Adrenal haemangioma

Case Discussion:

The left adrenal gland demonstrates a soft tissue mass (27HU on non-contrast phase) which demonstrates prominent arterial enhancement peripherally and gradually fills in. It remains a similar attenuation to the aorta on all sequences including delayed scans. 

Incidental note is made of a simple (grade 1) renal cyst on the left. 

The features, although consistent with the eventual diagnosis of an adrenal haemangioma, are indeterminate and a malignant lesion (e.g. adrenal metastasis or adrenal carcinoma) cannot be excluded. 

Histology

Macroscopic description

This is an adrenal gland weighing 29 grams,  covered in fatty  tissue measuring  75 x 40 x 25mm.  On one aspect of  the adrenal  gland,  the covering  fat is  sufficient.  This surface is inked blue, while the other surface is inked black.  The adrenal gland is serially  sliced to  reveal within  the gland  parenchyma there is reddish black tumour mass,  measuring 18 x 14 x  24mm in maximum dimension. Most of the  tumour  mass is  surrounded  by a rim of  adrenal  parenchyma. Focally the tumour  is present on the  surface of the  adrenal gland (inked black) with no overlying fat or adrenal gland.  The remaining adrenal gland is  unremarkable.   

Microscopic description

Sections of adrenal gland show a  circumscribed but non-encapsulated tumour within adrenal gland, involving cortex  and medulla.  There are irregularly shaped  anastomosing  vascular  channels  present,   separated by  variably abundant   hyalinised   collagenous   stroma.   The  vessels  are  lined by endothelial  cells  with  small nuclei  with  only mild  pleomorphism,  and mitotic figures  are not  identified.  In  areas, there are  larger vessels containing  organizing  blood and  fibrin clot.   The features  are most in keeping with a haemangioma.  Focally,  the lesion is disrupted; however, in intact regions, the lesion is clear of margins.  The adjacent adrenal gland is unremarkable.  There is no evidence of metastatic carcinoma.

 Final diagnosis

Left adrenalectomy  - Adrenal haemangioma. No metastatic carcinoma identified.