrenal masses with insufficiency. CD20-negative diffuse large B-cell lymphoma (DLBCL), a rarer variant, exhibits resistance to standard therapies and a poorer prognosis. We report a 60-year-old woman with bilateral adrenal masses diagnosed as CD20-negative unclassifiable DLBCL. Despite an initial response to CHOP chemotherapy, her disease progressed, necessitating salvage therapy with gemcitabine, cisplatin and dexamethasone. This case highlights the diagnostic complexity of CD20-negative DLBCL, particularly when presenting in rare extra-nodal sites such as the adrenal glands. Comprehensive immunohistochemical profiling and multidisciplinary management are crucial for accurate diagnosis and treatment planning. Given the poor prognosis and lack of standardized therapies, further research is needed to refine treatment strategies and improve outcomes for patients with CD20-negative DLBCL.

Original language	Undefined/Unknown
DOIs	https://doi.org/10.1016/j.radcr.2025.05.072
Publication status	Published - 21 Jun 2025

Publication series

Name	Section of Haematology/Oncology

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10.1016/j.radcr.2025.05.072Licence: Unspecified

http://ecommons.aku.edu/pakistan_fhs_mc_med_haematol_oncol/199

Cite this

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title = "Primary adrenal CD20-negative diffuse large B-cell lymphoma: Diagnostic and therapeutic challenges-A case report",

abstract = "Primary adrenal lymphoma (PAL) is a rare, aggressive malignancy, often manifesting as bilateral adrenal masses with insufficiency. CD20-negative diffuse large B-cell lymphoma (DLBCL), a rarer variant, exhibits resistance to standard therapies and a poorer prognosis. We report a 60-year-old woman with bilateral adrenal masses diagnosed as CD20-negative unclassifiable DLBCL. Despite an initial response to CHOP chemotherapy, her disease progressed, necessitating salvage therapy with gemcitabine, cisplatin and dexamethasone. This case highlights the diagnostic complexity of CD20-negative DLBCL, particularly when presenting in rare extra-nodal sites such as the adrenal glands. Comprehensive immunohistochemical profiling and multidisciplinary management are crucial for accurate diagnosis and treatment planning. Given the poor prognosis and lack of standardized therapies, further research is needed to refine treatment strategies and improve outcomes for patients with CD20-negative DLBCL.",

author = "Naviwala, \{Mohammad Saad Salim\} and Daania Shoaib and Reyan Shaikh and Romana Idress and Muhammad Afzal",

year = "2025",

month = jun,

day = "21",

doi = "10.1016/j.radcr.2025.05.072",

language = "Undefined/Unknown",

series = "Section of Haematology/Oncology",

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TY - GEN

T1 - Primary adrenal CD20-negative diffuse large B-cell lymphoma: Diagnostic and therapeutic challenges-A case report

AU - Naviwala, Mohammad Saad Salim

AU - Shoaib, Daania

AU - Shaikh, Reyan

AU - Idress, Romana

AU - Afzal, Muhammad

PY - 2025/6/21

Y1 - 2025/6/21

N2 - Primary adrenal lymphoma (PAL) is a rare, aggressive malignancy, often manifesting as bilateral adrenal masses with insufficiency. CD20-negative diffuse large B-cell lymphoma (DLBCL), a rarer variant, exhibits resistance to standard therapies and a poorer prognosis. We report a 60-year-old woman with bilateral adrenal masses diagnosed as CD20-negative unclassifiable DLBCL. Despite an initial response to CHOP chemotherapy, her disease progressed, necessitating salvage therapy with gemcitabine, cisplatin and dexamethasone. This case highlights the diagnostic complexity of CD20-negative DLBCL, particularly when presenting in rare extra-nodal sites such as the adrenal glands. Comprehensive immunohistochemical profiling and multidisciplinary management are crucial for accurate diagnosis and treatment planning. Given the poor prognosis and lack of standardized therapies, further research is needed to refine treatment strategies and improve outcomes for patients with CD20-negative DLBCL.

AB - Primary adrenal lymphoma (PAL) is a rare, aggressive malignancy, often manifesting as bilateral adrenal masses with insufficiency. CD20-negative diffuse large B-cell lymphoma (DLBCL), a rarer variant, exhibits resistance to standard therapies and a poorer prognosis. We report a 60-year-old woman with bilateral adrenal masses diagnosed as CD20-negative unclassifiable DLBCL. Despite an initial response to CHOP chemotherapy, her disease progressed, necessitating salvage therapy with gemcitabine, cisplatin and dexamethasone. This case highlights the diagnostic complexity of CD20-negative DLBCL, particularly when presenting in rare extra-nodal sites such as the adrenal glands. Comprehensive immunohistochemical profiling and multidisciplinary management are crucial for accurate diagnosis and treatment planning. Given the poor prognosis and lack of standardized therapies, further research is needed to refine treatment strategies and improve outcomes for patients with CD20-negative DLBCL.

U2 - 10.1016/j.radcr.2025.05.072

DO - 10.1016/j.radcr.2025.05.072

M3 - Other contribution

T3 - Section of Haematology/Oncology

ER -