Primary adrenal lymphoma (PAL) is an extremely rare extranodal lymphoma. Moreover, cauda equina syndrome (CES) as a first sign of a primary adrenal lymphoma is very exceptional. Here, we report a 35-year-old man was admitted because of primary adrenal lymphoma presenting with CES. He was treated with chemotherapy including rituximab, cyclophosphamide, vincristine, adriamycin, and prednisolone (R-CHOP). At present 30 months after chemotherapy of R-CHOP, the patient is considered free of tumor. The good results obtained for our case could be due to the relative early detection by CES and the use of combination of monoclonal antibody (R-CHOP).
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