Adrenal 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.
A 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.
Adrenal 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.
BMC surgery. 2018 Nov 20*** epublish ***
Carlo V Feo, Alessandro De Troia, Massimo Pedriali, Simone Sala, Maria Chiara Zatelli, Paolo Carcoforo, Claudio F Feo
Department of Surgery, Unit of General Surgery, Azienda USL di Ferrara, and University of Ferrara, Ferrara, Italy. ., Department of Surgery, Unit of Surgery 2, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy., Department of Diagnostic Imaging and Laboratory Medicine, Unit of Anatomic Pathology, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy., Department of Diagnostic Imaging and Laboratory Medicine, Unit of Radiology, S. Anna University Hospital of Ferrara, Ferrara, Italy., Department of Medical Sciences, Section of Endocrinology and Internal Medicine, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy., Department of Clinical and Experimental Medicine, Unit of General Surgery 2, University of Sassari, Sassari, Italy.