A rare cavernous hemangioma of the adrenal gland.
BACKGROUND
Cavernous hemangiomas of the adrenal gland are rare. We report a case of a cavernous hemangioma of the adrenal gland presenting as an adrenal incidentaloma suspicious for adrenal cortical carcinoma (ACC).


METHODS
A 78 year old woman was admitted after a fall. Abdominal computed tomography revealed a large right adrenal lesion with features suspicious for adrenal cortical carcinoma (5.4cm×3.3cm, unilateral, tumor calcifications, average Hounsfield units 55). The tumor was removed intact by a laparoscopic approach and pathology revealed a cavernous hemangioma of the adrenal gland.


CONCLUSIONS
Adrenal incidentalomas are found in up to 10% of patients undergoing abdominal imaging. Differential diagnosis includes both benign and malignant lesions. Guidelines for removal of adrenal incidentalomas recommend surgery based on functional status, size, and presence of concerning features on diagnostic imaging. Cavernous hemangiomas are rare, benign vascular malformations which can be challenging to distinguish pre-operatively from malignant lesions such as ACC.


CONCLUSIONS
Cavernous hemangiomas of the adrenal gland are exceedingly rare. These benign tumors have imaging features which may be suggestive of adrenal cortical carcinoma. The treatment of choice is surgical excision due the difficulty of excluding malignancy.
Department of Surgery, University of Calgary, North Tower, 1403 29th Street Northwest, Calgary, Alberta, Canada T2N 2T9.
Janet P
JP
Edwards
Department of Surgery, University of Calgary, North Tower, 1403 29th Street Northwest, Calgary, Alberta, Canada T2N 2T9.
Heather C
HC
Stuart
Department of Pathology, University of Calgary, North Tower, 1403 29th Street Northwest, Calgary, Alberta, Canada T2N 2T9.
Stefan J
SJ
Urbanski
Department of Surgery, University of Calgary, North Tower, 1403 29th Street Northwest, Calgary, Alberta, Canada T2N 2T9. Electronic address: janice.pasieka@alberthealthservices.ca.
Janice L
JL
Pasieka
Adrenal; Adrenal cortical carcinoma; Cavernous hemangioma