A Case of Hemorrhagic Adrenal Pseudocyst Mimicking Solid Tumor

Abstract

Patient: Female, 78Final Diagnosis: Adrenal pseudocystSymptoms: NoneMedication: —Clinical Procedure: OperationSpecialty: UrologyObjective:Mistake in diagnosisBackground:Adrenal pseudocysts are often discovered incidentally on imaging, but the diagnosis and treatment can be challenging. A case of adrenal pseudocyst with hemorrhage is presented that mimicked a solid tumor on imaging, resulting in adrenalectomy.Case Report:A 78-year-old woman was found to have a right adrenal lesion on abdominal imaging. Enhanced computed tomography (CT) showed a heterogeneously enhanced mass, and magnetic resonance imaging (MRI) showed a high-intensity T1-weighted and T2-weighed image, with an irregular enhanced margin. The imaging findings were suggestive of a solid tumor of the adrenal gland. Although full endocrine serological studies were negative, the lesion increased in size at two-year follow-up. Right laparoscopic adrenalectomy was performed, and a benign hemorrhagic adrenal pseudocyst was diagnosed histologically.Conclusions:Adrenal pseudocyst can be associated with acute intracystic hemorrhage, and imaging will show contrast enhancement, suggesting malignancy. In such cases, surgical excision is both diagnostic and curative.

Benign vascular tumors, cysts, and pseudocysts of the adrenal gland: a contemporary multi-institutional clinicopathological analysis of 55 cases

“…They occur in all age groups but most frequently in the forth to fifth decades. The reported mean diagnostic age of 8 cases was 46 years with lesion size ranging from 0.9 to 17 cm; in our case series, the mean age of 23 cases was 49 years with lesion size ranging from 1.6 to 23.2 cm [15]. The pathogenesis is believed to have a vascular origin, arising from organization of a previous traumatic hematoma or a toxic, infectious or abnormal hemorrhage [6].…”

“…All pseudocysts were unilocular, encapsulated, and devoid of inner wall lining and neoplastic epithelium. A substantial number of reported pseudocysts had well-defined fibrous cystic walls with variably sized cystic cavities and fluid collection with no predominant solid component [15]. However, pseudocysts may also be associated with concurrent adrenal tumors.…”

Role of MRI in the Diagnosis of Large Right Adrenal Abscess

“…These complicated internal cystic components are best evaluated by MRI, especially in cases of intracystic hemorrhage, which shows hyperintensity on T1-and T2-weighted images [15]. Due to the presence of these intracystic components, there have been multiple case reports of adrenal pseudocyst mimicking neoplastic processes [16][17][18]. In our current case, marked uniform restricted diffusion and surrounding edema in the perinephric space favored the diagnosis of an infected pseudocyst.…”

Pseudoquiste adrenal derecho

“…7 Acorde a la clasificación de Levison se dividen en cuatro categorías: quistes endoteliales (45%), quistes epiteliales (9%), pseudoquistes (39%) y quistes parasitarios (7%). 6,[8][9][10][11] Pueden medir desde milímetros hasta 50 cm de diámetro. 12 Son unilaterales, pero se pueden presentar de forma bilateral (8-15%).…”

“…10 La posible etiología del pseudoquiste adrenal incluye: malformación y hemorragia de las venas adrenales a la glándula adrenal por trauma, cirugía o coagulopatía. 3,9…”