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

Madhuri Nishtala; Dan Cai; William Baughman; Christopher R McHenry

doi:10.1016/j.sopen.2019.04.001

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

Surg Open Sci. 2019 Apr 27;1(1):7-13. doi: 10.1016/j.sopen.2019.04.001. eCollection 2019 Jul.

Authors

Madhuri Nishtala¹, Dan Cai^{2

3}, William Baughman^{4

3}, Christopher R McHenry^{5

3}

Affiliations

¹ Department of Surgery, University of Wisconsin, Madison, WI.
² Department of Pathology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
³ Department of MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
⁴ Department of, Radiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
⁵ Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.

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.