Adrenal Lymphangioma Research Articles

A case of adrenal lymphangioma successfully treated with laparoscopic partial adrenalectomy

IntroductionAdrenal lymphangioma is a rare benign tumor of lymphatic origin, usually incidentally detected from various imaging studies taken for an unrelated purpose. We present a case of a right adrenal lymphangioma treated successfully with surgical intervention.Case presentationA 36‐year‐old previously healthy woman was referred to our urology department for a right adrenal mass, discovered during a routine health checkup. The tumor had no endocrinological activity, and the patient opted for surgical resection following a concern for malignancy. A laparoscopic right partial adrenalectomy was performed, and on histological examination, the tumor was diagnosed as right adrenal lymphangioma.ConclusionAdrenal lymphangiomas lack disease specific radiological characteristics that allow for a definitive diagnosis from imaging alone. To rule out tumors of potentially malignant nature, surgical intervention should be considered.

Adrenal Lymphangioma and Hypertension: clinical case

Adrenal Lymphangioma and Hypertension: clinical case

MON-388 To Cut Or Not To Cut? Cystic Adrenal Lymphangioma Mimicking Pheochromocytoma.

Background:Lymphangiomas are rare benign vascular tumors. Adrenal gland lymphangiomas are an even less common occurrence. Although usually non-functional, these tumors may mimic pheochromocytomas [1]. We present a case of a patient with a cystic adrenal lymphangioma with elevated catecholamines in the setting of acute appendicitis. Case presentation:A 30 year-old-man with a history of intermittent anxiety presented with abdominal pain. An abdominal computer tomography (CT) scan, physical examination, and laboratory findings were consistent with acute appendicitis. The patient was incidentally found to have a well-demarcated 3.9x4.6 cm right adrenal mass measuring 10 HU. A prior CT scan of the abdomen performed four years earlier showed a 2.5x3.2 cm right adrenal mass. Hormonal evaluation had not been conducted at that time.Further evaluation during the hospitalization revealed normal electrolytes, dehydroepiandrosterone, overnight dexamethasone suppression test, aldosterone/renin ratio and plasma catecholamines. However, 24-hour urine catecholamines and metanephrines were elevated: epinephrine - 63 mcg/24hr (n<21), norepinephrine - 106 mcg/24hr (n 15-80) and dopamine - 540 mcg/24hr (n 65-400). Due to the size of the lesion (>4 cm), surgical resection was recommended. Due to concern that abnormal urinary values could indicate pheochromocytoma, the surgery was preceded by 14 days of alpha-adrenergic blockade. The patient underwent a successful laparoscopic right adrenalectomy with concomitant interval appendectomy. Final pathology results revealed a cystic lymphangioma of the right adrenal gland with positive D2-40 and CD-31 immunohistochemical stains supporting this diagnosis. During follow-up evaluation, the patient reported interval resolution of intermittent anxiety and urine catecholamines/metanephrines gradually normalized. While not confirmatory of a catecholamine secreting adrenal lymphangioma, interval resolution of the anxiety disorder could suggest this diagnosis as a possibility to consider. Conclusion:The rare nature of adrenal lymphangiomas has led to a paucity of information regarding their detection and management [2]. Although typically considered benign, there are no methods at our disposal to confirm this diagnosis without surgical removal. Adrenal lymphangiomas mimicking other adrenal masses, including pheochromocytoma, have been reported [2]. Increasing the awareness regarding these rare tumors may enable providers to be on the lookout for adrenal lymphangiomas when evaluating patients for large unilateral adrenal lesions.

Incidental giant adrenal lymphangioma presenting as nonfunctional cystic mass.

Surrenal masses can be encountered with many different clinical manifestations and a diverse spectrum of etiologies in clinical practice. Recent advances in imaging and laboratory studies as well as their increasingly widespread use and easy accessibility have currently made it possible to diagnose a greater number of surrenal masses than ever. The basic approach principles vary for incidentally detected masses, benign/malignant masses, and hormonoactive masses. Lymphangiomas are benign congenital malformations of lymphatic channels that primarily affect the neck and head region. They are typically found in children younger than 2 years of age, they are uncommon in adults, and they rarely involve surrenal glands. In this paper, we present a woman with a hormonally inactive right giant surrenal mass showing recent rapid growth, which was diagnosed to be a lymphangioma with an atypical localization in the histopathological examination. The patient was operated with right surrenalectomy and total mass excision via laparoscopic lateral transperitoneal approach.

Cystic Lymphangioma: A Rare Disease of the Adrenal Gland

Cystic adrenal neoplasms are uncommon and may be discovered incidentally or may be symptomatic but cystic lymphangioma is a rare benign tumour. The tumour usually occurs in the neck or axilla and rarely involves the adrenal gland. Here we report a case of a 42-year-old lady presented with symptoms of anorexia, vomiting and lethargy for 3 weeks. Apart from evidence of mild dehydration, there was no positive physical examination. Upon admission, her blood urea and creatinine was high and she was diagnosed with end stage renal disease secondary to chronic glomerulonephritis. Ultrasound of the abdomen revealed an incidental right adrenal mass and computed tomography (CT) scan showed a lesion with Hounsfield unit (HU) of 13, 20 and 21 on plain, venous and delayed phase, giving an absolute wash out of 12.5%. Biochemical tests were consistent with a non-functioning adrenal incidentaloma. Hence she was subjected for right retroperitoneoscopic adrenalectomy in view of suspicious of adrenal malignancy. However, histopathology reported as a rare adrenal cystic lymphangioma.

Adrenal Gland Lymphangiomas.

Lymphangiomas of the adrenal glands (ALs) are benign vascular lesions. Approximately, 53 cases have been reported in the literature. The current study reviews and analyzes the clinical and pathologic features of all reported ALs and additionally illustrates a typical case of adrenal lymphangioma (AL). In order to perform the review analysis, a search of the international literature for ALs in adults was conducted. Thirty-eight related articles were found. Clinical and pathological information were obtained for all the reported cases and a database was created. ALs were detected more frequently in women than men. The mean age of occurrence was 39.5years, while their mean size was 8.86cm. Fifty-nine percent of ALs were right-sided. Size and localization were responsible for the presenting symptoms, though 30.4% were asymptomatic. Diagnosis was made postoperatively in all cases by histological results. ALs are rare and benign lesions. They usually present as an incidental finding after abdominal imaging. The diagnosis is made after the surgical removal by histological and immunohistochemical examinations.

Adrenal Lymphangioma Masquerading as a Catecholamine Producing Tumor.

Objective. To report the unusual case of an adrenal lymphangioma presenting in a patient with an adrenal cystic lesion and biochemical testing concerning for pheochromocytoma. The pertinent diagnostic and imaging features of adrenal lymphangiomas are reviewed. Methods. We describe a 59-year-old patient who presented with hyperhidrosis and a 2.2 by 2.2 cm left adrenal nodule. Biochemical evaluation revealed elevated plasma-free normetanephrine, urine normetanephrine, urine vanillylmandelic acid, and urine norepinephrine levels. Elevated plasma norepinephrine levels were not suppressed appropriately with clonidine administration. Results. Given persistent concern for pheochromocytoma, the patient underwent adrenalectomy. The final pathology was consistent with adrenal lymphangioma. Conclusions. Lymphangiomas are benign vascular lesions that can very rarely occur in the adrenal gland. Imaging findings are generally consistent with a cyst but are nonspecific. Excluding malignancy in patients presenting with adrenal cysts can be difficult. Despite its benign nature, the diagnosis of adrenal lymphangioma may ultimately require pathology.

Adrenal Lymphangioma Mimicking Renal Cyst: A Case Report and Review of the Literature

We present a case of a 44-year-old female who was evaluated for left recurrent flank and abdominal pain. Abdominal ultrasonography demonstrated a large cystic mass on the upper pole of the left kidney. Magnetic resonance imaging showed a large, homogenous cystic mass measuring 8.5 × 9.5 cm with well-defined contours, being hypointense on T1-weighted images and hyperintense on T2-weighted images on the upper pole of the left kidney without a distinct plan between adrenal gland. According to clinical and radiological findings, surgical excision was carried out with a subcostal flank incision. Histologic and immunohistochemical examination demonstrates that the definite diagnosis is cystic lymphangioma of the left adrenal gland. Adrenal lymphangioma is a very rare lesion. This is the unique case of an adrenal lymphangioma considered as a renal cyst because of its radiological appearance.

Adrenal lymphangioma removed by a retroperitoneoscopic procedure

We report a case of an adrenal lymphangioma removed by retroperitoneal laparoscopy. A 45-year-old female was referred to the urological ward for an adrenal mass that was incidentally detected by ultrasound examination one month earlier. An abdominal ultrasonography (US) scan revealed a 3.0 cm anechoic cystic mass, while a computed tomography (CT) scan revealed a 3.0×2.7 cm left adrenal cystic mass, which was suspected to be an adrenal cyst. The patient underwent retroperitoneoscopic removal of the tumor. Pathological evaluation revealed a cystic lymphangioma in the left adrenal gland.

Adrenal lymphangioma: clinicopathologic and immunohistochemical characteristics of a rare lesion

Adrenal lymphangiomas, also known as cystic adrenal lymphangiomas, are rare, benign vascular lesions that usually remain asymptomatic throughout life. Although previously adrenal lymphangioma lesions were primarily found at autopsy, they are currently detected during imaging work-up for unrelated causes and are likely to imitate other adrenocortical or adrenal medullary neoplasms. We aimed to retrospectively review all adrenal lymphangioma cases at our hospital and further document their lymphatic origin by immunohistochemical staining. A search of surgical pathology records (1984-2008) was conducted. All hematoxylin and eosin sections were retrieved from archives and reviewed by 2 pathologists in the study. Clinical information was gathered from electronic medical records. Representative paraffin-embedded sections from each case were selected for immunohistochemical analysis using monoclonal antibodies D2-40 and AE1/AE3. A total of 9 adrenal lymphangioma cases were identified (6 women and 3 men). All 9 patients were adults at time of diagnosis with a mean age of 42 years (range, 28-56 years). There were 7 white patients, 1 African American patient, and 1 Asian patient. The average size of an adrenal lymphangioma lesion was 4.9 cm (range, 2.0-13.5 cm). Adrenal lymphangioma was twice more frequently located on the right side (6 right-sided and 3 left-sided). Clinically, 4 (44%) of the 9 lesions presented with abdominal, flank, or back pain. One lymphangioma was found during work-up for labile hypertension. The remaining 4 lesions (44%) were asymptomatic and incidentally found during imaging studies for unrelated causes. Surgical removal was achieved by total adrenalectomy in 8 of the 9 lesions and by partial adrenalectomy in the remaining case. No evidence of recurrence or development of a contralateral lesion was encountered in any of the patients. Histologically, our adrenal lymphangiomas showed a typical multicystic architecture with dilated spaces lined by flattened, bland, simple lining. The cystic channels/spaces occasionally contained proteinaceous material and lacked red blood cell content. On immunohistochemical stains, D2-40 cytoplasmic staining was positive in all 9 examined lesions, whereas AE1/AE3 was negative, thus, confirming their lymphatic nature. D2-40 staining was diffuse in 2 and focal in the 7 remaining lesions. Adrenal lymphangiomas are very rare, benign lymphatic neoplasms with a female, right-sided predominance in our current series. They may clinically present with abdominal pain or can be incidentally found during adulthood as a mass, necessitating surgical removal to rule out other types of adrenal neoplasms.

Cystic lymphangioma of adrenal gland

An 18 year old female presented with vaginal bleeding at 2 months of gestation. Ultrasonography revealed a large retroperitoneal cyst. Histopathological examination of the excised cyst showed features suggestive of a cystic adrenal lymphangioma. This case is reported because of its rarity and detection during pregnancy.

Linfangioma quístico de glándula suprarrenal: A propósito de un caso

Lymphangiomas are rare adrenal lesions, most of them asymptomatic. We report one case of adrenal lymphangioma in a 41-year-old female patient with elevated serum catecholamine levels. Lymphangiomas are multicystic lesions covered by endothelium and with serous content, the differential diagnosis of which is mainly established with hemangioma and adenomatoid tumor. Surgical treatment is indicated in big lesions and symptomatic cases, which are left asymptomatic after surgery.

Adrenal lymphangioma: a case report

We present a case of a 30-year-old female who was evaluated for right flank pain. Clinical and diagnostic work up revealed a urinary tract infection with focal pyelonephritis of the right kidney. Ultrasound and computed tomography of the abdomen were included in the evaluation and revealed incidental finding of cystic structure at right suprarenal space. Follow-up evaluation for further characterization of cyst was performed with MRI and displayed a 4.8×4.5-cm right adrenal cyst containing dystrophic calcification, septations, and minimal nodularity. Surgical resection and histologic findings were compatible with cystic lymphangioma of the adrenal gland. Adrenal lymphangioma is a rare and benign lesion that is most often identified incidentally during radiological investigation or at autopsy. Diagnostic features of adrenal cysts including lymphangiomas are discussed.