1
|
Lederer AK, Zimmer S, Margies R, Krettek P, Musholt TJ. Recurrent fever leading to the diagnosis of an angiosarcoma of the adrenal gland: a case report. J Med Case Rep 2024; 18:258. [PMID: 38783354 PMCID: PMC11118567 DOI: 10.1186/s13256-024-04583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Angiosarcoma of the adrenal gland is a very rare malignant vascular neoplasm. The clinical symptoms are atypical or completely absent. Angiosarcomas of the adrenal gland are therefore often discovered incidentally, and the diagnosis is made histologically after resection. CASE PRESENTATION A 46-year-old white Spanish male who was a previous smoker and nondrinker and was slightly overweight (92 kg, 176 cm, body mass index 29.7 kg/m2) with no relevant medical history presented to the internal medicine emergency department of our hospital with an unclear 12 cm tumor of the right adrenal gland. Prior to the computed tomography scan, he had had persistent evening fevers for 4 months and unintentional weight loss of 5 kg. The laboratory results showed anemia and an elevated C-reactive protein, but no hormone production. We performed an open adrenalectomy of the right adrenal gland. Finally, the histologic findings revealed an angiosarcoma of the adrenal gland. CONCLUSION Even though angiosarcomas of the adrenal gland are rare, the differential diagnosis of an angiosarcoma should be considered if a malignant tumor of the adrenal gland is suspected. Treatment decisions should be made on an interdisciplinary basis and preferably in a specialized center. Owing to the rarity of angiosarcomas of the adrenal gland, it is necessary to continue to share clinical experience to gain a better understanding of this particular tumor entity.
Collapse
Affiliation(s)
- Ann-Kathrin Lederer
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
- Center for Complementary Medicine, Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, 79106, Freiburg, Germany.
| | - Stefanie Zimmer
- Department of Pathology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131, Mainz, Germany
| | - Rabea Margies
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Philipp Krettek
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131, Mainz, Germany
| | - Thomas J Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| |
Collapse
|
2
|
Alsarraj OM, Alqahtani A, Alswayyed M, Almayouf M, Billa S. Primary Adrenal Angiosarcoma and its Management: A Case Report. Cureus 2023; 15:e48762. [PMID: 38098906 PMCID: PMC10719075 DOI: 10.7759/cureus.48762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Primary adrenal angiosarcoma is a very rare malignancy. This is a case report of a 54-year-old female, who presented with right-sided abdominal pain. Magnetic resonance imaging of the abdomen and pelvis showed a right adrenal mass with a maximum dimension of 5.7 cm. The patient went for a laparoscopic right adrenalectomy. The postoperative period was uneventful, and she was discharged on postoperative day 2. The patient was free from complaints at outpatient follow-up visits. Pathology confirmed the diagnosis of adrenal angiosarcoma and the metastasis workup was negative. A multidisciplinary approach through the expertise of medical oncology, surgical oncology, and histopathology is essential for the diagnosis and management of such rare diseases.
Collapse
Affiliation(s)
- Omar M Alsarraj
- Department of Surgery, Dr. Sulaiman Al-Habib Hospital, Al Takhasussi, SAU
| | | | - Mohammed Alswayyed
- Department of Pathology and Laboratory Medicine, King Saud University, Riyadh, SAU
| | - Mohammad Almayouf
- Department of Surgery, Prince Sattam bin Abdulaziz University, Alkharj, SAU
| | - Srikar Billa
- Department of Surgery, Dr. Sulaiman Al-Habib Hospital, Al Takhasussi, SAU
| |
Collapse
|
3
|
Toklu A, Mesa H, Collins K. Incidental adrenal hemangioma clinically suspicious for malignancy: diagnostic considerations and review of the literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2022; 15:444-458. [PMID: 36507066 PMCID: PMC9729942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/15/2022] [Indexed: 12/15/2022]
Abstract
Adrenal hemangiomas are rare lesions often found incidentally during unrelated diagnostic work-up. We report a case of a 67-year-old man with history of hypertension, hyperlipidemia, anemia, arthralgia, joint swelling and unexplained weight loss, which prompted imaging studies. Computed tomography scan revealed a 5.4 cm adrenal mass. The patient had no clinical manifestations of adrenal medullary or cortical hyperfunction. Urine and plasma metanephrines and aldosterone/renin ratio were within normal range. The patient was taking prednisone for hand and ankle swelling, precluding assessment for Cushing syndrome. Given the size of the lesion, the possibility of malignancy was considered, and the patient elected for surgical management. The left adrenalectomy specimen weighed 54 g and revealed a 4.9 cm tan-brown mass with congested cut surface and a thin rim of residual adrenal gland parenchyma. Histologic examination showed thick and thin-walled vessels intermingled with adrenocortical elements at the periphery characteristic of a hemangioma. Surgical resection is the mainstay treatment for large, isolated adrenal masses to exclude malignancy and prevent retroperitoneal hemorrhage. Herein, we report a case of adrenal hemangioma, review a variety of other diagnostic considerations occurring in the adrenal gland, and highlight useful distinguishing features to assist in accurate diagnosis.
Collapse
|
4
|
Elbaset MA, Zahran MH, Badawy M, Elhameed MA, Osman Y. Report of two rare cases of adrenal incidentalomas with different origins: revisiting pathological and radiological findings with a short review of the literature. J Egypt Natl Canc Inst 2020; 32:25. [PMID: 32462505 DOI: 10.1186/s43046-020-00039-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adrenal tumors can be detected incidentally in 4 to 8% of patients radiologically. Adenomas, pheochromocytomas, and adrenocortical carcinomas represent the most common tumors of the adrenal glands. Rare histopathological findings are uncommon. We aimed to report two rare primary adrenal tumors diagnosed initially as incidentalomas to identify clinical characteristics, management, and clinical outcomes after treatment. CASE PRESENTATION The first case was a 52-year-old man presented with an incidentally discovered locally advanced primary adrenal angiosarcoma. The patient was managed surgically with no adjuvant therapy. The patient was followed up for 3 years without evidence of local recurrence. The second case was a 63-year-old woman, presented with an incidentally discovered primary diffuse B-cell lymphoma of the left adrenal gland. She was treated by adrenalectomy. Later on, adjuvant six cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy were given. After 6 months follow-up, the patient was alive and disease-free. CONCLUSION The diagnosis of adrenal tumors increased nowadays because of the widespread use of imaging studies, though rare pathologies should be taken into consideration.
Collapse
Affiliation(s)
- M A Elbaset
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Mohamad H Zahran
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed Badawy
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - M Abd Elhameed
- Pathology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Yasser Osman
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| |
Collapse
|
5
|
Adrenal angiosarcoma with metastasis: Imaging and histopathology of a rare adrenal cancer. Radiol Case Rep 2020; 15:460-466. [PMID: 32123554 PMCID: PMC7036739 DOI: 10.1016/j.radcr.2020.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/04/2020] [Accepted: 01/07/2020] [Indexed: 01/15/2023] Open
Abstract
Adrenal angiosarcoma is an extremely rare malignancy with few reported cases in the literature. Patients may be asymptomatic or have nonspecific complaints at presentation. There are no pathognomonic imaging findings, while histopathology can be confounding due to overlap with other disease processes. We present a case of a 38-year-old woman with a long history of cocaine abuse who had metastatic adrenal angiosarcoma at the time of presentation. The adrenal tumor was an incidental finding on imaging. CT demonstrated a heterogeneous mass in the right adrenal gland with central calcification, and MRI identified central necrosis in the mass. Histopathology demonstrated sheets of epithelioid cells, dilated anastomotic vascular spaces, and abundant necrosis, and immunohistochemistry was positive for various vascular markers. The findings were consistent with adrenal angiosarcoma. The patient underwent adrenalectomy and is now receiving adjuvant chemotherapy. Due to the aggressive nature of adrenal angiosarcoma, timely diagnosis and treatment is critical. This case adds to the sparse literature surrounding this disease by highlighting crucial imaging and histopathologic findings that will aid in more efficient diagnosis. Although rare, the disease should be considered in the context of suspicious adrenal lesions. In the future, structured review of all reported cases of adrenal angiosarcoma can help inform diagnosis and therapy for this rare disease.
Collapse
|
6
|
Abstract
Primary angiosarcoma of the adrenal gland is both a rare and aggressive malignancy. Differentiating it from more common adrenal masses such as adrenal adenomas, adrenal cortical carcinomas, and metastatic carcinomas is one of several diagnostic challenges. Immunohistochemical analysis is imperative to arrive at the correct diagnosis. Treatment typically involves surgery and adjuvant chemotherapy, but prognosis remains poor.
Collapse
Affiliation(s)
- Nirav Antao
- Internal Medicine, St. Louis University School of Medicine, St. Louis, USA
| | - Michael Ogawa
- Hematology Oncology, St. Louis University School of Medicine, St. Louis, USA
| | - Zarir Ahmed
- Internal Medicine, St. Louis University School of Medicine, St. Louis, USA
| | - Jinhua Piao
- Pathology, St. Louis University School of Medicine, St. Louis, USA
| | - Nishant Poddar
- Hematology Oncology, St. Louis University School of Medicine, St. Louis, USA
| |
Collapse
|
7
|
Ishii S, Omori S, Uesugi N, Tsuyukubo T, Ito A, Kikuchi D, Onoda M, Takata R, Sugai T, Obara W. A case of angiosarcomas which occurred in an adrenal gland and spleen synchronously. Int Cancer Conf J 2019; 7:134-136. [PMID: 31149532 PMCID: PMC6498291 DOI: 10.1007/s13691-018-0337-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/04/2018] [Indexed: 11/05/2022] Open
Abstract
We report a case of a 56-year-old woman who simultaneously presented adrenal and spleen tumors. Computed tomography imaging revealed a 7-cm enhancing adrenal and 2-cm solitary spleen masses. The patient simultaneously underwent left adrenalectomy and splenectomy. The pathological findings revealed the presence of synchronous adrenal and spleen angiosarcomas. Remarkably, she is disease-free since postoperative 18 months.
Collapse
Affiliation(s)
- Shuhei Ishii
- 1Department of Urology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505 Japan
| | - So Omori
- 1Department of Urology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505 Japan
| | - Noriyuki Uesugi
- 2Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505 Japan
| | - Takashi Tsuyukubo
- 1Department of Urology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505 Japan
| | - Ayato Ito
- 1Department of Urology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505 Japan
| | - Daichi Kikuchi
- 1Department of Urology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505 Japan
| | - Mitsutaka Onoda
- 1Department of Urology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505 Japan
| | - Ryo Takata
- 1Department of Urology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505 Japan
| | - Tamotsu Sugai
- 2Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505 Japan
| | - Wataru Obara
- 1Department of Urology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505 Japan
| |
Collapse
|
8
|
Grajales-Cruz A, Baco-Viera F, Rive-Mora E, Ramirez-Tanchez C, Tasso D, Arroyo-Portela N, Calderon E, Padua-Octaviani IJ, Caceres-Perkins W. Primary Adrenal Angiosarcoma: A Rare and Potentially Misdiagnosed Tumor. Cancer Control 2018; 24:198-201. [PMID: 28441375 DOI: 10.1177/107327481702400213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A man aged 69 years presented with acute right flank pain secondary to a hemorrhagic large adrenal tumor. En bloc resection was performed to repair the inferior vena cava. Immunoperoxidase levels in the tumor were positive for factor VIII and CD31 and negative for S100, protein Melan-A, CD34, synaptophysin, chromogranin, desmin, muscle specific actin, ETFA (EMA), KRT20 (CK20), CDX2, TTF1, LNPEP (PLAP), inhibin, ?-fetoprotein, CD30, hepatocyte paraffin, and aberrant expression of cytokeratin 7 and pankeratin. The pathological diagnosis was consistent with adrenal angiosarcoma. Obtaining appropriate immunoperoxidase stains and multidisciplinary evaluation helped make the diagnosis of this rare adrenal tumor and determine its management. The patient had an uneventful postoperative course and completed 4 cycles of adjuvant chemotherapy with doxorubicin/ifosfamide and adequately tolerated the treatment. However, positive surgical margins were found, so he was referred to radiation oncology specialists for possible adjuvant radiotherapy to the surgical bed. Weeks after the first initiation of therapy, the patient presented to the emergency department complaining of shortness of breath, fatigue, and generalized weakness for 3 days. He was admitted and found to have new-onset anemia and a new-onset, large, right pleural effusion. Thoracentesis performed showed sanguinolent fluid that, after microscopic evaluation, was suggestive of recurrent malignancy. Thoracic aortography performed with subselective catheterization to several arteries (right bronchial, right phrenic, and right renal arteries) did not show any active bleeding. However, the right inferior intercostal and adrenal arteries were presumed to be the reason for the bleeding event, so they were embolized until stasis. The patient remained hemodynamically unstable but eventually experienced multiorgan failure. In spite of aggressive measures, he died 10 days after admission to the hospital.
Collapse
|
9
|
Li XM, Yang H, Reng J, Zhou P, Cheng ZZ, Li Z, Xu GH. A case report of primary adrenal angiosarcoma as depicted on magnetic resonance imaging. Medicine (Baltimore) 2017; 96:e8551. [PMID: 29137070 PMCID: PMC5690763 DOI: 10.1097/md.0000000000008551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
RATIONALE Angiosarcoma is an extremely rare malignant tumor of endothelial origin. The majority of studies reporting angiosarcoma have been concerned with the clinical and pathological aspects, with limited reporting of their imaging findings. To our knowledge, angiosarcoma of the adrenal gland is very rare. Herein we firstly report a primary adrenal angiosarcoma depicted on magnetic resonance imaging (MRI). PATIENT CONCERNS A 59-year-old man was referred to our hospital for 1 year left-flank pain that exacerbated in recent 4 months. DIAGNOSIS A regular mass with clear boundary was revealed on MRI in the region of left adrenal gland. Its signal intensity was inhomogeneous. It mainly showed isointensity with patchy slight hyperintensity on T1-weighted images and marked hyperintensity with patchy hypointensity on T2-weighted images. On contrast-enhanced images, it demonstrated significantly heterogeneous enhancement, and the peripheral solid component showed delayed enhancement. Bulky blood vessels and hemorrhage were identified in the tumor. INTERVENTIONS The mass was surgically excised under a left laparoscopic adrenalectomy. OUTCOMES Left adrenal angiosarcoma was confirmed by pathological and immunohistochemical examinations. No evidence of recurrence was found 6 months after operation. LESSONS In conclusion, primary adrenal angiosarcoma has some MRI features corresponding to its pathological nature. It should be included in the differential diagnosis when a mass was detected in the adrenal gland.
Collapse
Affiliation(s)
- Xue-Ming Li
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| | - Hong Yang
- Department of Pathology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| | - Jing Reng
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| | - Peng Zhou
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| | - Zhu-Zhong Cheng
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| | - Zhen Li
- Department of Urology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan China
| | - Guo-Hui Xu
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| |
Collapse
|