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

Abstract

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 11cm 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 11cm 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.

Keywords: Adrenal cavernous hemangioma; Adrenal hemangioma; Laparoscopic adrenalectomy; Laparoscopic surgery; Laparoscopy.

Fig. 1

(a) noncontrast-enhanced CT scan showing encapsulate large right adrenal lesion with regular margins; (b–d) contrast-enhanced CT images obtained in arterial, portal and late phase, 3 min after iodinated contrast administration, showing a hypodense centre with no infiltration of peri-adrenal organs.

Fig. 2

Resected adrenal gland with a smooth surface and adrenal vein.

Fig. 3

(a) representative tissue section with residual adrenal parenchyma (H&E 10x); (b) multiple dilated interconnecting vascular channels with thrombosis (H&E 20x); (c) areas of hemorrhage and necrosis (H&E 40 x).