Symptomatic leiomyoma of the adrenal gland in a woman with AIDS

Review of the Literature on Leiomyoma and Leiomyosarcoma of the Adrenal Gland: A Systematic Analysis of Case Reports

BACKGROUND/AIM

To date few cases of smooth muscle-derived tumors of the adrenal gland have been reported and their treatment remains a medical challenge. The aim of this manuscript was to systematically review the literature and present the tumor characteristics and their management in order to provide a standardized approach to their diagnosis and management.

MATERIALS AND METHODS

We searched five databases (PubMed, Scopus, Elsevier, ResearchGate, Google scholar) for relevant articles published until March 2020.

RESULTS

Twenty-two cases of adrenal leiomyoma, four cases of adrenal smooth muscle tumor and forty-five cases of adrenal leiomyosarcoma were included.

CONCLUSION

We present the demographic, clinical, radiological, pathological and oncological characteristics and prognosis of tumors of the adrenal gland arising from smooth muscle cells, as well as describe the common clinical investigations and therapeutic modalities that have been reported as part of their management.

Novel mutation in DOCK8-HIES with severe phenotype and successful transplantation

BACKGROUND

Hyper-IgE syndrome (HIES) due to DOCK8 deficiency is an autosomal recessive (AR) primary combined immunodeficiency which results in significant morbidity and mortality at a young age. Different mutations in the DOCK8 gene can lead to variable severity of the disease.

OBJECTIVE

We evaluated the genetic mutations in three related patients with severe clinical manifestations suggestive of AR HIES. We also explored whether treatment with stem cell transplantation could lead to complete disease resolution.

METHOD

We examined the clinical manifestations and immunological workup of these patients. Their DNA was also screened for causative mutation. Post transplantation, clinical and immunological data for the transplanted patient was also collected.

RESULTS

All patients had a severe course of the disease with rarely reported severe complications in HIES. One patient died with lymphoma while another died with progressive multifocal leukoencephalopathy (PML) due to a slow virus. All our patients had two novel mutations in the DOCK8 gene. One of these mutations was a novel pathogenic mutation and explains the severity of the disease (homozygous splice site mutation at position 5 after the end of exon 45), while the other mutation was mostly non-pathogenic. Hematopoietic stem cell transplantation (HSCT) was performed in the youngest patient with excellent engraftment and full reversibility of the clinical manifestations.

CONCLUSION

We report 3 patients from a consanguineous family diagnosed with AR-HIES due to a novel pathogenic mutation in DOCK8 gene leading to fatal outcome in 2 patients and complete resolution of the clinical and immunological features in the third patient by HSCT.

Large bilateral adrenal leiomyomas presenting as calcified adrenal masses: a rare case report

We report the case of a 55-year-old woman with bilateral, large, calcified adrenal tumors who was treated by laparoscopic adrenalectomy. The patient presented with upper abdominal discomfort for the past 5 years. Her imaging showed bilateral enlarged adrenal glands up to 10-cm size with punctate calcifications. Positron emission tomography scan demonstrated moderate fluorodeoxyglucose avidity in the left adrenal mass. Bilateral laparoscopic adrenalectomy was performed through a transperitoneal approach. The postoperative period was uneventful, and the patient was discharged on the third postoperative day. Histology findings were consistent with adrenal leiomyomatosis.

Sarcomas other than Kaposi sarcoma occurring in immunodeficiency: interpretations from a systematic literature review

PURPOSE OF REVIEW

In immunodeficiency, an increased sarcoma risk is confirmed for Kaposi's sarcoma. Whether rates of other sarcoma subtypes are elevated in the setting of immunodeficiency is not known. We therefore reviewed published case reports on HIV and AIDS patients and organ transplant recipients with sarcomas. For comparison, we assessed sarcomas in the U.S. general population using Surveillance Epidemiology End Results (SEER) data.

RECENT FINDINGS

A total of 176 non-Kaposi sarcoma were identified, 75 in people with HIV and AIDS and 101 in transplant recipients. Leiomyosarcomas (n = 101) were the most frequently reported sarcomas, followed by angiosarcomas (n = 23) and fibrohistiocytic tumors (n = 17). Leiomyosarcomas were reported with two age peaks, in children and young adults. Epstein-Barr virus (EBV) was detected in the tumor cells in 85 and 88% of leiomyosarcomas in HIV-infected people and transplant recipients, respectively. Angiosarcomas and fibrohistiocytic tumors were most frequently reported in men. Among kidney transplant recipients, 20% of sarcomas arose at the site of an arteriovenous fistula. In comparison, leiomyoscarcomas, angiosarcomas, and fibrohistiocytic tumors comprised 16.9, 3.8, and 18.7% of sarcomas in the U.S. general population.

SUMMARY

Leiomyosarcoma and angiosarcoma may occur disproportionately in immunodeficiency. Leiomyosarcomas appear causatively linked to EBV, whereas angiosarcomas might be correlated with an arteriovenous fistula. Additional studies are necessary to understand the contribution of immunodeficiency to the cause of these sarcomas.

Leiomyoma of the adrenal gland presenting as a non-functioning adrenal incidentaloma: case report and review of the literature

A 31-year-old woman was incidentally found to have a large right adrenal mass by computed tomography imaging and underwent a workup that included endocrinological evaluation and positron emission tomography imaging. Laboratory results revealed the mass to be non-functioning. Imaging studies revealed a 9-cm heterogeneous mass that was not FDG avid. Because of concern for adrenal cortical carcinoma, the patient underwent a successful right adrenalectomy. Pathology examination demonstrated an 11-cm circumscribed mass consisting of uniform spindle cells without nuclear pleomorphism, necrosis, or mitotic activity. The diagnosis of leiomyoma was supported by a panel of immunohistochemical stains. Adrenal leiomyomas have been reported in the literature, although most are small and not preoperatively suspicious for malignancy. This case illustrates that benign tumors such as leiomyomas, when large and heterogeneous on imaging, can clinically mimic adrenal cortical carcinomas and should be included in the differential diagnosis of adrenal incidentalomas.

Adrenal Leiomyoma Treated by Hand-Assisted Laparoscopic Adrenalectomy: A Case Report

A left adrenal incidentaloma was found by abdominal ultrasound and computed tomography (CT) in a 53-year-old woman who had a history of non-insulin dependent diabetes mellitus. Abdominal CT showed a well-circumscribed adrenal mass (5.5 x 4.5 x 3.5 cm) with low density (32HU) on precontrast scan and heterogeneous enhancement on postcontrast scan. Laboratory examinations revealed a nonfunctional adrenal tumor. As the malignant potential of the tumor could not be ruled out, the patient underwent hand-assisted laparoscopic adrenalectomy. Postoperative recovery was uneventful, and pathologic examination revealed leiomyoma.

Adrenal leiomyoma: a case report and review of the literature

We describe a case of a 65-year-old Caucasian woman found to have an enlarging mass of the left adrenal gland. Laboratory examination revealed the mass to be nonfunctional. The patient underwent an uneventful left adrenalectomy. Pathological examination revealed the mass to be a leiomyoma. These tumors are benign and develop from smooth muscle cells. They can occur in any part of the body where smooth muscular layers exist, but occur frequently in the uterus and gastrointestinal tract. This case report presents a review of the recent literature on this rare entity.

Cancers in human immunodeficiency virus-infected children

Although the exact incidence of cancers in human immunodeficiency virus (HIV)-infected children is not clear, an excess of non-Hodgkin's lymphomas and soft tissue tumors as well as a multitude of otherwise rare tumors in childhood, such as cervical, thyroid, or pulmonary carcinoma, has been reported. In contrast to the findings in HIV-infected adults, Kaposi's sarcoma is rare in children in industrialized countries but not in children living in the sub-Saharan area. Treatment of the neoplastic disease is often complicated by multiple HIV-associated organ dysfunctions as well as drug interactions and infectious complications secondary to severe immunosuppression. Nonetheless, preliminary results with dose-intensive, but brief, chemotherapeutic regimens have been encouraging, and HIV-infected children who develop cancer are likely to benefit from aggressive treatment combined with adequate supportive care. Furthermore, insights gained from the study and treatment of this very challenging group of patients may benefit other immunocompromised hosts as well as increase our understanding of oncogenesis in general.