Adrenal cavernous hemangioma: a case report

Springer Science and Business Media LLC - Tập 18 - Trang 1-5 - 2018
Carlo V. Feo1,2, Alessandro De Troia3, Massimo Pedriali4, Simone Sala5, Maria Chiara Zatelli6, Paolo Carcoforo3, Claudio F. Feo7
1Department of Surgery, Unit of General Surgery, Azienda USL di Ferrara, and University of Ferrara, Ferrara, Italy
2UO di Chirurgia Generale Provinciale, Azienda USL di Ferrara, Ferrara, Italy
3Department of Surgery, Unit of Surgery 2, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy
4Department of Diagnostic Imaging and Laboratory Medicine, Unit of Anatomic Pathology, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy
5Department of Diagnostic Imaging and Laboratory Medicine, Unit of Radiology, S. Anna University Hospital of Ferrara, Ferrara, Italy
6Department of Medical Sciences, Section of Endocrinology and Internal Medicine, S. Anna University Hospital of Ferrara, and University of Ferrara, Ferrara, Italy
7Department of Clinical and Experimental Medicine, Unit of General Surgery 2, University of Sassari, Sassari, Italy

Tóm tắt

Adrenal cavernous hemangiomas are very rare benign tumors that usually present as incidental findings on abdominal imaging. Preoperative differential diagnosis from other benign or malignant adrenal neoplasms may be challenging. A 70-year old man was referred for an 8-cm abdominal mass incidentally discovered on a contrast-enhanced computed tomography (CT) performed to investigate a pulmonary nodule. Biochemical tests ruled out any endocrine dysfunction and iodine 123 metaiodobenzylguanidine whole body scintiscan single-photon emission CT excluded a pheocromocitoma. Findings on magnetic resonance imaging were non-specific and the patient was elected for a left adrenalectomy. Histopathological diagnosis revealed a cavernous hemangioma. A portion of the resected tissue was tested for drug sensitivity to mitotane, doxorubicin, and sunitinib. Adrenal hemangioma is a rare disease but should be included in the differential diagnosis of adrenal tumors. The surgical resection is generally required to exclude malignant disease, resolve pressure-related symptoms, and prevent retroperitoneal hemorrhage. Although specific features in diagnostic imaging are often lacking, if the diagnosis is established preoperatively a laparoscopic adrenalectomy can be performed due to the benign nature of the lesion. Doxorubicin and sunitinib were both capable of reducing primary culture cell viability, this suggest that similar drugs may be useful in the medical treatment of adrenal hemangiomas.

Tài liệu tham khảo

Johnson C, Jeppsen F. Hemangioma of the adrenal. J Urol. 1955;74:573–7. Gagliano T, Gentilin E, Tagliati F, Benfini K, Di Pasquale C, Feo C, Falletta S, Riva E, degli Uberti E, Zatelli MC. Inhibition of epithelial growth factor receptor can play an important role in reducing cell growth and survival in adrenocortical tumors. Biochem Pharmacol. 2015;98(4):639–48. Gagliano T, Gentilin E, Benfini K, Di Pasquale C, Tassinari M, Falletta S, Feo C, Tagliati F, Uberti ED, Zatelli MC. Mitotane enhances doxorubicin cytotoxic activity by inhibiting P-gp in human adrenocortical carcinoma cells. Endocrine. 2014;47(3):943–51. Heis HA, Bani-Hani KE, Bani-Hani BK. Adrenal cavernous haemangioma. Singap Med J. 2008;49:236–7. Arkadopoulos N, Kyriazi M, Yiallourou AI, Stafyla VK, Theodosopoulos T, Dafnios N, Smyrniotis V, Kondi-Pafiti A. A rare coexistence of adrenal cavernous hemangioma with extramedullar hemopoietic tissue: a case report and brief review of the literature. World J Surg Oncol. 2009;7:13. Tarchouli M, Boudhas A, Ratbi MB, Essarghini M, Njoumi N, Sair K, Zentar A. Giant adrenal hemangioma: unusual cause of huge abdominal mass. Can Urol Assoc J. 2015;9:11–2. Oh BR, Jeong YY, Ryu SB, Park YI, Kang HK. A case of adrenal cavernous hemangioma. Int J Urol. 1997;4:608–10. Ng A, Loh H, Shum C, Yip S. A case of adrenal cavernous hemangioma presenting with progressive enlargement and apparent hormonal hypersecretion. Endocr Pr. 2008;14:104–8. Nursal TZ, Yildirim S, Tarim A. Giant adrenal hemangioma: a case report. Acta Chir Belg. 2004;104:224–5. Forbes TL. Retroperitoneal hemorrhage secondary to a ruptured cavernous hemangioma management of perforated duodenal. Can J Surg. 2005;48:78–9. Thiele JW, Bodie B. Adrenal hemangioma. Surgery. 2001;129:373–4. Boraschi P, Campatelli A, Di Vito A, Perri G. Hemorrhage in cavernous hemangioma of the adrenal gland: US, CT and MRI appearances with pathologic correlation. Eur J Radiol. 1995;21:41–3. Yamada T, Ishibashi T, Saito H, Majima K, Tsuda M, Takahashi S, Moriya T. Two cases of adrenal hemangioma: CT and MRI findings with pathological correlations. Radiat Med. 2002;20:51–6. Xu H-X, Liu G-J. Huge. Cavernous hemangioma of the adrenal gland: sonographic, computed tomographic, and magnetic resonance imaging findings. J Ultrasound Med. 2003;22:523–6. Rothberg M, Bastidas J, Mattey WE, Bernas E. Adrenal hemangiomas: angiographic appearance of a rare tumor. Radiology. 1978;126:341–4. Noh JJ, Choi SH, Hwang HK, Kang CM, Lee WJ. Adrenal cavernous hemangioma: a case report with review of the literature. J Pancreas. 2014;15(3):254–7. National Comprehensive Cancer Network. Adrenal Gland Tumors (Version 2.2016). https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf. Accessed 25 Nov 2016. Assalia A, Gagner M. Laparoscopic adrenalectomy. Br J Surg. 2004;91:1259–74. Ramacciato G, Mercantini P, La Torre M, Di Benedetto F, Ercolani G, Ravaioli M, Piccoli M, Melotti G. Is laparoscopic adrenalectomy safe and effective for adrenal masses larger than 7 cm? Surg Endosc Other Interv Tech. 2008;22:516–21. Nigri G, Bellagamba R, Giaccaglia V, Felicioni F, Aurello P, D’Angelo F, Del Gaudio M, Ramacciato G. Minimally invasive adrenalectomy for incidentally discovered cavernous hemangioma. Minim Invasive Ther Allied Technol. 2008;17:255–8. Agrusa A, Romano G, Salamone G, Orlando E, Di Buono G, Chianetta D, Sorce V, Gulotta L, Galia M, Gulotta G. Large cavernous hemangioma of the adrenal gland: laparoscopic treatment. Report of a case. Int J Surg Case Rep. 2015;16:150–3. Feo CV, Portinari M, Maestroni U, Del Rio P, Severi S, Viani L, Pravisani R, Soliani G, Zatelli MC, Ambrosio MR, Tong J, Terrosu G, Bresadola V. Applicability of laparoscopic approach to the resection of large adrenal tumours: a retrospective cohort study on 200 patients. Surg Endosc. 2016;30:3532–40.