A rare cavernous hemangioma of the adrenal gland

Incidental adrenal hemangioma clinically suspicious for malignancy: diagnostic considerations and review of the literature

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.

Clinical Features and Outcomes of Adrenal Cavernous Hemangioma: A Study of 8 Cases from a Single Center

BACKGROUND

Cavernous hemangioma is a rare benign tumor that develops from the adrenal glands. In this study, we present our experience with patients with adrenal cavernous hemangiomas (ACH) in a Chinese population.

METHODS

Demographic, diagnostic, surgical, and pathological findings in patients at a single institution who were adrenalectomized as a result of ACH were retrospectively reviewed.

RESULTS

Among 601 patients who underwent adrenalectomy, 8 (1.33%; 5 men, 3 women) cases were diagnosed with ACH between January 1, 1998, and December 31, 2018, in a single institution. The mean age was 53.25 ± 11.9 years (range, 35-67 years). Four (50%) were asymptomatic, and three (37.5%) complained of abdominal or flank discomfort. Preoperative computed tomography (CT) revealed ACH in 3 (37.5%) cases. Well-defined borders and heterogeneous enhancement with characteristic progressive partial filling-in were characteristic CT features of ACH (tumor size>3 cm). The mean tumor size was 5.16 ± 3.4 cm (range, 1.5-11 cm). No recurrence occurred during a median follow-up period of 38.37 months (range, 8-60 months).

CONCLUSIONS

ACH was asymptomatic in most cases, and diagnosis could be challenging. Adrenalectomy is a safe treatment modality for ACH, and it ensures favorable outcomes.

Cavernous Hemangioma of the Adrenal Gland: A Rare Adrenal Incidentaloma

Cavernous hemangiomas of the adrenal gland are rare, benign, endocrinologically inactive tumors. They present as adrenal incidentalomas, mostly asymptomatic, but patients may have abdominal pain. Surgery is the mainstay of treatment.

Adrenal Cavernous Hemangioma: A Rarely Perceived Pathology-Case Illustration and Review of Literature

Cavernous hemangiomas are endothelial tumors that rarely affect the adrenal glands. Most of these tumors remain silent and are incidentally found on abdominal imaging. Hardly ever, these tumors are endocrinologically functional. They may present as vague abdominal pain. Surgical resection remains the mainstay for large masses. In this paper, we are presenting a case of adrenal cavernous hemangioma in a 83-year-old male patient who initially presented for workup of vague abdominal and bilateral flank pain. A computed tomography scan of the abdomen showed an 8 cm right adrenal adenoma which was metabolically nonfunctional. The mass was completely resected through an open subcostal incision, with no encountered postoperative complications. A highlight of all published cases of adrenal hemangiomas since 1955 is also presented and reviewed.

Adrenal cavernous hemangioma: A rare tumor that mimics adrenal cortical carcinoma

Background

Adrenal cavernous hemangioma is a rare tumor with only 60 cases previously reported. The aim of this study was to determine the frequency and clinical significance of adrenal cavernous hemangioma at our institution.

Methods

A retrospective review of consecutive patients undergoing adrenalectomy from 1994 to 2018 was completed to determine the frequency of cavernous hemangioma, characterize the clinical presentation, imaging and pathologic features and review the operative management and outcome.

Results

Of 144 consecutive patients who underwent adrenalectomy by a single surgeon, 5 (3.5%) had an adrenal cavernous hemangioma. All were incidentally discovered, nonfunctional adrenal masses varying in size from 7 to 12 cm with imaging features that were indeterminate in differentiating a benign adenoma from an adrenal cortical carcinoma. Attenuation values for the adrenal masses on noncontrast computed tomography varied from 28 to 34 Hounsfield units. All adrenal cavernous hemangiomas were large, heterogeneous, complex masses with a variable presence of calcification, hemorrhage, and necrosis. These features, along with tumor enlargement were concerning for adrenal cortical carcinoma. During the operation, there was no local invasion and all adrenal tumors were successfully removed laparoscopically without tumor rupture or bleeding. All patients had an uneventful postoperative course without complications.

Conclusion

Adrenal cavernous hemangioma is a rare tumor that can grow to a very large size without causing symptoms, making it difficult to differentiate from adrenal cortical carcinoma clinically or radiographically. Despite its large size, adrenal cavernous hemangioma can be safely resected laparoscopically.

Benign vascular tumors, cysts, and pseudocysts of the adrenal gland: a contemporary multi-institutional clinicopathological analysis of 55 cases

Benign adrenal vascular tumors, cysts, and pseudocysts are a heterogeneous group of relatively uncommon entities that may pose diagnostic challenges radiologically and pathologically. However, there are only a few small cases series systematically characterizing the clinicopathological features of these lesions. We identified 55 cases of benign adrenal vascular tumors, cysts, and pseudocysts (23 pseudocysts, 17 hemangiomas, 8 lymphangiomas, 6 angiomatous endothelial cysts, and 1 arteriovenous malformation) from a multi-institutional urologic pathology database between 2000 and 2017 and retrospectively analyzed their clinicopathological features. We found that these lesions have a female predominance and most are right sided. These lesions may occur simultaneously with other adrenal tumors associated with hormonal hypersecretion. A substantial portion of pseudocysts were semisolid or solid with no fluid collection, mimicking a solid adrenal tumor and resulting in adrenalectomy. In addition, a small proportion of benign vascular lesions may have coexisting epithelial tumors, requiring extensive specimen sampling and thorough microscopic examination.

A Rare Adrenal Incidentaloma That Mimics Adrenocortical Carcinoma

OBJECTIVE

We present a case of an adrenal hemangioma, an uncommon cause of an adrenal mass, and review the clinical presentation, work-up, and management of adrenal incidentalomas.

BACKGROUND

A 64-year-old male was found to have a right adrenal incidentaloma during work-up for elevated liver transaminase levels, later found to be from hepatitis C. The mass was suspicious for adrenocortical carcinoma on CT imaging. Biochemical evaluation revealed no evidence of function. He underwent an open right adrenalectomy. The mass was found to be an adrenal hemangioma on histopathologic analysis.

METHODS

This is a case report with pertinent review of the diagnosis and management of adrenal incidentalomas.

RESULTS

Adrenal hemangiomas are rare, benign, nonfunctional tumors typically found during imaging for other reasons. As illustrated by this case, they appear similar to adrenocortical carcinoma on CT imaging. The diagnosis is usually not made prior to surgical resection.

CONCLUSION

Adrenal hemangioma is a rare nonfunctional adrenal incidentaloma that displays atypical features on CT imaging. The suspicion for adrenocortical carcinoma usually prompts adrenalectomy.

Computer tomography imaging findings of adrenal cavernous hemangiomas: a report of 10 cases

BACKGROUND

Cavernous hemangiomas (CHs) of the adrenal gland are extremely rare. To date, only a few studies of adrenal CH imaging have been reported.

PURPOSE

To analyze the computed tomography (CT) imaging findings of adrenal CHs.

MATERIAL AND METHODS

Ten cases of adrenal CHs confirmed by a histopathological examination were retrospectively analyzed. All of the patients had undergone unenhanced and enhanced CT examinations, and eight had also undergone multiphase CT enhancement examinations. CT characteristics, including shape, size, margin, attenuation, and enhancement patterns, were analyzed.

RESULTS

The study included six women and four men with a mean age of 49.2 years (age range, 25-62 years) and no signs of abnormal endocrine activity. The unenhanced CTs showed well-defined, heterogeneous (n = 8) or homogeneous (n = 2) density masses with scattered (n = 8) or spread calcifications (n = 2) in six tumors. In the contrast-enhanced CTs, seven tumors appeared to be marked with heterogeneous enhancement, whereas three cases exhibited no obvious enhancement. The evaluation of the pattern of dynamic enhancement in eight patients revealed that the tumors showed early peripheral enhancement (n = 4), early central enhancement (n = 1), and mixed enhancement (n = 1) with progressive partial filling-in, and no obvious enhancement in any phases (n = 2).

CONCLUSION

Adrenal CHs should be included in the differential diagnosis when an adrenal neoplasm is incidentally found and appears as a well-defined, heterogeneous mass with calcifications and various enhancement patterns, including heterogeneous enhancement with characteristic progressive partial filling-in, as well as lack of enhancement in any phase.

Giant adrenal hemangioma: Unusual cause of huge abdominal mass

Adrenal hemangioma is an extremely rare benign and non-functioning neoplasm of the adrenal gland. We report a case of a 71-year-old woman admitted for intermittent abdominal pain and abdominal distension associated with vomiting and chronic constipation for 5 years. Physical examination revealed a large abdominal mass. Both computed tomography scan and magnetic resonance imaging suggested hemangioma in the right lobe of the liver. Laboratory examinations and tumour markers were within normal limits, except for hypochromic microcytic anemia. The mass was removed intact by conventional surgery and histopathology revealed a cavernous hemangioma of the adrenal gland with no signs of malignancy. Surgical resection was curative, with no recurrence at the 2-year follow-up.

Large cavernous hemangioma of the adrenal gland: Laparoscopic treatment. Report of a case

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Identify the preoperative radiologic features of adrenal hemangioma.

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We examine the better surgical approach for adrenal tumors and adrenal hemangioma.

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Controindication to laparoscopic adrenalectomy.

Introduction

Cavernous hemangioma of the adrenal gland is a rare benign tumor. The diagnosis is often postoperative on histological exam with the presence of blood-filled, dilated vascular spaces.

Presentation of case

We report the clinical case of a 49 years-old woman who came to our observation with aspecific abdominal pain. A computed tomography (CT) abdominal scan revealed a 11 cm right adrenal mass. This lesion was well circumscribed, round, encapsulated. After iodinated-contrast we observed a progressive, inhomogeneous enhancement without evidence of active bleeding and with pre-operative diagnosis of adrenal hemangioma. Laparoscopic adrenalectomy was performed by a transperitoneal flank approach. Pathological examination revealed a 11 cm adrenal mass with extensive central necrotic areas mixed to sinusoidal dilation and fibrotic septa. Postoperative diagnosis was adrenal hemangioma.

Discussion

Adrenal hemangiomas occur infrequently. Generally these adrenal masses are non-functioning and there is no specific symptoms. Recent records demonstrate that laparoscopic adrenalectomy is technically safe and feasible for large adrenal tumors, but controversy exists in cases of suspected malignancy. We choose laparoscopic approach to adrenal gland on the basis of preoperative CT abdominal scan that excludes radiological signs of adrenocortical carcinoma (ACC) such as peri-adrenal infiltration and vascular invasion.

Conclusion

Laparoscopic adrenalectomy is considered the standard treatment in case of diagnosis of benign lesions. In this case report we discussed a large adrenal cavernous hemangioma treated with laparoscopic approach. Fundamental is the study of preoperative endocrine disorders and radiologic findings to exclude signs of malignancy.