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LETTERS TO EDITOR |
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| Year : 2019 | Volume
: 35
| Issue : 2 | Page : 173-174 |
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Primary bilateral non-Hodgkin's lymphoma of the adrenal gland
Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
| Date of Submission | 03-Dec-2018 |
| Date of Acceptance | 15-Jan-2019 |
| Date of Web Publication | 1-Apr-2019 |
Correspondence Address:
Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad
Iraq
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/iju.IJU_359_18
How to cite this article:
Al-Mendalawi MD. Primary bilateral non-Hodgkin's lymphoma of the adrenal gland. Indian J Urol 2019;35:173-4 |
Sir,
I have two comments on the interesting case report by Raoofziaee et al.[1] published in the October–December 2018 issue of the Indian Journal of Urology.
First, the authors described the clinical presentation, imaging findings, and histopathologic and immunohistochemical results as well as the chemotherapy plan of the primary bilateral non-Hodgkin's lymphoma (NHL) of the adrenal gland in a 38-year-old Iranian patient.[1] I assume that the rarity of this aggressive tumor occurring at an unusual site would have alerted the authors to take into consideration the possibility of impaired immune status in the studied patient. Among the conditions associated with defective immunity, human immunodeficiency virus (HIV) infection is paramount. My assumption is based on the following point. It is known that due to impaired immunity, co-infection with oncogenic viruses increases, and with increased life expectancy secondary to the use of antiretroviral therapy, patients with HIV infection are at greater risk to various kinds of tumors compared to immunocompetent individuals.[2] Among these tumors, NHL has been reported in patients infected with HIV.[3] In Iran, HIV infection is an evolving health hazard. Although no data are present on the current HIV seroprevalence in Iran, the available data suggest that the overall HIV rates have alarmingly increased by 80% per year for the past decade.[4] I assume that the authors did not consider the underlying HIV infection in the studied patient as the contemplated laboratory tests did not include HIV testing. I also assume that the contemplation of the diagnostic panel of blood CD4 lymphocyte count and viral overload measurements was envisaged in the studied patient. If that panel was done and it revealed HIV positivity, the case in question could be truly regarded a novel case report. This is because HIV-associated primary bilateral adrenal NHL has never been reported in the published literature to date.
Second, the pathogenesis of primary lymphoma of the adrenal gland is still a matter of research. The detection of the presence of both Epstein–Barr virus (EBV) and JC polyomavirus (JCV) genome sequences in biopsy specimens suggests the relevance of EBV and JCV co-infection in the pathogenesis of this rare type of tumors.[5] I assume that an attempt to detect EBV and JCV DNA sequences in the studied patient was also solicited.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Raoofziaee M, Yarmohamadi A, Ahmadnia H. Primary bilateral non-Hodgkin's lymphoma of the adrenal gland. Indian J Urol 2018;34:300-2.  [ PUBMED] [Full text] |
| 2. | Valencia Ortega ME. Malignancies and infection due to the human immunodeficiency virus. Are these emerging diseases? Rev Clin Esp 2018;218:149-55. |
| 3. | Busi Rizzi E, Schininà V, Cristofaro M, Bellussi A, Alba L, Bibbolino C, et al. Primary renal non-Hodgkin's lymphoma with inferior vena cava involvement: Report of one case in HIV-infected patient. Radiol Med 2002;103:279-82. |
| 4. | Heidary M, Nasiri MJ. Why has HIV/AIDS prevalence increased in Iran? Clin Infect Dis 2016;63:846. |
| 5. | Barzon L, Trevisan M, Marino F, Guzzardo V, Palù G. Primary bilateral adrenal B-cell lymphoma associated with EBV and JCV infection. Infect Agent Cancer 2009;4:1. |
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