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

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.

Figure 1

Enhanced magnetic resonance images (MRI) of the abdomen and pelvis with gadolinium. (a) Coronal view of an in-phase T1-weighted image identifying a large suprarenal mass measuring around 7.3 × 6.5 × 6 cm occupying the space of the right adrenal gland, showing a significant rim enhancement with marked vascularity. (b) Coronal view of a T2-weighted image identifying the similar right suprarenal mass with heterogeneous component inside it, possessing various signal intensities.

Figure 2

Histopathological images of an adrenal cavernous hemangioma cross section, showing dilated capillaries with capsule and significant fibrosis on Hematoxylin and Eosin (H&E) staining (a). Magnified image showing red blood cells inside dilated capillaries (b), divided by thick fibrous septa (c).