Adrenal Hemangiomas Research Articles

FRI260 Adrenal Hemangioma, Mimicker Or Malignant?

Abstract Disclosure: C. Pham: None. C.E. Chiu: None. B. Barnett: None. Background: Adrenal hemangioma is a rare condition that can mimic other adrenal pathologies. Clinical Case: A 49 year old male with history of heart failure presented with cardiogenic shock requiring inotropes and heart transplant evaluation. On CT patient was noted to have a 2.2 cm left adrenal nodule containing calcifications. Initial tests had indeterminate 1 mg overnight DST, normal plasma free metanephrines and elevated plasma free normetanephrines 2.06 nmol/L (0-0.89 nmol/L). PRA was 22.82 ng/mL/hr (0.25-5.82 ng/ml/hr) with aldosterone 10.8 ng/dL (<16 ng/dL) on spironolactone. 24 hour urine tests showed normal free cortisol 9.8 mcg/24hr (4-50 mcg/24hr) and elevated total metanephrines at 1245 mcg/24hr (182-739 mcg/24hr), metanephrines at 303 mcg/24hr (58-283 mcg/24hr), and normetanephrines at 942 mcg/24hr (88-649 mcg/24hr). Adrenal CT demonstrated HU of 59 units on noncontrast phase, with -86.7% absolute washout and -17.6% relative washout. I-123 MIBG Scan was obtained with no radiotracer uptake noted. Patient underwent laparoscopic adrenalectomy for definitive diagnosis and was found to have adrenal hemangioma with CD31 and ERG with hemosiderin laden macrophages on pathology. Adrenal hemangioma is rare and can mimic other adrenal pathology. Most patients present with abdominal symptoms such as flank pain or are found to have an adrenal incidentaloma on imaging. CT findings are associated with heterogenous internal structure, peripheral patchy enhancement, or calcifications, which are also seen in malignancy and pheochromocytoma. In all cases, HU if recorded are noted to be >10 on the unenhanced phase and <60% absolute washout. In one case series of 52 adrenal hemangiomas, only 3 patients had positive biochemical tests and on average were 11 cm in size. Formal diagnosis is made pathologically. Treatment for adrenal hemangioma is typically resection for symptomatic relief, with some patients with small lesions electing to observe. In all surgical cases reviewed in a case series adrenalectomy was pursued as opposed to needle biopsy due to large size of lesion and concern for possible malignancy. In this specific case, biochemical testing was falsely positive given the patient’s presentation of cardiogenic shock and inotropes causing elevated catecholamine levels and given imaging findings could not fully rule out pheochromocytoma. Given the small size of lesion, the patient in a non-transplant setting likely could have pursued close observation as opposed to resection. Conclusion: Adrenal hemangioma can have imaging characteristics that can mimic several other adrenal pathological conditions, such as malignancy or pheochromocytoma. Treatment through surgical management is likely not necessary in patients with hemangioma, though would be important in ruling out other adrenal pathology. Presentation: Friday, June 16, 2023

A rare case of adrenal hemangioma: A case report

Adrenal hemangiomas are rare benign tumors arising from the endothelial cells lining the blood vessels, which are made up of angioblastic cells. They are usually identified incidentally on radiographic imaging and post-operative histopathology is usually the definitive diagnosis. Computed tomography and magnetic resonance imaging help in the detection of silent adrenal lesions. We present a case and outline the diagnostic work-up and treatment of incidentally detected adrenal hemangioma in a 66-year-old woman.

Abstract #1171787: A Rare Case of an Adrenal Hemangioma with Subclinical Cushing’s Syndrome

Adrenal hemangiomas are extremely rare causes of adrenal masses with less than 100 reported cases in the literature. We present a patient with a large left adrenal mass with biochemical work-up suggestive of subclinical Cushing’s syndrome who was found to have an adrenal hemangioma.

Adrenal Hemangioma: A Common Tumor at Uncommon Site

AbstractAdrenal hemangiomas are rare vascular tumors. These are benign, mostly nonfunctioning and asymptomatic. Cavernous adrenal hemangiomas are more common in the elderly, with female preponderance. A computed tomography (CT) scan can diagnose their benign nature. Most cases are managed surgically, and laparoscopy is the most common approach followed nowadays.A young female presented with nausea, pain, and a vague mass palpable in the right abdomen. With CT findings favoring benign lesion or nonfunctioning adenoma but symptomatic, the patient had to undergo diagnostic laparoscopy and adrenalectomy. Adrenal hemangiomas are rare lesions. Moreover, involving a young female further makes their diagnosis difficult. Hence, they must be kept as one of the differential diagnosis in evaluation of adrenal mass in young females.

A Huge Adrenal Incidentaloma With Suspicious Features and a Complete Cure!

Introduction: Adrenal hemangioma is an extremely rare benign vascular tumor occurring in adrenal glands (~0.01%). Its clinical presentation is usually vague and is frequently discovered as an incidentaloma. These tumors are mostly encountered at 40–70 years of age and are twice as common in women. We report a case of a nonfunctioning large adrenal incidentaloma with suspicious features on imaging. This in fact was an adrenal hemangioma diagnosed postoperatively with histopathology. Case Description: Our patient was 76 year old Hispanic male, active smoker, with medical history significant for well controlled Type 2 diabetes, hyperlipidemia and hypertension. He was seen for evaluation and management of an adrenal incidentaloma discovered on iv contrast enhanced CT performed to investigate recurrent hematuria. Imaging of the abdomen and pelvis revealed a posterior bladder mass measuring up to 2.6 cm and 20.1 cm x 17.1 cm x 20.5 cm left adrenal mass with few punctuate calcifications displacing the left kidney and spleen- findings concerning for adrenal cortical carcinoma. The right adrenal gland unremarkable. Given the size of mass and suspicious features hormonal workup was initiated in preparation for surgery. Workup was unremarkable for Pheochromocytoma {24 hour urine metanephrine 124 (nl: 0–300), normetanephrine 440 (nl: 0–400)}, Cushing syndrome {(negative 1 mg overnight dexamethasone suppression test), ACTH 22 (nl: 7—63)} and hyperaldosteronism (Aldosterone 5, renin 0.7). Patient underwent an uncomplicated total radical left adrenalectomy, he had no evidence of invasive disease. Pathology showed a large entirely encapsulated heterogenous adrenal mass weighing 2300 grams with largely solid (80%) and cystic components. There was hemorrhage and extensive infarcts- findings consistent with a Hemangioma. He recovered well. No evidence of adrenal insufficiency was noted on subsequent follow-ups. He had a normal surveillance CT scan at 6 months. Discussion: Adrenal hemangiomas are difficult to differentiate clinically and radiographically from adrenal cortical cancer. They must be evaluated to exclude hormonal hypersecretion and malignancy. Previous case reports hypothesized that adrenal hemangiomas may have functional hypersecretion due to mass effect on the adrenal parenchyma. There was no evidence of this in our patient. These tumors increase in size overtime. Surgical resection is often necessary to rule out any malignant potential and alleviate symptoms secondary to mass effect. Adrenal hemangiomas though rare and must be considered in the differential diagnosis.

Clinical Features and Outcomes of Adrenal Cavernous Hemangioma: A Study of 8 Cases from a Single Center.

Background Cavernous hemangioma is a rare benign tumor that develops from the adrenal glands. In this study, we present our experience with patients with adrenal cavernous hemangiomas (ACH) in a Chinese population. Methods Demographic, diagnostic, surgical, and pathological findings in patients at a single institution who were adrenalectomized as a result of ACH were retrospectively reviewed. Results Among 601 patients who underwent adrenalectomy, 8 (1.33%; 5 men, 3 women) cases were diagnosed with ACH between January 1, 1998, and December 31, 2018, in a single institution. The mean age was 53.25 ± 11.9 years (range, 35–67 years). Four (50%) were asymptomatic, and three (37.5%) complained of abdominal or flank discomfort. Preoperative computed tomography (CT) revealed ACH in 3 (37.5%) cases. Well-defined borders and heterogeneous enhancement with characteristic progressive partial filling-in were characteristic CT features of ACH (tumor size>3 cm). The mean tumor size was 5.16 ± 3.4 cm (range, 1.5–11 cm). No recurrence occurred during a median follow-up period of 38.37 months (range, 8–60 months). Conclusions ACH was asymptomatic in most cases, and diagnosis could be challenging. Adrenalectomy is a safe treatment modality for ACH, and it ensures favorable outcomes.

Adrenal cavernous hemangioma: a case report

BackgroundAdrenal cavernous hemangiomas are very rare benign tumors that usually present as incidental findings on abdominal imaging. Preoperative differential diagnosis from other benign or malignant adrenal neoplasms may be challenging.Case presentationA 70-year old man was referred for an 8-cm abdominal mass incidentally discovered on a contrast-enhanced computed tomography (CT) performed to investigate a pulmonary nodule. Biochemical tests ruled out any endocrine dysfunction and iodine 123 metaiodobenzylguanidine whole body scintiscan single-photon emission CT excluded a pheocromocitoma. Findings on magnetic resonance imaging were non-specific and the patient was elected for a left adrenalectomy. Histopathological diagnosis revealed a cavernous hemangioma. A portion of the resected tissue was tested for drug sensitivity to mitotane, doxorubicin, and sunitinib.ConclusionsAdrenal hemangioma is a rare disease but should be included in the differential diagnosis of adrenal tumors. The surgical resection is generally required to exclude malignant disease, resolve pressure-related symptoms, and prevent retroperitoneal hemorrhage. Although specific features in diagnostic imaging are often lacking, if the diagnosis is established preoperatively a laparoscopic adrenalectomy can be performed due to the benign nature of the lesion. Doxorubicin and sunitinib were both capable of reducing primary culture cell viability, this suggest that similar drugs may be useful in the medical treatment of adrenal hemangiomas.

Benign Adrenal Hemangiomas May Mimic Metastases on PET

CT or MRI are utilized in the initial evaluation of adrenal incidentalomas; however, overlap exists between benign and malignant lesions on these examinations. The American College of Radiology recommends PET scans to complement CT and MRI for patients with adrenal masses and a moderate-to-high likelihood of neoplastic disease. We present images of a PET-avid adrenal lesion in a patient with pulmonary and pancreatic neoplasms that mimicked metastasis, but was found to be a benign adrenal hemangioma on surgical resection. The use of PET for adrenal tumors, specifically adrenal hemangiomas, will be reviewed.

Giant cavernous hemangioma of the adrenal gland

INTRODUCTIONCavernous hemangioma of the adrenal gland is a rare non-functioning benign neoplasm. PRESENTATION OF CASEA 62-year-old woman with chronic obstructive pulmonary disease was diagnosed as having an incidental non-functioning adrenal tumor. Because of the impossibility of ruling out the presence of malignancy, conventional surgical resection was carried out. The histopathology revealed a 12.5cm×11.5cm×8cm adrenal mass with large and lacunae vascular spaces lined with mature endothelial cells. These findings were compatible with cavernous hemangioma. DISCUSSIONThe majority of patients in the literature underwent surgical resection due to the impossibility of excluding malignancy, because of related symptoms in patients with large masses, or because of the risk of spontaneous tumoral rupture. CONCLUSIONThese tumors are quite infrequent. Due to the low frequency and the lack of specific symptoms, most adrenal hemangiomas are diagnosed postoperatively.

Bilateral Cavernous Hemangiomas Causing Liver and Inferior Vena Cava Compression: A Case Report

This case highlights extensive progression of a relatively rare disease. In our case summary we highlight the progression of a bilateral adrenal hemangioma progressing to a size significant enough to cause severe pain and partially compressing the IVC. Adrenal hemangiomas of this significance are rare, and mass effect to this degree is also an underreported phenomenon. To our knowledge this is the first case of a symptomatic bilateral adrenal hemangioma causing mass effect.

Adrenal hemangioma in a 19-year-old female

Adrenal masses are being detected with increasing frequency due to the widespread use of computed tomography, magnetic resonance imaging and even ultrasonography for the evaluation of diseases with abdominal involvement. It is estimated that adrenal masses are an accidental finding in 1% to 5% of all abdominal CT scans performed. Adrenal hemangiomas are rare and nonfunctioning benign tumors and their differential diagnosis preoperatively is rather challenging. Adrenal hemangiomas are most usually cavernous, unilateral lesions of the adrenal glands; bilateral involvement has been reported twice, which appears between the ages 50 and 70 years, with a 2:1 female-to-male ratio. Approximately 60 surgical cases have been reported in the literature. In general, this tumor is large, and all cases reported were treated with open surgery or retroperitoneoscopic procedure. We report a case of a 19-year-old female patient with adrenal hemangioma that was removed by laparoscopic adrenalectomy.

ES21P LEFT LAPAROSCOPIC ADRENALECTOMY FOR A RARE CAVERNOUS HAEMANGIOMA

Purpose: The adrenal gland is an extremely rare location for a cavernous haemangioma, and so far only 53 cases have been reported in the literature. Here, we present a rare case of a laparoscopically resected left adrenal haemangioma. Indication for resection of adrenal incidentalomas, laparoscopic technique, and unexpected histologies are discussed with review of the current literature.Methodology: Incidentally a 5 × 4 cm adrenal tumour was diagnosed in a 30 year old female patient. Preoperative imaging was performed and hormonactive tumours were ruled out. Laparoscopic left adrenalectomy was carried out using a transabdominal lateral flank approach. After mobilization of the spleen and rotation of the tail of the pancreas medially the adrenal vein was endoscopically clipped. Mobilization of all other borders was performed using the harmonic scalpel.Results: Time of surgery was 100 minutes. Histology revealed a rare case of adrenal cavernous haemangioma. Postoperative follow up after 6 months was normal.Conclusion: Despite comprehensive preoperative work‐up adrenal lesions may present with rare unexpected histologies, including neurogenic tumours, myelolipoma, metastases, adrenal carcinoma, or hemangioma. Adrenal hemangiomas possess a potential risk of haemorrhage, thrombosis and necrosis. Today, laparoscopic adrenalectomy is the safe and effective treatment of choice for benign tumours and isolated metastases. Operative time and complexity are reduced by using the harmonic scalpel. Incidentalomas larger than 4 cm should be resected laparoscopically if no adrenal carcinoma is suspected.

A rare coexistence of adrenal cavernous hemangioma with extramedullar hemopoietic tissue: a case report and brief review of the literature

BackgroundCavernous hemangiomas of the adrenal gland are rare, benign, non-functioning neoplastic tumors. To our knowledge, 55 cases have been reported in the literature to date.Case presentationWe report the first case of a large, non-functioning adrenal cavernous hemangioma that was incidentally found during the preoperative staging workup of a 75 year old woman with left breast adenocarcinoma. Imaging with US, CT scan and MRI showed a heterogeneous 8 cm mass with non-specific radiological features that was located on the left adrenal gland. The mass was surgically excised and pathology revealed an adrenal hemangioma with areas of extramedullar hemopoiesis.ConclusionAlthough adrenal hemangiomas are rare and their preoperative diagnosis is difficult, they should always be included in the differential diagnosis of adrenal neoplasms.

A Case of an Adrenal Hemangioma Mimicking a Pancreatic Tail Tumor

Adrenal hemangiomas are rare non-functioning tumors that originate from the retroperitoneal organs. They are generally asymptomatic, and are usually discovered at autopsy. In 1955, Johnson and Jeppensen reported the first case of a surgically removed adrenal hemangioma. We report a case of adrenal hemangioma that mimicked a pancreatic tail tumor, as detected by computed tomography. We made a diagnosis of an adrenal hemangioma from endoscopic ultrasonography and confirmed the diagnosis following a laparascopic adrenalectomy. If one is suspicious of an adrenal hemangioma, one needs to assess the lesion from every aspect. With the advancement of diagnostic techniques in arteriography, ultrasound, and computed tomography, the frequency of preoperative recognition and diagnosis is on the increase. Still, it is difficult to diagnose an adrenal hemangioma just from an imaging study. One should consider performing surgery for removal of the tumor to rule out a malignancy, and to prevent traumatic rupture. With the case presentation, we review the clinical, radiographic, and pathological features of adrenal hemangiomas. (J Kor Endocr Soc 23:62~65, 2008) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

CT and MR Imaging of Adrenal Hemangioma

Cavernous hemangiomas of the adrenal gland are rare, and we here describe CT and MR features of an additional case including delayed contrast CT. On CT, the tumor appeared as a well-delineated mass. Fatty areas and calcifications were seen. On delayed contrast CT, a progressive enhancement from the periphery to the center of the tumor was noticed, similar to the contrast enhancement of liver hemangiomas. In T1-weighted MR images, a hypointense tumor with a central stellate area of hypointensity was found. The tumor had a predominantly peripheral contrast enhancement. CT and MR findings of adrenal hemangiomas are in some cases similar to those of liver hemangiomas. A tumor resection must be considered if the tumor changes in appearance or size.