The largest adrenal leiomyoma: A case report and literature review

Abstract

Leiomyoma is a benign tumor of smooth muscle origin. Primary leiomyoma of the adrenal gland is very rare. Adrenal tumors are often diagnosed during the ultrasound or computerized tomography (CT) study as incidentaloma. According to the literature review, up to 2018, the largest size of adrenal leiomyoma which had ever been reported was 12 × 10 × 8 cm in dimension (Maher et al.). Herein, we report the largest adrenal leiomyoma with the tumor mass of 600 g (14,1x11,4x10,1 cm) from a female patient admitted to our hospital.

Review of the Literature on Leiomyoma and Leiomyosarcoma of the Adrenal Gland: A Systematic Analysis of Case Reports

“…A total of 46.43% of cases presented with abdominal or flank pain/discomfort (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). A total of 14.29% of cases presented with weight loss and/or anorexia (7, 13,16,17) and malaise (7, 13,15,18). 1 case out of 28 had fever at the time of diagnosis (7), and 1 presented with weight gain (19).…”

“…A total of 14.29% of the cases had a follow-up image study 4 months -3 years after diagnosis that showed increase of the mass (7,8,21,27). Two cases showed possible IVC extension of the tumor, one of which was confirmed after an inferior venacavagram (25) and the other was found intraoperatively to be compressing the IVC without infiltrating it (13). One case had Hounsfield units (HU) values suggestive of malignancy (17) and one case showed an IVC defect suggestive of thrombus (15).…”

“…One HIV-positive case that died due to sepsis was diagnosed with Non-Hodgkin's lymphoma of the brain in the autopsy findings (24), one case was associated with bilateral testicular microlithiasis and empty sella turcica (22), one case had non-insulin dependent diabetes melitus (28) and one patient had Hashimoto's thyroiditis (27). One patient had a history of hepatitis B infection (13), one had a synchronous ovarian mature cystic teratoma (29) and one patient with congenital immunodeficiency developed a large B-cell EBVpositive lymphoma 5 years after the adrenal leiomyoma was treated (18).…”

“…Management. A total of 39.29% of the cases underwent an open unilateral adrenalectomy (5-7, 12,13,16,17,19,23,26,27). A total of 14.29% of the cases underwent bilateral open adrenalectomy (11,14,18,25), 2 cases had en bloc resection of the tumor with surrounding structures (9,30), 2 patients underwent laparoscopic adrenalectomy (8,29), one patient had bilateral laparoscopic adrenalectomy (10), one case underwent hand-assisted laparoscopic adrenalectomy (28), one patient underwent staged tumor mass resection (15), one case with bilateral involvement had two operations, the first for the excision of one adrenal and the second for the excision of the contralateral adrenal mass as well as resection of splenic and epicardial masses (22), one patient underwent a second exploration 28 days after the first operation for the excision of a residual adrenal tumor (11).…”

“…A total of 33.33% of masses were described as well-defined or round (6,11,16,23,24,28,30) and 23.81% were multilobulated (10,11,14,18,23). Five cases presented a central area of hyalinization, haemorrhage, myxoid change or blot clot (13,14,18,23,30), two had areas of calcification (14,16) and one case presented as a unilocular cyst filled with blood clot (9). Two cases showed no areas of haemorrhage or necrosis (5, 17).…”