Enormous bilateral adrenal uptake of F-18FDG caused by non-Hodykin's lymphoma

A 50-year-old woman with fever and unclear abdominal symptoms was examined. Ultrasound and magnetic resonance imaging showed massive enlargement of both adrenal glands. Serum tests showed normal adrenal function. Histologic analysis revealed non-Hodgkin's lymphoma (centroblastic centrocytic lymphoma). F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) performed to determine the stage of the disease showed intensely increased glucose metabolism in both enlarged adrenal glands. In addition, two hot spots in the lower mediastinum were detected. After chemotherapy, the findings of the PET scan normalized, but an MRI still showed slightly enlarged adrenal glands. This massive symmetric FDG accumulation in the adrenal glands is uncommon and has not been reported before.