The patient, therefore, went on to have a resection. 

Histology

Macroscopic description

This is an adrenal gland weighing 29 grams,  covered in fatty tissue measuring  75 x 40 x 25mm.  The adrenal gland is serially sliced to reveal within the gland parenchyma a is reddish black tumor mass,  measuring 18 x 14 x  24mm in maximum dimension. Most of the mass is surrounded by a rim of adrenal parenchyma. 

Microscopic description

Sections of adrenal gland show a  circumscribed but a non-encapsulated tumor 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 hemangioma.  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: adrenal hemangioma. No metastatic carcinoma identified.