A Rare Presentation of Lisegang Rings in Adrenal Cavernous Hemangioma : Case Report and Literature Review

Abstract

Background. Adrenal cavernous hemangiomas (AH) are benign nonfunctional vascular tumors rarely discovered as incidental findings on imaging studies or autopsies. This study presents a single case report of AH with another rare finding of the Liesegang ring. Also, we reviewed 73 case reports of cavernous adrenal hemangioma to provide an overview of AH’s clinical characteristics. Case Report. A nonfunctional AH was incidentally discovered in a 59-year-old morbidly obese female patient with a 10-year history of hypertension and thyroidectomy. An abdominal computed tomography (CT) scan showed a left suprarenal mass of ∼16 cm in diameter. While the patient had no clinical manifestations from the hemangioma, all laboratory tests were within the normal values with no indication of a functional adrenal tumor. The mass was removed by open left adrenalectomy. The microscopic histological examination revealed a laminated structure with wide blood-filled spaces with a central core of necrotic and hemorrhagic changes, characteristic of a cavernous AH with the presence of a rare Liesegang ring. Conclusion. Although rare, AH should be considered as a differential diagnosis for adrenal masses. This is the first reported case of a cavernous AH with rare microscopic findings of the Liesegang ring.

Liesegang rings in peritoneal fluid: A rare phenomenon

“…Major factors affecting their formations are charge, flocculation, stoichiometry, chemical concentration, pH, temperature, and impurities 3,5 . They occur as a consequence of the rhythmic and periodic accumulation zones around a central nidus due to alternating cycles of sub‐saturation and super‐saturation of insoluble products of reactants in a colloidal matrix, which precipitates by diffusion resulting in characteristic precipitation rings 3,5,7 . In the current case, the ring‐like structures with a central nidus and inconspicuous laminations of variable thickness were highlighted by Giemsa, Papanicolaou, and PAS stain.…”

“…Liesegang ring has been described in the histology of various pathologies like ovarian endometriosis, para-tubal cyst, renal cyst, xanthogranulomatous pyelonephritis, fibrocystic disease of the breast, fibroadenoma, tuberculous lymphadenitis, cavernous hemangioma, and conjunctival cyst. [2][3][4][5][6][7][8][9][10][11][12][13] However, their description in a cytology specimen was found only occasionally.…”

Adrenal Cavernous Hemangioma: A Rare Incidental Finding from A Routine Ultrasound Assessment

“…3 The presence of hemangioma in the adrenal gland is extremely rare with only 73 cases reported to our knowledge. 2 However, the incidence of this non-functioning, benign vascular tumour has been increasing in number due to the advancement and widespread utilization of the abdominal imaging modalities for the workup of various patient's complaints. Adrenal cavernous hemangioma is commonly unilateral and affects more females in their 6 th to 7 th decade of life with a 3:2 female to male predilection.…”

“…3 The majority of these tumours are asymptomatic or have a vague clinical presentation owing to the tumour's compressive effects towards the surrounding organs when they reach a large size. 2 Most frequently, these adrenal cavernous hemangiomas are incidentally found on ultrasound and CT. Preoperatively, the diagnosis of adrenal cavernous hemangioma is challenging as it is difficult to differentiate from adenoma and adrenal cortical carcinoma. 4 CT scan shows a well demarcated mass with heterogeneous appearance.…”

“…1 To date, there are only 73 cases reported. 2 Its rarity and nonspecific presentation pose a challenge to the radiologists and surgeons in making the correct diagnosis. This case describes a large adrenal hemangioma as incidental finding during routine ultrasound assessment of another condition.…”