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LETTER TO THE EDITOR |
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Year : 2015 | Volume
: 8
| Issue : 5 | Page : 685-686 |
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Adrenal hemangioma: A rare adrenal lesion
Binit Sureka, Veena Singh, Mukul Sinha, Mahesh Kumar Mittal
Department of Radiodiagnosis and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
Date of Web Publication | 10-Sep-2015 |
Correspondence Address: Binit Sureka Department of Radiodiagnosis and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029 India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0975-2870.164957
How to cite this article: Sureka B, Singh V, Sinha M, Mittal MK. Adrenal hemangioma: A rare adrenal lesion. Med J DY Patil Univ 2015;8:685-6 |
Sir,
A 50-year-old female patient diagnosed case of right breast cancer was admitted to the emergency department with abdominal pain. Ultrasound examination revealed heterogeneous mass lesion in left adrenal gland. Due to the concern of metastasis to the adrenal gland, patient underwent triple phase computed tomography (CT) examination for staging workup prior to surgery. On CT, a heterogeneous mass lesion measuring 3 cm × 3 cm was seen in left adrenal gland which showed classical peripheral nodular enhancement with centripetal filling in delayed phase [Figure 1]. The lesion had a CT density of 12 HU in the unenhanced phase, density of 70 HU in early enhanced phase and density of 22 HU in delayed phase. Absolute percentage washout (APW) was 82%, and relative percentage washout (RPW) was 68%. Since the lesion had classical peripheral nodular enhancement, APW >60% and RPW >40%, the diagnosis of a benign adrenal hemangioma was made. The patient underwent mastectomy for breast malignancy and was started on chemotherapy. In view of radiologically benign and small adrenal lesion, she is on regular follow-up with ultrasound examination to see if there is any increase in the size of the lesion. | Figure 1: (a) Axial noncontrast study showing a heterogeneous soft tissue density mass lesion in the left adrenal measuring 3 cm × 3 cm (b) arterial phase contrast-enhanced computed tomography scan shows peripheral nodular enhancement in left adrenal mass (arrow) (c) delayed phase shows centripetal filling (arrow)
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Adrenal hemangiomas are extremely rare tumors of the adrenal gland, and their differential diagnosis preoperatively is challenging. They are usually seen in the sixth or seventh decade of life with 2:1 female to male ratio. Usually, they are nonfunctioning tumors.[1] The importance of diagnosing adrenal hemangioma cannot be underestimated as adrenal glands are a common site of metastasis for various cancers. Treatment and further management of cancer patients depend on staging and accurate preoperative diagnosis of these benign adrenal masses. In most of the cases, the diagnosis is made after histopathological examination of surgical specimen. However, there are some radiological features that although not entirely specific, should raise the suspicion of adrenal hemangioma. CT scans usually display a characteristic peripheral nodular enhancement with centripetal progression. Speckled calcifications suggestive of phleboliths may be seen.[2],[3] APW >60% and RPW >40% are indicative of benign adrenal lesion.[4]
Management consists of surgical excision. Adrenal incidentalomas >6 cm are excised due to the risk of development of malignancy in 35-98% of cases. Other indications for surgery in cases of adrenal hemangioma include symptoms due to mass-effect and complications such as hemorrhage and rupture.
Differential diagnosis of adrenal lesions with necrotic center includes hemorrhage, adenoma, metastases, pheochromocytoma, adrenocortical carcinoma, abscess, myelolipoma, lymphoma and adrenal pseudolesions like gastric diverticulum, splenules, varices, exophytic hepatic mass, dilated colon, splenic lobulation, upper pole renal cyst, and aneurysm of the splenic artery.[5]
Not all adrenal masses in a known primary are metastasis. Therefore, using proper imaging protocol can differentiate benign and malignant adrenal lesions.
Acknowledgment | | |
Dr. Brij Bhushan Thukral for his guidance.
References | | |
1. | Heis HA, Bani-Hani KE, Bani-Hani BK. Adrenal cavernous haemangioma. Singapore Med J 2008;49:e236-7. |
2. | Yamada T, Ishibashi T, Saito H, Majima K, Tsuda M, Takahashi S, et al. Two cases of adrenal hemangioma: CT and MRI findings with pathological correlations. Radiat Med 2002;20:51-6. |
3. | Quildrian SD, Silberman EA, Vigovich FA, Porto EA. Giant cavernous hemangioma of the adrenal gland. Int J Surg Case Rep 2013;4:219-21. |
4. | Naidu V, Singh B. Adrenal lesions encountered in current medical practice − A review of their radiological imaging. S Afr J Radiol 2013;17:128-38. |
5. | Johnson PT, Horton KM, Fishman EK. Adrenal mass imaging with multidetector CT: Pathologic conditions, pearls, and pitfalls. Radiographics 2009;29:1333-51. |
[Figure 1]
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