Patient Data
There is a large thin-walled cystic mass adjacent to the spleen. This lesion does not show solid components or internal vascularity, with its content consisting of fluid with echogenic debris. The study is otherwise unremarkable.
The cystic mass measures up to 8 cm which has thin walls and anechoic content. It apparently originates from the left adrenal gland, which is displaced/compressed by the cyst and is difficult to characterize.
Macroscopy: Labeled "Left adrenal cyst". A cyst 35g and 82 x 68 x 22 mm, with attached adrenal gland 74 x 9 mm, and fat 45 x 32 x 13 mm. The cyst appears to arise from the adrenal gland. There is a defect in the cyst wall, 52 mm (inked green), and a 40 mm staple resection margin which traverses the adrenal gland parenchyma (amputated, resulting surface inked black). The cyst wall is up to 3 mm thick and the internal surface is diffusely roughened, with patchy areas of soft brown discolouration. The cyst is devoid of content however the formalin within the pot is murky, discoloured and gritty. Part processed.
Microscopy: The sections show adrenal gland, arising from the cortex is a unilocular cyst with a fibrous wall. Focally there is a flattened endothelial lining which shows immunoreactivity with CD31, no reactivity is seen for AE1/3, calretenin or WT1. Elsewhere the cyst is lined by proteinaceous material and histiocytic inflammation. The cyst wall contains numerous histiocytes, many of which contain pigmented material as well as two small foci of dystrophic calcification. Focally within the cyst is proteinaceous material containing numerous cholesterol clefts. A laminated cyst wall, daughter cysts or parasites are not identified. The surrounding adrenal gland is normal.
Conclusion: Left adrenal cyst: organizing re-endothelialised hematoma / Hemorrhagic cyst.
Case Discussion
The patient underwent surgical resection that confirmed a hemorrhagic adrenal cyst.