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Tan T, Diab J, Chia P, Singh A, Campbell P, Guevara R. An imaging and diagnostic conundrum-the adrenal haemangioma. J Surg Case Rep 2024; 2024:rjae286. [PMID: 38706490 PMCID: PMC11068444 DOI: 10.1093/jscr/rjae286] [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] [Received: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 05/07/2024] Open
Abstract
The adrenal haemangioma, a rare benign vascular tumour, is increasingly detected through abdominal imaging. Just over 70 surgical cases have been reported since 1955. Their potential large size and overlapping imaging features with adrenocortical carcinoma poses a diagnostic challenge. Adrenalectomy is often needed for a definitive diagnosis due to inconclusive imaging. We report the case of a 61-year-old female presenting with an incidental finding of a right-sided 9.5-cm adrenal mass on imaging. Due to the risk of adrenocortical carcinoma with inconclusive imaging findings, an open right adrenalectomy was performed. The patient was discharged after 6 days with no complications. Post-surgical histopathology confirmed a diagnosis of adrenal haemangioma with a secondary adrenal pseudocyst. The presence of an adrenal incidentaloma with discordant radiological features proves to be a diagnostic conundrum. Therefore, in the setting of contradictory radiology and concerning mass size, we recommend adrenalectomy for definitive diagnosis of an adrenal haemangioma.
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Affiliation(s)
- Tiffany Tan
- Department of Endocrine Surgery, Liverpool Hospital, Liverpool, NSW 2170, Australia
| | - Jason Diab
- Department of Endocrine Surgery, Liverpool Hospital, Liverpool, NSW 2170, Australia
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- School of Medicine, University of Notre Dame, Darlinghurst, NSW 2010, Australia
| | - Philip Chia
- Department of Endocrine Surgery, Liverpool Hospital, Liverpool, NSW 2170, Australia
- School of Medicine, University of Sydney, NSW 2052, Australia
| | - Amandeep Singh
- Department of Endocrine Surgery, Liverpool Hospital, Liverpool, NSW 2170, Australia
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Anatomical Pathology, Liverpool Hospital, Liverpool, NSW 2170, Australia
| | - Peter Campbell
- Department of Endocrine Surgery, Liverpool Hospital, Liverpool, NSW 2170, Australia
- School of Medicine, University of Sydney, NSW 2052, Australia
| | - Ronald Guevara
- Department of Endocrine Surgery, Liverpool Hospital, Liverpool, NSW 2170, Australia
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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.
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DAMBURACI N, SEVİNÇ B, DURAN C, KARAHAN Ö. Adrenal Cystic Lesion Presented With Spontaneous Hemorrhage. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2020. [DOI: 10.33706/jemcr.514519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Adrenal Cavernous Hemangioma: A Rarely Perceived Pathology-Case Illustration and Review of Literature. Case Rep Pathol 2019; 2019:8463890. [PMID: 31949968 PMCID: PMC6944974 DOI: 10.1155/2019/8463890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/03/2019] [Accepted: 11/29/2019] [Indexed: 12/02/2022] Open
Abstract
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.
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