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. 2014;5(2):52-5.
doi: 10.1016/j.ijscr.2013.11.003. Epub 2013 Nov 20.

A rare cavernous hemangioma of the adrenal gland

Janet P Edwards  1 , Heather C Stuart  1 , Stefan J Urbanski  2 , Janice L Pasieka  3
Affiliations

A rare cavernous hemangioma of the adrenal gland

Janet P Edwards et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: Cavernous hemangiomas of the adrenal gland are rare. We report a case of a cavernous hemangioma of the adrenal gland presenting as an adrenal incidentaloma suspicious for adrenal cortical carcinoma (ACC).

Presentation of case: A 78 year old woman was admitted after a fall. Abdominal computed tomography revealed a large right adrenal lesion with features suspicious for adrenal cortical carcinoma (5.4cm×3.3cm, unilateral, tumor calcifications, average Hounsfield units 55). The tumor was removed intact by a laparoscopic approach and pathology revealed a cavernous hemangioma of the adrenal gland.

Discussion: Adrenal incidentalomas are found in up to 10% of patients undergoing abdominal imaging. Differential diagnosis includes both benign and malignant lesions. Guidelines for removal of adrenal incidentalomas recommend surgery based on functional status, size, and presence of concerning features on diagnostic imaging. Cavernous hemangiomas are rare, benign vascular malformations which can be challenging to distinguish pre-operatively from malignant lesions such as ACC.

Conclusion: Cavernous hemangiomas of the adrenal gland are exceedingly rare. These benign tumors have imaging features which may be suggestive of adrenal cortical carcinoma. The treatment of choice is surgical excision due the difficulty of excluding malignancy.

Keywords: Adrenal; Adrenal cortical carcinoma; Cavernous hemangioma.

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Figures

Fig. 1
Fig. 1
(a) Large right adrenal lesion (5.4 cm × 3.3 cm) containing regions of dystrophic calcification but well circumscribed with no obvious areas of invasion (a) axial and (b) sagittal. (b) Large right adrenal lesion (5.4 cm × 3.3 cm) containing regions of dystrophic calcification but well circumscribed with no obvious areas of invasion (a) axial and (b) sagittal.
Fig. 2
Fig. 2
Resected adrenal gland showing a smooth surface and on sectioning an ill defined markedly congested lesion within which were isolated cystic spaces.
Fig. 3
Fig. 3
Thick walled, large interconnecting vascular channels filled with blood are present adjacent to the adrenal cortex. H&E 100×.
See this image and copyright information in PMC

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