Angiosarcoma of the adrenal gland with concurrent contralateral advanced renal cell carcinoma: A diagnostic and management dilemma

Incidental adrenal hemangioma clinically suspicious for malignancy: diagnostic considerations and review of the literature

Adrenal hemangiomas are rare lesions often found incidentally during unrelated diagnostic work-up. We report a case of a 67-year-old man with history of hypertension, hyperlipidemia, anemia, arthralgia, joint swelling and unexplained weight loss, which prompted imaging studies. Computed tomography scan revealed a 5.4 cm adrenal mass. The patient had no clinical manifestations of adrenal medullary or cortical hyperfunction. Urine and plasma metanephrines and aldosterone/renin ratio were within normal range. The patient was taking prednisone for hand and ankle swelling, precluding assessment for Cushing syndrome. Given the size of the lesion, the possibility of malignancy was considered, and the patient elected for surgical management. The left adrenalectomy specimen weighed 54 g and revealed a 4.9 cm tan-brown mass with congested cut surface and a thin rim of residual adrenal gland parenchyma. Histologic examination showed thick and thin-walled vessels intermingled with adrenocortical elements at the periphery characteristic of a hemangioma. Surgical resection is the mainstay treatment for large, isolated adrenal masses to exclude malignancy and prevent retroperitoneal hemorrhage. Herein, we report a case of adrenal hemangioma, review a variety of other diagnostic considerations occurring in the adrenal gland, and highlight useful distinguishing features to assist in accurate diagnosis.

Adrenal angiosarcoma with metastasis: Imaging and histopathology of a rare adrenal cancer

Adrenal angiosarcoma is an extremely rare malignancy with few reported cases in the literature. Patients may be asymptomatic or have nonspecific complaints at presentation. There are no pathognomonic imaging findings, while histopathology can be confounding due to overlap with other disease processes. We present a case of a 38-year-old woman with a long history of cocaine abuse who had metastatic adrenal angiosarcoma at the time of presentation. The adrenal tumor was an incidental finding on imaging. CT demonstrated a heterogeneous mass in the right adrenal gland with central calcification, and MRI identified central necrosis in the mass. Histopathology demonstrated sheets of epithelioid cells, dilated anastomotic vascular spaces, and abundant necrosis, and immunohistochemistry was positive for various vascular markers. The findings were consistent with adrenal angiosarcoma. The patient underwent adrenalectomy and is now receiving adjuvant chemotherapy. Due to the aggressive nature of adrenal angiosarcoma, timely diagnosis and treatment is critical. This case adds to the sparse literature surrounding this disease by highlighting crucial imaging and histopathologic findings that will aid in more efficient diagnosis. Although rare, the disease should be considered in the context of suspicious adrenal lesions. In the future, structured review of all reported cases of adrenal angiosarcoma can help inform diagnosis and therapy for this rare disease.

A case report of primary adrenal angiosarcoma as depicted on magnetic resonance imaging

RATIONALE

Angiosarcoma is an extremely rare malignant tumor of endothelial origin. The majority of studies reporting angiosarcoma have been concerned with the clinical and pathological aspects, with limited reporting of their imaging findings. To our knowledge, angiosarcoma of the adrenal gland is very rare. Herein we firstly report a primary adrenal angiosarcoma depicted on magnetic resonance imaging (MRI).

PATIENT CONCERNS

A 59-year-old man was referred to our hospital for 1 year left-flank pain that exacerbated in recent 4 months.

DIAGNOSIS

A regular mass with clear boundary was revealed on MRI in the region of left adrenal gland. Its signal intensity was inhomogeneous. It mainly showed isointensity with patchy slight hyperintensity on T1-weighted images and marked hyperintensity with patchy hypointensity on T2-weighted images. On contrast-enhanced images, it demonstrated significantly heterogeneous enhancement, and the peripheral solid component showed delayed enhancement. Bulky blood vessels and hemorrhage were identified in the tumor.

INTERVENTIONS

The mass was surgically excised under a left laparoscopic adrenalectomy.

OUTCOMES

Left adrenal angiosarcoma was confirmed by pathological and immunohistochemical examinations. No evidence of recurrence was found 6 months after operation.

LESSONS

In conclusion, primary adrenal angiosarcoma has some MRI features corresponding to its pathological nature. It should be included in the differential diagnosis when a mass was detected in the adrenal gland.

[Primary epithelioid adrenal angiosarcoma mimicking undifferentiated carcinoma]

The adrenal primary epithelioid angiosarcoma (ASE) is a rare malignant tumor which can be histologically confused with other neoplasms. We report one case in a 79-year-old man who underwent adrenal tumor surgery for a mass fortuitly discovered by imaging for examination of an inflammatory syndrome associated with anemia. The histological diagnosis was difficult because of the undifferentiated and epithelioid appearance of tumor cells, whose immunohistochemical epithelial markers positivity led to frequent confusion with a metastatic carcinoma. Careful research for vascular differentiation at histopathological study and expression of immunohistochimical endothelial markers, are crucial to confirm the diagnosis.

Angiosarcoma of the Adrenal Gland Treated Using a Multimodal Approach

Angiosarcoma of the adrenal gland is an extremely rare malignancy. We report a case of a 59-year-old female who presented with abdominal pain and profound anemia. A 7 cm enhancing, lipid-poor adrenal mass with calcifications that extended posterior to the vena cava was identified on imaging. Patient underwent right adrenalectomy with retroperitoneal lymph node dissection. Pathology demonstrated angiosarcoma of the adrenal gland. Consolidative treatment included adjuvant radiation and chemotherapy. Patient remains disease free 1.5 years following treatment. Prior reported literature on the diagnosis and management of adrenal angiosarcoma is reviewed.