Case report of bilateral adrenal leiomyoma with review of literature

Adrenal Leiomyoma: A case report

Introduction and importance

Adrenal Leiomyomas are infrequent tumors with only a few cases reported to date. They are difficult to differentiate from malignant adrenal tumors due to non-specific findings on clinical examination and imaging studies.

Case presentation

We discuss the case of a 49-year old male who had been experiencing generalized abdominal pain for 14 months and was found to have a mass on ultrasonography. Further evaluation with Contrast-enhanced Computerized Tomography (CECT) revealed an uneven soft tissue density mass in the retroperitoneal region of the left side. The histopathological examination of the excised mass was suggestive of a mesenchymal tumor, which was further confirmed as leiomyoma by immunohistochemistry.

Clinical discussion

Adrenal Leiomyomas are rare smooth muscle tumors that present with heterogeneously enhancing mass on radiologic imaging. On histopathological examination, spindle cells arranged in lobules and fascicles can be appreciated. Positive staining for desmin and smooth muscle actin in immunohistochemistry confirms the diagnosis.

Conclusion

Identification of the type of tumor in any adrenal mass is challenging pertaining to the non-specific findings on imaging studies. So, prompt surgical resection is the mainstay of the treatment.

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Adrenal leiomyomas are rare tumors.

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These tumors are usually identified incidentally on USG and CT scans of the abdomen & pelvis.

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Histopathological and immunohistochemical studies of the resected tumor mass aid in reaching a definitive diagnosis.

Review of the Literature on Leiomyoma and Leiomyosarcoma of the Adrenal Gland: A Systematic Analysis of Case Reports

BACKGROUND/AIM

To date few cases of smooth muscle-derived tumors of the adrenal gland have been reported and their treatment remains a medical challenge. The aim of this manuscript was to systematically review the literature and present the tumor characteristics and their management in order to provide a standardized approach to their diagnosis and management.

MATERIALS AND METHODS

We searched five databases (PubMed, Scopus, Elsevier, ResearchGate, Google scholar) for relevant articles published until March 2020.

RESULTS

Twenty-two cases of adrenal leiomyoma, four cases of adrenal smooth muscle tumor and forty-five cases of adrenal leiomyosarcoma were included.

CONCLUSION

We present the demographic, clinical, radiological, pathological and oncological characteristics and prognosis of tumors of the adrenal gland arising from smooth muscle cells, as well as describe the common clinical investigations and therapeutic modalities that have been reported as part of their management.

Primary ovarian leiomyoma with predominant cystic change

Ovarian leiomyoma is a rare benign tumor, seen mostly in women 20-65 years old. The case of a 51-year-old woman with a large tumor in the pelvic cavity is reported. The dominant feature of the tumor was its cystic component, but an irregular, solid component was recognized along the dorsal margin of the tumor. The latter area showed signal intensity as low as muscle on T2-weighted images and significant contrast enhancement; however, it did not show restricted diffusion, which implied that it was benign. The large tumor was resected because malignancy could not be ruled out, and it was pathologically diagnosed as ovarian leiomyoma with predominant necrosis. When a low-intensity component without malignant features is seen on magnetic resonance imaging, leiomyoma should be included in the differential diagnosis despite its rare occurrence in the ovary.