Presentation
History of urothelial carcinoma.
Patient Data
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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.
Conclusion:
The features indeterminate and a malignant lesion (e.g. adrenal metastasis or adrenal carcinoma) cannot be excluded.
Case Discussion
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.
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