A case report of primary adrenal angiosarcoma as depicted on magnetic resonance imaging

Abstract

Rationale:Angiosarcoma is an extremely rare malignant tumor of endothelial origin. The majority of studies reporting angiosarcoma have been concerned with the clinical and pathological aspects, with limited reporting of their imaging findings. To our knowledge, angiosarcoma of the adrenal gland is very rare. Herein we firstly report a primary adrenal angiosarcoma depicted on magnetic resonance imaging (MRI).Patient concerns:A 59-year-old man was referred to our hospital for 1 year left-flank pain that exacerbated in recent 4 months.Diagnosis:A regular mass with clear boundary was revealed on MRI in the region of left adrenal gland. Its signal intensity was inhomogeneous. It mainly showed isointensity with patchy slight hyperintensity on T1-weighted images and marked hyperintensity with patchy hypointensity on T2-weighted images. On contrast-enhanced images, it demonstrated significantly heterogeneous enhancement, and the peripheral solid component showed delayed enhancement. Bulky blood vessels and hemorrhage were identified in the tumor.Interventions:The mass was surgically excised under a left laparoscopic adrenalectomy.Outcomes:Left adrenal angiosarcoma was confirmed by pathological and immunohistochemical examinations. No evidence of recurrence was found 6 months after operation.Lessons:In conclusion, primary adrenal angiosarcoma has some MRI features corresponding to its pathological nature. It should be included in the differential diagnosis when a mass was detected in the adrenal gland.

Primary Adrenal Epithelioid Angiosarcoma: A Case Report

“…Prominent irregular vascular forms have also been described. 21 Most of the features, however, overlap with imaging findings of much more common adrenal masses, in particular, metastases from hypervascular primary tumors, pheochromocytomas, and especially adrenocortical carcinomas. 20 Wash-out enhancement kinetics do not seem to be characteristic of angiosarcomas based on the limited available information.…”

A Rare Case of Primary Adrenal Epithelioid Angiosarcoma

“…Some previous case reports indicate that the imaging findings of adrenal angiosarcoma include a circumscribed mass with T1-hyperintensity, which is likely an intratumoral hemorrhage, punctate calcifications, heterogeneous enhancement, and delayed enhancement [18][19][20][21]. However, a greater proportion of Bosco et al [24] described a case of PAEA in the right adrenal gland of a 54-year-old patient and reported that the tumor cells tested positive for factor VIII and cytokeratin.…”

Adrenal Angiosarcoma: A Diagnostic Dilemma

“…In our case, pathology was inconclusive and required outside review to help establish a diagnosis. Also, adrenal angiosarcomas have more of an epithelioid appearance on histology, as opposed to most angiosarcomas that have vasoformative patterns [1]. Finally, an incorrect diagnosis can be made if a wide immunohistochemical panel is not performed.…”

“…Angiosarcoma is a rare high-grade malignancy that originates from the endothelium of blood and lymphatic vessels. It accounts for less than 1% of all soft tissue sarcomas [1]. Skin and soft tissue angiosarcomas are more common than sarcomas that arise in the visceral organs or bone, which are typically sites of metastatic disease [2-3].…”