75 year old male with a history of urothelial carcinoma.
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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 patient therefore went on to have resection.
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.
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.
Left adrenalectomy - Adrenal haemangioma. No metastatic carcinoma identified.