Case Reports in Pathology

Case Reports in Pathology / 2019 / Article

Case Report | Open Access

Volume 2019 |Article ID 8463890 | https://doi.org/10.1155/2019/8463890

Jad A. Degheili, Nassib F. Abou Heidar, Mouhammad El-Moussawi, Ayman Tawil, Rami W. Nasr, "Adrenal Cavernous Hemangioma: A Rarely Perceived Pathology—Case Illustration and Review of Literature", Case Reports in Pathology, vol. 2019, Article ID 8463890, 9 pages, 2019. https://doi.org/10.1155/2019/8463890

Adrenal Cavernous Hemangioma: A Rarely Perceived Pathology—Case Illustration and Review of Literature

Academic Editor: Imtiaz A. Chaudhry
Received12 Jul 2019
Revised03 Oct 2019
Accepted29 Nov 2019
Published26 Dec 2019

Abstract

Cavernous hemangiomas are endothelial tumors that rarely affect the adrenal glands. Most of these tumors remain silent and are incidentally found on abdominal imaging. Hardly ever, these tumors are endocrinologically functional. They may present as vague abdominal pain. Surgical resection remains the mainstay for large masses. In this paper, we are presenting a case of adrenal cavernous hemangioma in a 83-year-old male patient who initially presented for workup of vague abdominal and bilateral flank pain. A computed tomography scan of the abdomen showed an 8 cm right adrenal adenoma which was metabolically nonfunctional. The mass was completely resected through an open subcostal incision, with no encountered postoperative complications. A highlight of all published cases of adrenal hemangiomas since 1955 is also presented and reviewed.

1. Introduction

Incidental adrenal masses are a growing concern, especially with the significant increase in their detection upon the many abdominal imaging modalities utilized for the workup of various patient’s complaints. The prevalence of incidental adrenal masses approaches 7% in the general population [1]. Adrenal masses tend to be heterogeneous in nature and comprise of benign adenomas, secreting adenomas, lymphomas, myelolipomas, cysts, and adrenocortical carcinoma most commonly as well as other rarer pathologies such as adenomatoid tumors and sex-cord stromal tumors [2]. On the other hand, adrenal cavernous hemangiomas are unusual tumors arising from the endothelial lining of blood vessels [3]. We hereby present a case of a cavernous hemangioma diagnosed on histopathology after an adrenalectomy, as well as a review of all reported cases of this entity in the literature.

2. Case Presentation

A 83-year-old previously healthy male presented with vague abdominal and bilateral flank pain of several months duration. The pain was dull in nature, with no recent change in weight and appetite, no reported hematuria, no gastrointestinal symptoms, and no reported episodes of headache. All basic blood work up, including complete blood count, creatinine, electrolytes, and liver function tests, were within normal range. An initial imaging with an enhanced computed tomography (CT) scan of the abdomen and pelvis was performed, revealing a right supra renal mass measuring around 8 cm in greatest dimension, possessing a significant enhancement, with a Hounsfield Unit (HU) of 15 on noncontrast phase and a 55HU on the contrast phase. No other abdominal or pelvic findings were noted.

For better characterization of such adrenal lesion, a Magnetic Resonance Imaging (MRI) of the abdomen with gadolinium was requested. Again showing was a mass in the right suprarenal space, measuring 7.3 × 6.5 × 6 cm, showing heterogeneous signal intensity on all sequences, predominately mildly increased on T2-weighted and predominately decreased signal on T1-weighted images, and no appreciable signal drop on the out-of-phase images. The lesion appeared inseparable from the lateral limb of the right adrenal gland and remained separate from the upper edge cortex of the right kidney (Figure 1).

Imaging was also accompanied by a full metabolic work-up, as usually performed for any incidentally discovered large adrenal mass, including: urine and plasma metanephrines, dexamethasone suppression test, DHEA-S, and aldosterone/renin ratio, and all yielded results were within normal range.

Due to the size of the tumor, a shared decision was made to surgically remove the adrenal gland due to a potential risk of being an adrenocortical carcinoma. The patient therefore underwent a right radical adrenalectomy through an open subcostal incision. Intraoperatively, the adrenal was noticeably friable and tended to bleed on minimal manipulation, which was expected from the preoperative imaging done (Figure 1). No significant blood loss was encountered since complete dissection of the adrenal gland was done for better hemostatic control.

On gross pathological examination, the specimen measured 8 × 7 × 3 cm and the tumor was shiny tan-yellow, in nature with distinct demarcation from the normal adrenal parenchyma. Histologically, the tumor was proven to be a hemorrhagic cavernous hemangioma (Figure 2).

Patient recovered well after his operation with no complications encountered thereafter. He was discharged home on his fourth postoperative day, to follow-up in clinic one month from discharge.

3. Discussion

Cavernous hemangiomas are unusual tumors of the endothelial linings with a propensity for skin, liver, and brain involvement [3]. Cavernous hemangiomas tend rarely to affect the genitourinary system [3].

Adrenal hemangiomas are one of the rarest nonfunctioning benign adrenal tumors that are commonly diagnosed postoperatively [4]. Although many cases of adrenal hemangiomas were presented at autopsy reports before 1869, the first surgical adrenal hemangioma was reported by Johnson and Jeppesen in 1995 [3].

Sixty-six cases of adrenal cavernous hemangiomas were published between the years 1955 and 2018 (Table 1), and identified after conducting an extensive literature review using PubMed, Medline, Embase, and Scopus databases. These cases were reviewed and summarized in Table 2. The median age of patients at diagnosis was 60 years. This neoplasm had a female preponderance with a female to male prevalence ratio of 3 to 2. No laterality preference was associated with adrenal hemangiomas. Two bilateral cases were only reported in the literature so far. Metabolic workup of adrenal neoplasms was normal in 45 of the 66 reported cases. Only 6 clinically functional adrenal hemangiomas were identified; with 3 cases of hyperaldosteronism and three other cases of subclinical Cushing’s syndrome. The so far reported cases of adrenal hemangiomas, with detailed published tumor characteristics, exhibited a mean diameter of 11 cm and a mean weight of 752 grams. Of the 66 published cases, 38 were incidentalomas that were clinically silent and asymptomatic; 8 presented with vague abdominal symptoms such as bloating, epigastric pain, and heaviness, and 6 cases reported solely flank pain. Another two cases presented with spontaneous rupture of the adrenal mass with subsequent retroperitoneal hemorrhage and hematoma; a serious complication that is seldom seen.


Case numberAuthors (year of publication)Age/genderLateralitySize (cm)PresentationSurgery

1Johnson and Jeppesen (1955) [3]46/FRight6.5  4  3HypertensionOpen right adrenalectomy
2Elliot et al. (1963) [5]37/FLeft25Incidental findingOpen left adrenalectomy
3Chodof et al. (1966) [6]76/FLeft18  16Abdominal mass and discomfortOpen left adrenalectomy
4Weiss and Schulte (1966) [7]70 /MRight11  7  6Acute urinary retention (−ve met)Open right adrenalectomy
5Ruebel (1973) [8]75/MRight8  7.3  6.5HematuriaOpen right adrenalectomy
6Rothberg et al. (1978) [9]72`/FRight14  10  7Long standing hypertensionOpen right adrenalectomy
7Rothberg et al. (1978) [9]74/FLeft9  8Incidental findingOpen left adrenalectomy
8Vargas (1980) [10]67/FLeftNAIncidental finding on barium study for chronic anemiaOpen left adrenalectomy
9Lee et al. (1982) [11]59/FRight8.5  7  6Incidental abdominal calcificationOpen right adrenalectomy
10Orringer et al. (1983) [4]51/MRight17Epigastric heavinessExploratory laparotomy with adrenalectomy
11Goren et al. (1986) [12]79/FRight9  7  5Incidental finding (−ve metab)Open right adrenalectomy
12Nakagawa et al. (1986) [13]71/MLeft10  18  24Night sweat and generalised fatigueOpen left adrenalectomy
13Guerin et al. (1988) [14]78/FLeft3  2.5  2.5Elevated ESROpen left adrenalectomy
14Derchi et al. (1989) [15]69/FLeft20Incidental findingOpen left adrenalectomy
15Derchi et al. (1989) [15]60/MRight18Hepatomegaly and abdominal painOpen right adrenalectomy
16Yoshihirio et al. (1990) [16]78/FLeft6  5.5  5Incidental findingOpen left adrenallectomy
17Honig et al. (1991) [17]73/MLeftNAIncidental findingExprolatory laparotomy with adrenalectomy
18Takahe et al. (1991) [18]55/MLeft10  9  9Incidental findingOpen left adrenalectomy with splenectomy
19Salup et al. (1992) [19]73/FLeft15Syncope (incidental finding)Open left adrenalectomy,distal pancreatectomy, splenectomy and left radical nephrectomy
20Hamrick et al. (1993) [20]66/Mleft9Incidental findingOpen adrenalectomy
21Sabanegh et al. (1993) [21]60/Fleft20  20Incidental findingOpen left adrenalectomy
22Boraschi et al. (1995) [22]64/Mright10  8  6.5Megaloblastic anemiaOpen adrenalectomy
23Stumvoll et al. (1996) [23]60/FRight8Mineralocorticoid excess syndromeOpen partial right adrenalectomy
24Marotti et al. (1997) [24]68/FLeft14  10  10Incidental findingOpen adrenalectomy
25Marotti et al. (1997) [24]60/FLeft9  7.5  5Incidental findingOpen adrenalectomy
26Oh et al. (1997) [25]56/MRight6  5  4Right flank discomfortOpen right adrenalectomy
27Hayakawa et al. (1998) [26]56/MLeft5Incidental findingOpen left adrenalectomy
28Hisham et al. (1998) [27]61/FRight25Flank painOpen right adrenalectomy
29Makiyama et al. (1998) [28]61/FRight5.5  3.5  3.5Incidental findingOpen right adrenalectomy
30Thiele and Bodie (2001) [29]72/FLeft9.5  4.2  4.5Incidental findingOpen left adrenalectomy
31Yagisawa et al. (2001) [30]52/MRight6.5  7Dull back painLaparoscopic right adrenalectomy
32Xu and Liu (2002) [31]60/MRight17Abdominal mass incidental findingOpen right adrenalectomy
33Nursal et al. (2004) [32]48/FLeft13Palpitation and unremitting hypertensionLaparotomy with left adrenalectomy
34Wang et al. (2004) [33]63/FLeft5.5  5  4Left upper quadrant painLeft adrenalectomy
35Forbes (2005) [34]75/MLeft19  18  8Retroperitoneal hemorrhageLaparotomy
36Heis et al. (2008) [35]50/FRight10Flank painOpen right adrenalectomy
37Ng et al. (2008) [36]59/MLeft3.1  2.9Incidental finding (primary hyperaldosteronism)Laparoscopic left adrenalectomy
38Nigri et al. (2008) [37]58/FRight7  4.5  3Incidental findingLaparoscopic right adrenalectomy
39Arkadopoulos et al. (2009) [38]75/FLeft8  6  4Incidental findingOpen left adrenalectomy
40Matsuda et al. (2009) [39]51/MLeft4  4  3.5Incidental findingLaparoscopic left adrenalectomy
41Siddiqi et al. (2009) [40]54/FRight2.8  2.5Abdominal painNA
42Telem et al. (2009) [41]42/FLeft12Left flank painLaparoscopic left adrenalectomy q
43Cheong and Kim (2010) [42]66/FLeft4.5  3.4Incidental findingLaparoscopic left adrenalectomy
44Paluszkieweicz et al. (2010) [43]45/MLeftNARetroperitoneal hemorrhageLaparotomy
45Abu EL Ghar et al. (2011) [44]44/MRight11  6Incidental findingNA
46Al Jabri et al. (2011) [45]19/FRight4.3  7.3  5.4Incidental findingLaparoscopic right adrenalectomy
47kieger et al. (2011) [46]53/FRight2Microscopic hematuriaNo surgical management
48Oishi et al. (2012) [47]75/FLeft5  5  3Incidental finding with positive metabolic workup for subclinical cushing diseaseOpen adrenalectomy
49Quildrian et al. (2012) [48]62/FLeft12.5  11.5  8Incidental findingOpen left adrenalectomy
50Edward et al. (2013) [49]78/FRight5.4  3.3Incidental findingLaparoscopic right adrenalectomy
51Galea et al. (2013) [50]84/FLeft13  11Flank painOpen left adrenalectomy
52Noh et al. (2014) [51]27/FRight7.8  7.8Incidental findingLaparoscopic right adrenalectomy
53Wang et al. (2014) [52]37/MRight6  5  4.5Incidental findingLaparoscopic right adrenalectomy
54Agrusa et al. (2015) [53]49/FRight11  7.5  7Nonspecific abdominal symptoms (epigastric pain, nausea and vomiting)Laparoscopic right adrenalectomy
55Wong et al. (2015) [54]80/FRight12.3  13.9  13.8Incidental findingLaparotomy and right adrenalectomy
56Pang et al. (2015) [55]71/FLeft9.5  8  7.5Chronic abdominal distentionLaparoscopic left adrenalectomy
57Tarchouli et al. (2015) [56]71/FRight42  38  17Intermittent abdominal pain and increase abdominal girthLaparotomy and open adrenalectomy
58Bacha et al. (2016) [57]60/MLeft17.5  17  9Incidental findingOpen adrenalectomy
59Kinebuchi et al. (2016) [58]77/MLeft5.4  4.3Incidental findingLaparoscopic adrenalectomy
60Njoumi et al. (2017) [59]30/FRight7Incidental findingLaparoscopic right adrenalectomy
61Tadic et al. (2017) [60]50/FRight11.5  11  11Intermittent flank pain and abdominal discomfortOpen right adrenalectomy
62Feo et al. (2018) [61]70/MLeft9  6.5  7Incidental findingOpen left adrenalectomy
63Hashimoto et al. (2018) [62]70/MLeft27  17  5.5Loss of appetiteLaparoscopic left adrenalectomy
64Iwamot et al. (2018) [63]52/MLeft5  3.7  3Incidental findingAdreno-nephrectomy
65Lavingia et al. (2018) [64]64/MRight64  5.5  4.7Incidental findingOpen right adrenalectomy
66Peng et al. (2018) [65]31/FRightNARight upper quadrant and flank painLaparotomy and adrenalectomy


CharacteristicsData ()

Median age (year)60.04

Sex
Female41(62%)
Male25((38%)

Laterality
Right31(47%)
Left35(53%)
Mean size (cm)10.8
Mean weight (g)751.9

Symptoms
Asymptomatic38(57.5%)
Vague abdominal symptoms8(12.1%)
Flank pain6(9%)

Speckled calcifications
Present29(44%)
Absent32(48.5%)

Metabolic workup
Normal45(68%)
Abnormal6 (9%)
Hyperaldosteronism3(4.5%)
Subclinical Cushing’s syndrome3(4.5%)

Surgical approach
Open47(71%)
Laparoscopic16(24%)

On imaging, 32 adrenal masses were associated with speckled calcification, a historically described finding in any adrenal hemangioma; and 29 cases failed to show calcifications. Sixty-five of the reported cases were managed surgically; out of them, 47 were excised through an open approach, and the remaining 16 cases were excised laparoscopically.

Most of the cavernous hemangiomas reported in the literature are incidental findings on imaging performed for unrelated or unspecific complaints [66]. These tumors grow insidiously until they reach a large size and start producing symptoms by virtue of mass effect and mechanical pressure on adjacent organs. Vague symptoms such as fever, weight loss, and sweating are nonspecific findings for neoplastic lesions that are reported in adrenal hemangiomas [41, 67]. Flank pain in the setting of normal urine analysis is the most commonly reported presenting complaint in symptomatic patients. Hypertension has been identified as a presenting symptom for adrenal hemangiomas in the setting of normal adrenal functions. Six cases reported so far presented with a hyperfunctioning adrenal mass; three of them presented with signs of hyperaldosteronism such as hypokalemia, and three other cases were consistent with subclinical Cushing [20, 44].

Histopathologically, adrenal hemangiomas are stratified into two subtypes: cavernous and capillary. The cavernous subtype is composed of an enlarged mass of blood filled endothelially-lined sinusoids, displacing potentially normal tissues. Whereas in the rarer capillary subtype, it is composed of small tufts of submucosal capillaries arranged in radiating loops or lobules [20].

Historically, adrenal hemangiomas were usually identified on plain abdominal radiographies for unrelated complaints. On radiographs, these neoplasms appear as calcified masses. Calcifications, if present, are universally speckled through the entire mass as opposed to the curvilinear calcifications usually associated with adrenal pseudocysts [68]. Computed tomography can effectively define the anatomy, configuration, and volume of any adrenal mass and can partially delineate the general tissue’s characteristics. On CT scanning, these masses are generally encapsulated and heterogenous with scattered calcifications [68]. Calcifications are usually correlated with benign adrenal lesions; however, some reports describe calcifications in malignant lesions as well. Therefore, calcifications become an unreliable sign to assess the malignant potential of any adrenal mass. Cavernous hemangiomas are mostly masses with smooth margins and low relative attenuation coefficient [20, 68]. However, rim-like calcifications within the suprarenal glands have been adopted radiologically as a sign of benignity of such lesions. A radiologic sign was first described by Rothberg et al., referred to as phleboliths, which are round calcifications with translucent centers. This finding is considered pathognomonic for adrenal gland hemangiomas [68, 69]. CT scan has been shown to be superior to ultrasound for suprarenal masses. The masses are usually heterogeneously echogenic on ultrasonography. Magnetic Resonance Imaging (MRI) has sometimes been used, although a CT scan is enough as an imaging modality to identify adrenal neoplasms. Cavernous hemangiomas are hypo-intense masses on T1-weighted images and hyper-intense on T2-weighted images with peripheral enhancement after contrast administration [66].

Although not required for routine diagnostic workup of any adrenal masses, angiography on adrenal hemangiomas can reveal marked neovascularity with small vascular channels, usually arranged in a rim-like manner which retain contrast in delayed films [69]. These angiomas could be of many variants which include: angiomyelolipoma (more commonly seen), angiolipomas, cavernous hemangiomas, or epithelioid hemangioendothelioma, depending on the histopathological differences. Moreover, during pathologic examination, adrenal hemangiomas could be mistaken for adrenocortical carcinoma that has undergone cystic degeneration; therefore proper assessment of the subcapsular area is paramount [25].

After identification of adrenal masses on imaging, the common practice necessitated a full hormonal and metabolic workup to rule out primary functioning adrenal neoplasms mainly pheochromocytomas. Most cases of adrenal cavernous hemangiomas are nonsecretory and hormonally silent neoplasms [44]. Due to the scarcity of this condition, no guidelines have been developed so far to guide the treatment and therapeutic management of such entity.

Tumors originating from vessels could be associated with syndromes, but these are rather neonatal tumors, and not acquired tumors such as our present case. Nevertheless, there has been a previous single report of an adrenal cavernous hemangioma associated with familial adenomatous polyposis [57].

Most adrenal hemangiomas reported in the literature were managed surgically [20]. Asymptomatic small and benign-looking masses may be treated medically and conservatively with close monitoring. However, the follow-up schedule tends to be according to physician’s preference. Larger masses bear the risk of spontaneous hemorrhage and should be resected surgically [20, 44]. Early cases were operated through open adrenalectomy. However, a laparoscopic approach is favored due to better postoperative results and lesser complications [70]. Knowing that, the risk of malignancy might sway the operating surgeon against a minimally invasive approach.

4. Conclusion

Adrenal cavernous hemangioma is a rare entity that might be encountered when dealing with an adrenal pathology. Surgical resection is sometimes necessary to rule out any malignant potential and alleviate symptoms secondary to mass effect. Retroperitoneal bleeding is a concern in such pathology, especially when large lesions are detected. Observation is an alternative in cases where lesions are small, asymptomatic, and metabolically inactive, especially when confirmed by biopsy.

Ethical Approval

Written consent was obtained from the patient to publish his case including clinical and pathological images, and available to Editor-in-chief upon his request.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Authors’ Contributions

N.A. and M.M. performed the literature review, J.D., N.A. and R.N. were involved in the workup and surgery, N.A., J.D., and M.M. wrote the initial draft of the manuscript. A.T. provided the histopathological slides and commentaries. All authors approved of the final manuscript prior to submission. Jad A. Degheili and Nassib F. Abou Heidar were contributed equally to this manuscript and qualify as first authors.

References

  1. W. W. Mayo-Smith, J. H. Song, G. L. Boland et al., “Management of incidental adrenal masses: a white paper of the ACR incidental findings committee,” Journal of the American College of Radiology, vol. 14, no. 8, pp. 1038–1044, 2017. View at: Publisher Site | Google Scholar
  2. H. S. Bhat and B. N. Tiyadath, “Management of adrenal masses,” Indian Journal of Surgical Oncology, vol. 8, no. 1, pp. 67–73, 2017Mar. View at: Publisher Site | Google Scholar
  3. C. C. Johnson and F. B. Jeppesen, “Hemangioma of the adrenal,” Journal of Urology, vol. 74, no. 5, pp. 573–575, 1955 Nov. View at: Publisher Site | Google Scholar
  4. R. D. Orringer, J. A. Lynch, and W. V. McDermott, “Cavernous hemangioma of the adrenal gland,” Journal of Surgical Oncology, vol. 22, no. 2, pp. 106–108, 1983. View at: Publisher Site | Google Scholar
  5. G. B. Elliott, R. H. Walker, A. S. Wright, and K. A. Elliott, “Adrenal giant cyst: hemangioma of medulla with osmotic pseudocyst formation,” Annals of Surgery, vol. 159, no. 2, pp. 275–278, 1964. View at: Publisher Site | Google Scholar
  6. R. J. Chodoff, J. W. Smith, and N. Hering, “Cavernous hemangioma of the adrenal gland,” The American Journal of Surgery, vol. 111, no. 4, pp. 595–597, 1966. View at: Publisher Site | Google Scholar
  7. J. M. Weiss and J. W. Schulte, “Adrenal hemangioma: a case report,” Journal of Urology, vol. 95, no. 5, pp. 604–606, 1966. View at: Publisher Site | Google Scholar
  8. A. A. Ruebel, “Adrenal hemangioma,” Urology, vol. 2, no. 3, pp. 289–291, 1973. View at: Publisher Site | Google Scholar
  9. M. Rothberg, J. Bastidas, W. E. Mattey, and E. Bernas, “Adrenal hemangiomas: angiographic appearance of a rare tumor,” Radiology, vol. 126, no. 2, pp. 341–344, 1978. View at: Publisher Site | Google Scholar
  10. A. D. Vargas, “Adrenal hemangioma,” Urology, vol. 16, no. 4, pp. 389-390, 1980. View at: Publisher Site | Google Scholar
  11. W. J. Lee, J. Weinreb, S. Kumari, G. Phillips, R. Pochaczevsky, and G. Pillari, “Case report adrenal hemangioma,” Journal of Computer Assisted Tomography, vol. 6, no. 2, pp. 392–394, 1982. View at: Publisher Site | Google Scholar
  12. E. Goren, D. Bensal, R. M. Reif, and A. Eidelman, “Cavernous hemangioma of the adrenal gland,” Journal of Urology, vol. 135, no. 2, pp. 341-342, 1986. View at: Publisher Site | Google Scholar
  13. N. Nakagawa, M. Takahashi, K. Maeda, N. Fujimura, and M. Yufu, “Case report: adrenal haemangioma coexisting with malignant haemangioendothelioma,” Clinical Radiology, vol. 37, no. 1, pp. 97–99, 1986. View at: Publisher Site | Google Scholar
  14. E. Guérin, C. Babin, C. Lehujeur, G. Lucas, and F. Barret, “Hemangioma of the adrenal gland. Apropos of a case,” Journal of Radiology, vol. 69, no. 1, pp. 57–59, 1988. View at: Google Scholar
  15. L. E. Derchi, G. L. Rapaccini, A. Banderali, F. M. Danza, and F. Grillo, “Ultrasound and CT findings in two cases of hemangioma of the adrenal gland,” Journal of Computer Assisted Tomography, vol. 13, no. 4, pp. 659–661, 1989. View at: Publisher Site | Google Scholar
  16. K. Yoshihiro and S. Irisawa, “Adrenal hemangioma: a case report,” Acta Urologica Japonica, vol. 36, no. 2, pp. 143–145, 1990. View at: Google Scholar
  17. S. C. Honig, M. S. Klavans, C. Hyde, and M. B. Siroky, “Adrenal hemangioma: an unusual adrenal mass delineated with magnetic resonance imaging,” Journal of Urology, vol. 146, no. 2, pp. 400–402, 1991. View at: Publisher Site | Google Scholar
  18. N. Takaha, M. Hosomi, K. Sekii et al., “Retroperitoneal cavernous hemangioma: a case report,” Hinyokika Kiyo Acta Urologica Japonica, vol. 37, no. 7, pp. 725–728, 1991. View at: Google Scholar
  19. R. Salup, R. Finegold, D. Borochovitz, M. Boehnke, and M. Posner, “Cavernous hemangioma of the adrenal gland,” Journal of Urology, vol. 147, no. 1, pp. 110–112, 1992. View at: Publisher Site | Google Scholar
  20. J. E. Hamrick-Turner, P. L. Grider, B. C. Allen, J. E. Fowler, P. E. Cranston, and R. B. Harrison, “Adrenal hemangioma: MR findings with pathologic correlation,” Journal of Computer Assisted Tomography, vol. 17, no. 3, pp. 503–505, 1993. View at: Publisher Site | Google Scholar
  21. E. Sabanegh, M. J. Harris, and D. Grider, “Cavernous adrenal hemangioma,” Urology, vol. 42, no. 3, pp. 327–330, 1993. View at: Publisher Site | Google Scholar
  22. P. Boraschi, A. Campatelli, A. Di Vito, and G. Perri, “Hemorrhage in cavernous hemangioma of the adrenal gland: US, CT and MRI appearances with pathologic correlation,” European Journal of Radiology, vol. 21, no. 1, pp. 41–43, 1995. View at: Publisher Site | Google Scholar
  23. M. Stumvoll, A. Fritsche, M. Wehrmann, F. Dammann, H. D. Becker, and M. Eggstein, “A functioning adrenocortical hemangioma,” Journal of Urology, vol. 155, no. 2, pp. 638–638, 1996. View at: Publisher Site | Google Scholar
  24. M. Marotti, Z. Sucić, I. Krolo et al., “Adrenal cavernous hemangioma: MRI, CT, and US appearance,” European Radiology, vol. 7, no. 5, pp. 691–694, 1997. View at: Publisher Site | Google Scholar
  25. B. R. Oh, Y. Y. Jeong, S. B. Ryu, Y. I. Park, and H. K. Kang, “A case of adrenal cavernous hemangioma,” International Journal of Urology, vol. 4, no. 6, pp. 608–610, 1997. View at: Publisher Site | Google Scholar
  26. K. Hayakawa, H. Sato, T. Aoyagi, M. Ohashi, H. Ishikawa, and M. Hata, “Cavernous hemangioma of the adrenal gland in a patient on chronic hemodialysis,” Journal of Urology, vol. 160, no. 4, pp. 1418-1419, 1998. View at: Publisher Site | Google Scholar
  27. A. N. Hisham, S. A. Samad, and N. A. Sharifah, “Huge adrenal haemangioma,” Australasian Radiology, vol. 42, no. 3, pp. 250-251, 1998. View at: Publisher Site | Google Scholar
  28. K. Makiyama, H. Fukuoka, K. Kawamoto, and Y. Suwa, “Surgical removal of adrenal hemangioma after five years of follow-up: a case report,” Hinyokika Kiyo, vol. 44, no. 8, pp. 579–581, 1998. View at: Google Scholar
  29. J. W. Thiele and B. Bodie, “Adrenal hemangioma,” vol. 129, no. 3, pp. 373-374, 2001. View at: Publisher Site | Google Scholar
  30. T. Yagisawa, H. Amano, F. Ito, S. Horita, Y. Yamaguchi, and H. Toma, “Adrenal hemangioma removed by a retroperitoneoscopic procedure,” International Journal of Urology, vol. 8, no. 8, pp. 457-458, 2001. View at: Publisher Site | Google Scholar
  31. H. X. Xu and G. J. Liu, “Huge cavernous hemangioma of the adrenal gland: sonographic, computed tomographic, and magnetic resonance imaging findings,” Journal of Ultrasound in Medicine, vol. 22, no. 5, pp. 523–526, 2003. View at: Publisher Site | Google Scholar
  32. T. Z. Nursal, S. Yildirim, and A. Tarim, “Giant adrenal hemangioma: a case report,” Acta Chirurgica Belgica, vol. 104, no. 2, pp. 224-225, 2004. View at: Publisher Site | Google Scholar
  33. J. H. Wang, J. H. Chiang, and T. Chang, “Adrenal hemangioma: computed tomogram and angiogram appearances,” Chinese Medical Journal (Taipei), vol. 50, no. 2, pp. 161–164, 2004. View at: Google Scholar
  34. T. L. Forbes, “Retroperitoneal hemorrhage secondary to a ruptured cavernous hemangioma,” Canadian Journal of Surgery, vol. 48, no. 1, pp. 78-79, 2005. View at: Google Scholar
  35. H. A. Heis, K. E. Bani-Hani, and B. K. Bani-Hani, “Adrenal cavernous haemangioma,” Singapore Medical Journal, vol. 49, no. 9, pp. e236–e237, 2008. View at: Google Scholar
  36. A. C. Ng, H. L. Loh, C. F. Shum, and S. K. Yip, “A case of adrenal cavernous hemangioma presenting with progressive enlargement and apparent hormonal hypersecretion,” Endocrine Practice, vol. 14, no. 1, pp. 104–108, 2008. View at: Publisher Site | Google Scholar
  37. G. Nigri, R. Bellagamba, V. Giaccaglia et al., “Minimally invasive adrenalectomy for incidentally discovered cavernous hemangioma,” Minimally Invasive Therapy & Allied Technologies, vol. 17, no. 4, pp. 255–258, 2008. View at: Publisher Site | Google Scholar
  38. N. Arkadopoulos, M. Kyriazi, A. I. Yiallourou et al., “A rare coexistence of adrenal cavernous hemangioma with extramedullar hemopoietic tissue: a case report and brief review of the literature,” World Journal of Surgical Oncology, vol. 7, no. 1, p. 13, 2009. View at: Publisher Site | Google Scholar
  39. D. Matsuda, M. Iwamura, and S. Baba, “Cavernous hemangioma of the adrenal gland,” International Journal of Urology, vol. 16, no. 4, pp. 424–424, 2009. View at: Publisher Site | Google Scholar
  40. A. J. Siddiqi, F. H. Miller, D. Kasuganti, and P. Nikolaidis, “Adrenal hemangioma-adenoma: an exceedingly rare adrenal collision tumor,” Journal of Magnetic Resonance Imaging, vol. 29, no. 4, pp. 949–952, 2009. View at: Publisher Site | Google Scholar
  41. D. A. Telem, S. Q. Nguyen, E. H. Chin, K. Weber, and C. M. Divino, “Laparoscopic resection of giant adrenal cavernous hemangioma,” Journal of the Society of Laparoendoscopic Surgeons, vol. 13, no. 2, pp. 260–262, 2009. View at: Google Scholar
  42. J. H. Cheong and G. H. Kim, “A case of adrenal hemangioma misdiagnosed as a pancreatic tail tumor,” The Korean Journal of Gastroenterology, vol. 56, no. 5, pp. 273–275, 2010. View at: Publisher Site | Google Scholar
  43. P. Paluszkiewicz, I. Ambroziak, K. Hołyńska-Dąbrowska, Z. Siezieniewska-Skowrońska, and A. Paluszkiewicz, “Spontaneous rupture of adrenal haemangioma mimicking abdominal aortic aneurysm rupture,” Archives of Medical Science, vol. 6, no. 1, pp. 122–125, 2010. View at: Publisher Site | Google Scholar
  44. M. Abou El-Ghar, H. Refaie, A. El-Hefnawy, and T. El-Diasty, “Adrenal hemangioma: findings at multidetector CT with short review of the literature,” Case Reports in Radiology, vol. 2011, Article ID 601803, pp. 1–3, 2011. View at: Publisher Site | Google Scholar
  45. K. S. Aljabri, S. A. Bokhari, and M. Alkeraithi, “Adrenal hemangioma in a 19-year-old female,” Annals of Saudi Medicine, vol. 31, no. 4, pp. 421–423, 2011. View at: Publisher Site | Google Scholar
  46. A. J. Kieger, P. Nikolaidis, and D. D. Casalino, “Adrenal gland hemangioma,” Journal of Urology, vol. 186, no. 6, pp. 2415-2416, 2011. View at: Publisher Site | Google Scholar
  47. M. Oishi, S. Ueda, S. Honjo, H. Koshiyama, Y. Yuba, and A. Takabayashi, “Adrenal cavernous hemangioma with subclinical Cushing’s syndrome: report of a case,” Surgery Today, vol. 42, no. 10, pp. 973–977, 2012. View at: Publisher Site | Google Scholar
  48. S. D. Quildrian, E. A. Silberman, F. A. Vigovich, and E. A. Porto, “Giant cavernous hemangioma of the adrenal gland,” International Journal of Surgery Case Reports, vol. 4, no. 2, pp. 219–221, 2013. View at: Publisher Site | Google Scholar
  49. J. P. Edwards, H. C. Stuart, S. J. Urbanski, and J. L. Pasieka, “A rare cavernous hemangioma of the adrenal gland,” International Journal of Surgery Case Reports, vol. 5, no. 2, pp. 52–55, 2014. View at: Publisher Site | Google Scholar
  50. N. Galea, V. Noce, F. Ciolina, S. Liberali, and M. Francone, “Giant adrenal cavernous hemangioma: a rare abdominal mass,” Urology, vol. 82, no. 1, pp. e3–e4, 2013. View at: Publisher Site | Google Scholar
  51. J. J. Noh, S. H. Choi, H. K. Hwang, C. M. Kang, and W. J. Lee, “Adrenal cavernous hemangioma: a case report with review of the literature,” Journal of Periodontology, vol. 15, no. 3, pp. 254–257, 2014. View at: Google Scholar
  52. L. Wang, Y. Dang, R. He, and G. Chen, “Rare cavernous hemangioma of adrenal gland: case report,” Sao Paulo Medical Journal, vol. 132, no. 4, pp. 249–252, 2014. View at: Publisher Site | Google Scholar
  53. A. Agrusa, G. Romano, G. Salamone et al., “Large cavernous hemangioma of the adrenal gland: laparoscopic treatment. Report of a case,” International Journal of Surgery Case Reports, vol. 16, pp. 150–153, 2015. View at: Publisher Site | Google Scholar
  54. G. L. Wong, R. Kwok, and V. W. Wong, “Huge adrenal hemangioma: a rare cause of deceivingly high liver stiffness measurement by transient elastography,” Clinical Gastroenterology and Hepatology, vol. 13, no. 4, pp. e37–e38, 2015. View at: Publisher Site | Google Scholar
  55. C. Pang, P. Wu, and G. Zhu, “A rare cavernous hemangioma of the adrenal gland,” Urology Case Reports, vol. 3, no. 4, pp. 120–122, 2015. View at: Publisher Site | Google Scholar
  56. M. Tarchouli, A. Boudhas, M. B. Ratbi et al., “Giant adrenal hemangioma: unusual cause of huge abdominal mass,” Canadian Urological Association Journal, vol. 9, no. 11-12, pp. 834–836, 2015. View at: Publisher Site | Google Scholar
  57. D. Bacha, A. Chaabane, F. Khanche, S. Néchi, H. Touinsi, and E. Chelbi, “Giant adrenal cavernous hemangioma in a patient with familial adenomatous polyposis,” Clinics and Practice, vol. 6, no. 3, p. 878, 2016. View at: Publisher Site | Google Scholar
  58. Y. Kinebuchi, H. Daimon, and K. Kawaguchi, “Adrenal cavernous hemangioma associated with myelolipomatous metaplasia,” International Journal of Urology, vol. 23, no. 1, pp. 106–108, 2016. View at: Publisher Site | Google Scholar
  59. N. Njoumi, N. Jakhlal, M. Laaroussi et al., “Adrenal gland hemangioma: about a case,” Pan African Medical Journal, vol. 28, p. 172, 2017. View at: Publisher Site | Google Scholar
  60. B. Tadić, N. Grubor, V. Milosavljević, S. Matić, N. Grubor, and I. Ignjatovic, “Giant cavernous hemangioma of the adrenal gland: case report and review of the literature,” Journal of Clinical Case Reports, vol. 7, no. 12, p. 1063, 2017. View at: Publisher Site | Google Scholar
  61. C. V. Feo, A. De Troia, M. Pedriali et al., “Adrenal cavernous hemangioma: a case report,” BMC Surgery, vol. 18, no. 1, p. 103, 2018. View at: Publisher Site | Google Scholar
  62. A. Hashimoto, H. Yoshino, F. Yoshikawa et al., “giant cavernous hemangioma of the adrenal gland in an elderly patient,” Internal Medicine, vol. 57, no. 9, pp. 1317–1319, 2018. View at: Publisher Site | Google Scholar
  63. G. Iwamoto, K. Shimokihara, T. Kawahara et al., “Adrenal hemangioma: a case of retroperitoneal tumor,” Case Reports in Medicine, vol. 2018, Article ID 8796327, pp. 1–4, 2018. View at: Publisher Site | Google Scholar
  64. K. Lavingia, R. Torabi, S. W. Kim, M. S. Hughes, E. C. Feliberti, and R. R. Perry, “A rare adrenal incidentaloma that mimics adrenocortical carcinoma,” Case Reports in Surgery, vol. 2018, Article ID 9607972, pp. 1–4, 2018. View at: Publisher Site | Google Scholar
  65. X. Peng, W. Luo, X. Zhang, and W. Zhu, “Sudden onset flank pain: a case report of retroperitoneal hemorrhage secondary to a ruptured adrenal hemangioma,” Journal of Pain Research, vol. 31, no. 11, pp. 1421–1424, 2018. View at: Publisher Site | Google Scholar
  66. T. Yamada, T. Ishibashi, and H. K Majima SaitoM. Tsuda, S. Takahashi, and T. Moriya, “Two cases of adrenal hemangioma: CT and MRI findings with pathological correlations,” Radiation Medicine, vol. 20, no. 1, pp. 51–56, 2002. View at: Google Scholar
  67. T. L. Krebs and B. J. Wagner, “MR imaging of the adrenal gland: radiologic pathologic correlation,” Radiographics, vol. 18, no. 6, pp. 1425–1440, 1998. View at: Publisher Site | Google Scholar
  68. K. Ishigami, A. H. Stolpen, Y. Sato, L. Dahmoush, H. N. Winfield, and L. L. Fajardo, “Adrenal adenoma with organizing hematoma:diagnostic dilemma at MRI,” Magnetic Resonance Imaging, vol. 22, no. 8, pp. 1157–1159, 2004. View at: Publisher Site | Google Scholar
  69. L. E. Quint, G. M. Glazer, I. R. Francis, B. Shapiro, and T. L. Chenevert, “Pheochromocytoma and paraganglioma: comparison of MR imaging with CT and I-131 MIBG scintigraphy,” Radiology, vol. 165, no. 1, pp. 89–93, 1987. View at: Publisher Site | Google Scholar
  70. D. M. Elfenbein, J. E. Scarborough, P. J. Speicher, and R. P. Scheri, “Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project,” Journal of Surgical Research, vol. 184, no. 1, pp. 216–220, 2013. View at: Publisher Site | Google Scholar

Copyright © 2019 Jad A. Degheili et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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