title: Large cavernous hemangioma of the adrenal gland: Laparoscopic treatment. Report of a case.
abstract: BACKGROUND
  Cavernous hemangioma of the adrenal gland is a rare benign tumor. The diagnosis is often postoperative on histological exam with the presence of blood-filled, dilated vascular spaces.
  
  
  METHODS
  We report the clinical case of a 49 years-old woman who came to our observation with aspecific abdominal pain. A computed tomography (CT) abdominal scan revealed a 11cm right adrenal mass. This lesion was well circumscribed, round, encapsulated. After iodinated-contrast we observed a progressive, inhomogeneous enhancement without evidence of active bleeding and with pre-operative diagnosis of adrenal hemangioma. Laparoscopic adrenalectomy was performed by a transperitoneal flank approach. Pathological examination revealed a 11cm adrenal mass with extensive central necrotic areas mixed to sinusoidal dilation and fibrotic septa. Postoperative diagnosis was adrenal hemangioma.
  
  
  CONCLUSIONS
  Adrenal hemangiomas occur infrequently. Generally these adrenal masses are non-functioning and there is no specific symptoms. Recent records demonstrate that laparoscopic adrenalectomy is technically safe and feasible for large adrenal tumors, but controversy exists in cases of suspected malignancy. We choose laparoscopic approach to adrenal gland on the basis of preoperative CT abdominal scan that excludes radiological signs of adrenocortical carcinoma (ACC) such as peri-adrenal infiltration and vascular invasion.
  
  
  CONCLUSIONS
  Laparoscopic adrenalectomy is considered the standard treatment in case of diagnosis of benign lesions. In this case report we discussed a large adrenal cavernous hemangioma treated with laparoscopic approach. Fundamental is the study of preoperative endocrine disorders and radiologic findings to exclude signs of malignancy.
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy. Electronic address: antonino.agrusa@unipa.it.
authors.forename: A
authors.initials: A
authors.lastname: Agrusa
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy. Electronic address: giorgio.romano@unipa.it.
authors.forename: G
authors.initials: G
authors.lastname: Romano
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy. Electronic address: salamone.giuseppe@unipa.it.
authors.forename: G
authors.initials: G
authors.lastname: Salamone
authors.affiliation: Department of Human Pathology, Section of Anatomic Pathology, University of Palermo, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Orlando
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy. Electronic address: g.dibuono@libero.it.
authors.forename: G
authors.initials: G
authors.lastname: Di Buono
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy. Electronic address: chianetta83@libero.it.
authors.forename: D
authors.initials: D
authors.lastname: Chianetta
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy. Electronic address: vincenzosorce@me.com.
authors.forename: V
authors.initials: V
authors.lastname: Sorce
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Gulotta
authors.affiliation: Section of Radiology-Di.Bi.Me.F., University of Palermo, Italy. Electronic address: massimo.galia@unipa.it.
authors.forename: M
authors.initials: M
authors.lastname: Galia
authors.affiliation: Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy. Electronic address: gaspare.gulotta@unipa.it.
authors.forename: G
authors.initials: G
authors.lastname: Gulotta
keywords: Adrenal cavernous hemangioma; Adrenal hemangioma; Laparoscopic adrenalectomy; Laparoscopic surgery; Laparoscopy