A small proportion of patients with chronic lymphocytic leukemia (CLL) may progress to large cell lymphoma, or Richter syndrome (RS). The large cells of RS may arise through transformation of the original CLL clone (clonally related) or represent a new neoplasm (clonally unrelated), which might be Epstein-Barr virus (EBV)-associated. We present a 61-year-old male with 5-year history of CLL who developed RS on bilateral adrenal glands.
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