Endocrine Abstracts

JOINT2069

Cavernous hemangiomas are rare benign vascular lesions that are difficult to diagnose preoperatively. We present two cases of cavernous hemangiomas of the adrenal glands and provide radiographic clues that can hint at the correct diagnosis. The first case is an 80-year-old woman presenting with an enlarging hemorrhagic left adrenal mass measuring 72×63×66 mm. Computed tomography (CT) imaging showed that the mass exhibited marginal and nodular enhancement in the venous post-contrast phase, with no evidence of infiltration into surrounding structures. The hormonal workup was consistent with a non-functioning tumor. The mass was first identified 3 years prior and was described as heterogeneous and of unknown etiology, measuring 27×23 mm. The patient was presented at an adrenal multidisciplinary team meeting and because adrenal cortical carcinoma (ACC) could not be ruled out, the patient underwent a laparoscopic adrenalectomy. Pathohistological findings were consistent with a hemorrhagic cavernous hemangioma of the left adrenal gland. The second case is a 71-year-old woman presenting with an incidentaloma of the right adrenal gland measuring 12 mm with radiological characteristics suspicious of a pheochromocytoma (highly vascular tumor with non-contrast CT HU >20). The patient did not have clinical symptoms suggestive of pheochromocytoma, thus the diagnosis of silent pheochromocytoma was considered. The patient underwent a laparoscopic adrenalectomy with pathohistological findings consistent with a hemorrhagic cavernous hemangioma of the right adrenal gland. Adrenal cavernous hemangiomas are rare benign vascular tumors, and to the best of our knowledge, only 90 cases have been described. Due to the increase in abdominal imaging, the incidence of adrenal incidentalomas is on the rise, and cavernous hemangioms should be considered in the differential diagnosis of lipid-poor lesions. These cases highlight several points. Firstly, they demonstrate the importance of imaging phenotype. The CT reports of both cases described the lesions as heterogenous with high HU. This should raise the concern for potentially malignant lesions, metastatic lesions, or pheochromocytomas. Thus, surgical resection or close follow-up imaging should be considered despite tumor size and hormonal activity. Although these lesions are benign, the natural history is unknown because most cases have been operated. Even with close follow-up imaging, it is often difficult to rule out more sinister lesions. Thus, patients should be presented in multidisciplinary teams with a preference for surgical resection despite negative hormonal workup and size.