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

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.