Past history of breast cancer. Adrenal mass.
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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 hemangioma. The smaller lesion has rim calcification suggesting prior hemorrhage or granulomatous disease. Metastatic disease cannot be excluded.
The patient went on to have surgery.
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 hemangioma and a benign calcified nodule.