Adrenal cavernous hemangioma: A rare tumor that mimics adrenal cortical carcinoma

Abstract

Background Adrenal cavernous hemangioma is a rare tumor with only 60 cases previously reported. The aim of this study was to determine the frequency and clinical significance of adrenal cavernous hemangioma at our institution. Methods A retrospective review of consecutive patients undergoing adrenalectomy from 1994 to 2018 was completed to determine the frequency of cavernous hemangioma, characterize the clinical presentation, imaging and pathologic features and review the operative management and outcome. Results Of 144 consecutive patients who underwent adrenalectomy by a single surgeon, 5 (3.5%) had an adrenal cavernous hemangioma. All were incidentally discovered, nonfunctional adrenal masses varying in size from 7 to 12 cm with imaging features that were indeterminate in differentiating a benign adenoma from an adrenal cortical carcinoma. Attenuation values for the adrenal masses on noncontrast computed tomography varied from 28 to 34 Hounsfield units. All adrenal cavernous hemangiomas were large, heterogeneous, complex masses with a variable presence of calcification, hemorrhage, and necrosis. These features, along with tumor enlargement were concerning for adrenal cortical carcinoma. During the operation, there was no local invasion and all adrenal tumors were successfully removed laparoscopically without tumor rupture or bleeding. All patients had an uneventful postoperative course without complications. Conclusion Adrenal cavernous hemangioma is a rare tumor that can grow to a very large size without causing symptoms, making it difficult to differentiate from adrenal cortical carcinoma clinically or radiographically. Despite its large size, adrenal cavernous hemangioma can be safely resected laparoscopically.

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

“…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. 3 Presence of calcification within the mass raises the possibility of a hemangioma but not specific, as other adrenal masses such as carcinoma and cysts may also exhibit this feature.…”

Rare adrenal cavernous hemangioma: a case report highlighting diagnostic challenges

“…Congenital or hereditary factors are usually involved in skin, brain, and liver hemangiomas. These benign tumors present diagnostic challenges as their non-specific imaging characteristics can encompass benign and malignant entities, mainly mimicking adrenocortical carcinomas (5). Specifically, heterogenous features such as calcifications, necrosis, and hemorrhage raise concern for adrenocortical carcinomas when assessing adrenal masses.…”

Clinical Features and Outcomes of Adrenal Cavernous Hemangioma: A Study of 8 Cases from a Single Center

“…It was only indicated that the tumor was mildly enhanced. On imaging, ACH must be differentiated from adrenal schwannoglioma, adrenocortical carcinoma, and hepatic hemangioma [14,15]. e final diagnosis of ACH depends on histopathology.…”