Adrenal haemangioma

Case contributed by A.Prof Frank Gaillard

Presentation

Past history of breast cancer. Adrenal mass.

Patient Data

Age: 65 years
Gender: Female
CT

Non-contrast, arterial and delayed sequences are obtained through the upper abdomen.

Left-sided well-circumscribed and homogenous adrenal posterior limb mass is noted with peripheral areas of calcification.

On the unenhanced scan, the density of the lesion measures 23 Hounsfield units. After contrast administration, at 1 min, the lesion measures 76 Hounsfield units. At 10 and 15 mins post contrast, the lesion measures 55 and 64 Hounsfield units respectively. Therefore the percentage of relative washout of the lesion is 16%.

The imaged liver, gallbladder and spleen are normal. Left-sided renal cysts are seen ( recent renal ultrasound noted). The imaged lung bases are clear.

Conclusion: There are two left adrenal nodules. On adrenal washout CT they cannot be confidently identified as adenomas. The pattern of enhancement of the (larger) superior lesion raises the possibility of an adrenal haemangioma. The smaller lesion has rim calcification suggesting prior haemorrhage or granulomatous disease. Metastatic disease cannot be excluded.

 

Case Discussion

The patient went on to have surgery.

Histology

MICROSCOPIC DESCRIPTION: Sections show adrenal gland and adipose tissue. There is a proliferation of dilated thin walled CD31+, CD34+, M2A- vessels in the medulla. The vessels are surrounded by thick cuffs of amorphous eosinophilic extracellular material containing erythrocytes and some hemosiderin. The eosinophilic material is negative in Masson and Congo Red stains. It most likely represents extravasated plasma proteins. There is a separate focus of dystrophic calcification in the medulla. The cortex is unremarkable. H+E stains and cytokeratin immunohistochemistry (AE1/AE3, CAM5.2) show no evidence of malignancy.

FINAL DIAGNOSIS: Left adrenal haemangioma and a benign calcified nodule.

PlayAdd to Share

Case information

rID: 33078
Case created: 30th Dec 2014
Last edited: 14th Jul 2016
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.