Introduction: Adrenal cystic lesions are rare. Differential diagnoses include pseudocysts, echinococcal cysts, hemangiomas, cystic pheochromocytomas, adrenal hematomas and lymphangiomas. We present here a rare case of an adrenal lymphangioma.
Case report: A 35-year old man was referred to our department for investigation of a right adrenal cystic mass, incidentally found during an abdominal ultrasound. The patient was completely asymptomatic and had a medical history of chronic hepatitis C, recently treated with a combination of sofosbuvir and velpatasvir. Physical examination was unremarkable and hormonal evaluation revealed that the mass was non functional. Adrenal CT imaging demonstrated a large multilocular, with low attenuation (2±24 Hounsfield units on non-contrast scan) and non-enhancing cystic lesion of approximately 5 cm diameter with peripheral calcifications. The mass was excised laparoscopically and histopathological examination revealed the presence of a dual-chamber lymphangioma of the adrenal. Immunohistochemical staining was positive for ERG, CD31, CD34 and D2-40, confirming the diagnosis.
Conclusion: Adrenal lymphangiomas are extremely rare. Just around 60 cases have been reported in the literature so far. They are usually large, unilateral, benign, non-secreting masses presenting mainly with pain and showing greater prevalence in young female subjects. Differential diagnosis of adrenal lymphangiomas is challenging due to their rarity. Laboratory evaluation is essential in order to exclude hormonal hypersecretion. In case of large masses over 4 cm surgical excision represents the gold standard of treatment, while it also offers definite diagnosis.
18 - 21 May 2019
European Society of Endocrinology