Uncovering Primary Extranodal Diffuse Large B Cell Lymphoma in the Adrenal and Thyroid Glands

30 January 2024: Articles

Unusual clinical course, Challenging differential diagnosis, Rare disease

Judy Li ^A* , Raisa Balbuena-Merle ^B , Morgan Hrones ^B , Courtney Elizabeth Gibson ^A

DOI: 10.12659/AJCR.942659

Am J Case Rep 2024; 25:e942659

Table 1. Case 1 laboratory findings upon presentation (initial workup).

	Value (reference range)

White blood cell count	5.4 (4.0–11.0×1000/µL)
Red blood cell count	4.55 (4–6 M/µL)
Hemoglobin	14.1 (11.7–15.5 g/dL)
Hematocrit	42.60 (35.00–45.00%)
Mean corpuscular volume	93.6 (80.0–100.0 fL)
Mean corpuscular hemoglobin	31.0 (27.0–33.0 pg)
Mean corpuscular hemoglobin concentration	33.1 (31.0–36.0 g/dL)
Red cell distribution width	13.2 (11.0–15.0%)
Platelets	267 (150–420×1000/µL)
Mean platelet volume	11.4 (8.0–12.0 fL)
Neutrophils	40.5 (39.0–71.0%)
Lymphocytes	41.4 (17.0–50.0%)
Monocytes	11.6 (4.0–12.0%)
Eosinophils	5.8 (0.0–5.0%)
Basophils	0.7 (0.0–1.4%)
Immature granulocytes	0.0 (0.0–1.0%)
Nucleated red blood cells	0.0 (0.0–1.0%)

Sodium	140 (136–144 mmol/L)
Potassium	4.2 (3.3–5.3 mmol/L)
Chloride	102 (98–107 mmol/L)
Blood urea nitrogen	12 (8–23 mg/dL)
Creatinine	0.57 (0.40–1.30 mg/dL)
Alanine aminotransferase	107 (10–35 U/L)
Alanine aminotransferase	91 (10–35 U/L)
Alkaline phosphatase	77 (9–122 U/L)
Total bilirubin	0.4 (≤1.2 mg/dL)

Thyroid stimulating hormone	3.7 (0.27–4.20 µIU/mL)
Free cortisol, overnight dexamethasone suppression test	1.4 (6.0–18.4 µg/dL)
Adrenocorticotropic hormone	6.2 (7.2–63.3 pg/mL)
Norepinephrine
Plasma	459 (80–520 pg/mL)
24-hour urine	75 (15–100 mcg/24 h)
Metanephrines
Plasma, free
24-hour urine	97 (21–153 mcg/g cr)
Dehydroepiandrosterone sulfate	29.0 (35.0–430.0 µg/dL)
Plasma renin activity	0.65 (0.25–5.82 ng/mL/h)
Aldosterone, morning

Lipase	25 (11–55 U/L)
Troponin, high sensitivity	Negative