Adrenal hemangioma

The left adrenal gland demonstrates a soft tissue mass (27HUpatient therefore went on non-contrast phase) which demonstrates prominent arterial enhancement peripherally and gradually fills in. It remains a similar attenuation to the aorta on all sequences including delayed scanshave resection.

Incidental note is made of a simple (grade 1) renal cyst on the left. Histology

The features, although consistent with the eventual diagnosis of an adrenal haemangioma, are indeterminate and a malignant lesion (e.g. adrenal metastasis or adrenal carcinoma) cannot be excluded. 

Histology

Macroscopic description

This is an adrenal gland weighing 29 grams,  covered covered in fatty  tissue tissue measuring  75 75 x 40 x 25mm.  On On one aspect of  the the adrenal  gland gland,  the the covering  fat fat is  sufficient sufficient.  This This surface is inked blue, while the other surface is inked black.  The The adrenal gland is serially  sliced sliced to  reveal reveal within  the the gland  parenchyma parenchyma there is reddish black tumour mass,  measuring measuring 18 x 14 x  24mm 24mm in maximum dimension. Most of the  tumour  mass tumour  mass is  surrounded  by surrounded  by a rim of  adrenal  parenchyma adrenal  parenchyma. Focally the tumour  is is present on the  surface surface of the  adrenal adrenal gland (inked black) with no overlying fat or adrenal gland.  The The remaining adrenal gland is  unremarkable unremarkable.

Microscopic description description

Sections of adrenal gland show a  circumscribed circumscribed but non-encapsulated tumour within adrenal gland, involving cortex  and and medulla.  There There are irregularly shaped  anastomosing  vascular  channels  present anastomosing  vascular  channels  present, separated by  variably variably abundant hyalinised collagenous stroma. The  vessels  are  lined vessels  are  lined by endothelial  cells  with  small cells  with  small nuclei  with  only with  only mild  pleomorphism pleomorphism,  and and mitotic figures  are are not  identified identified.  In  areas In  areas, there are  larger larger vessels containing  organizing  blood organizing  blood and  fibrin fibrin clot. The features  are are most in keeping with a haemangioma.  Focally Focally,  the the lesion is disrupted; however, in intact regions, the lesion is clear of margins.  The The adjacent adrenal gland is unremarkable.  There There is no evidence of metastatic carcinoma.

 Final

Final diagnosis

Left adrenalectomy - Adrenal haemangioma. No metastatic carcinoma identified.