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Despite the significant progress in the treatment of haematological malignancies and the improvement of treatment efficacy, it is still associated with numerous side effects. Among them, endocrinological and diabetic complications of immunotherapy are of particular importance, and they belong to the most frequently observed, mainly due to the interference of the treatment with functioning of the immune system. As a result, it can lead to the induction of autoimmune processes in many systems, including endocrine glands. The effectiveness of some therapies may also be determined by the occurrence of side effects in the form of autoimmune diseases. Increasing use of tyrosine kinase inhibitors, immune checkpoint inhibitors, as well as glucocorticosteroids exerting immunosuppressive effect, which are applied, leads to the development of various pathologies of the endocrine system. The most common complications developing on the background of autoimmune inflammation are disturbances in the function of thyroid gland, pituitary gland in its anterior lobe, and very rarely in the posterior lobe in the form of diabetes insipidus. The above-mentioned disorders may occur in patients of all ages, regardless of gender. Some dysfunctions are subclinical and are found incidentally during routine check-up, both in the course of the treatment process or after its completion. Taking into account the possibility of serious consequences of the therapy, it is now recommended to periodically control the patients.

Primary adrenal lymphomas (PAL) are rare neoplasms that should be considered in the differential diagnosis of adrenal insufficiency and incidentally detected focal lesions within the adrenal glands, especially those located bilaterally. PAL are tumors characterized by a rapid growth, an aggressive course and a poor prognosis. The disease usually develops in the elderly, most often in the 6.–7. decade of life, 2–7 times more often in men than in women. The etiopathogenesis of PAL is complex, multifactorial and still not fully understood.. The most commonly reported symptoms include fever of unknown origin, abdominal pain, fatigue, and weight loss. In the case of lesions localized on both sides, symptoms of adrenal insufficiency are relatively common. PAL may also be clinically silent and be detected as incidentalomas. The examination of choice in PAL diagnostics is computed tomography (CT) of the abdominal cavity aimed at the adrenal glands and combined with hormonal assessment. The gold standard in the diagnosis of PAL is percutaneous fine-needle aspiration biopsy under ultrasound or CT guidance, which allows for the final diagnosis. Histopathologically, the vast majority of cases are diffuse large B-cell lymphoma. It has been suggested to combine various methods of treatment, including immunochemotherapy/chemotherapy, surgery with subsequent immunochemotherapy/chemotherapy and/or radiotherapy. The purpose of the following systematic review was to perform an interdisciplinary analysis of the clinical picture, pathogenesis, diagnostic methods and current therapeutic strategies, taking into account the prognosis for individual PAL subtypes.

StreszczenieZespół hemofagocytowy (ang. hemophagocytic lymphohistiocytosis – HLH) charakteryzuje się nieprawidłową aktywacją układu immunologicznego, u podłoża której leżą zmiany genetyczne lub nabyte zaburzenia cytotoksyczności limfocytów T i NK. Objawy kliniczne są niespecyficzne i różnorodne, a postawienie rozpoznania, pomimo dostępności badań dodatkowych, jest niezwykle trudne. W artykule zaprezentowano przypadek kliniczny chorej, u której pierwotnie w obrazie klinicznym dominowała nawracająca gorączka oraz zmiany skórne sugerujące rozpoznanie rumienia guzowatego. Pomimo rozpoczęcia steroidoterapii oraz stosowania empirycznej antybiotykoterapii stan pacjentki nie ulegał poprawie. Do objawów klinicznych dołączyły się splenomegalia oraz zaburzenia w badaniach dodatkowych: trójukładowa cytopenia, hiperferrytynemia, hipertriglicerydemia, hipofibrynogenemia. Ponadto w obrazie histopatologicznym szpiku kostnego stwierdzono obecność hemofagocytów. Na podstawie obrazu klinicznego oraz badań dodatkowych postawiono rozpoznanie HLH. W terapii zastosowano chemioterapię zgodnie z protokołem HLH-2004, uzyskując całkowitą remisję.

Secondary nervous system lymphoma (SCNSL) is a rare extranodal form of non-Hodgkin lymphoma (NHL). This applies to a particular form of lymphoma that does not originally derive from the central nervous system (CNS); it can be both an isolated form of relapse or a systemic part of disease progression. Due to poor prognosis and a lack of established algorithms of therapeutic procedures, it is a big challenge for physicians from many specializations. In our study, we present an interesting case of a patient with a relapsed form of SCNSL for whom a unique form of treatment was used – intraventricular administration of rituximab and methotrexate.