Adrenal Lymphoma: Early Signs, Diagnosis, and Modern Treatment Approaches

Adrenal lymphoma is a rare and often overlooked form of non-Hodgkin lymphoma that originates in the adrenal glands. In its early stages, this condition typically presents with subtle or nonspecific symptoms, making it difficult to detect without thorough medical evaluation. Because lymphoma is fundamentally a systemic disease affecting the body's lymphatic and hematopoietic systems, primary adrenal involvement may initially go unnoticed.

Common Early Symptoms of Adrenal Lymphoma

During the initial phase, many patients experience no clear signs. However, when symptoms do appear, they are often mild and easily mistaken for other conditions. One of the more frequent complaints is dull or persistent pain in the flank area—the region just above the hips where the adrenal glands are located. This discomfort may be intermittent and is sometimes dismissed as muscle strain or back pain.

In addition to localized pain, some individuals develop systemic symptoms such as unexplained fever, night sweats, and unintentional weight loss—commonly referred to as "B symptoms" in oncology. Fatigue and a general sense of malaise may also accompany these signs, further indicating an underlying immune or hematologic disorder.

Diagnosing Adrenal Lymphoma: Challenges and Methods

Because adrenal lymphoma lacks distinctive early indicators, diagnosis usually occurs incidentally during imaging tests performed for unrelated reasons. Routine physical exams or abdominal CT scans might reveal a mass or space-occupying lesion in the adrenal region. These findings prompt further investigation, including MRI or PET-CT scans to assess metabolic activity and rule out metastasis from other cancers.

Definitive diagnosis generally requires histopathological confirmation. Due to the deep anatomical location and proximity to vital blood vessels, performing a biopsy on the adrenal gland can be technically challenging and risky. As a result, many cases are confirmed post-surgically after the tumor has been removed. Pathologists then examine the tissue under a microscope to identify malignant lymphoid cells characteristic of lymphoma.

Treatment Strategies and Prognosis

Once diagnosed, adrenal lymphoma is typically managed using a multimodal approach. Surgical resection may be performed if the tumor is localized and accessible, often combined with regional lymph node dissection to prevent local spread. However, because lymphoma is inherently a systemic condition, surgery alone is rarely sufficient.

Postoperative chemotherapy is a cornerstone of treatment, commonly involving regimens like R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) for B-cell lymphomas. In recent years, targeted therapies—including monoclonal antibodies and kinase inhibitors—have significantly improved outcomes by attacking cancer cells with greater precision while sparing healthy tissue.

For advanced or relapsed cases, additional options such as immunotherapy, stem cell transplantation, or clinical trial-based treatments may be considered. Long-term follow-up with regular imaging and blood work is essential to monitor remission and detect any recurrence early.

While adrenal lymphoma remains a rare and complex diagnosis, increased awareness among clinicians and advances in imaging and molecular medicine are improving early detection rates and patient survival. Recognizing subtle symptoms and pursuing timely diagnostic evaluation can make a critical difference in prognosis.