Aggressive B-cell lymphoma with bilateral adrenal involvement and overlapping features of DLBCL and pleomorphic MCL

We report a rare case of extranodal NHL presenting with bilateral adrenal involvement and multiple additional sites of disease. A 71-year-old female, presenting with weakness and unexplained weight loss, was found to have large nodular masses in both adrenal glands. During the subsequent diagnostic workup, the patient’s condition rapidly deteriorated. [¹⁸F]FDG PET/CT confirmed a generalized neoplastic process of unknown primary origin. Biopsy revealed an aggressive B-cell lymphoma with an aberrant immunophenotype, combining features characteristic of both DLBCL, NOS, ABC-type and the pleomorphic variant of MCL. Unfortunately, the patient succumbed to the disease just a few days after the initial diagnosis was established. This case highlights the potential for aggressive lymphomas to present with non-specific, oligosymptomatic initial features and presents how rapidly clinical deterioration can occur.