Myofibrosarcoma of the adrenal gland

Adrenal masses have varying presentations. Most commonly, adrenal masses are discovered incidentally on CT or MRI during an evaluation for an unrelated complaint. Although the majority of these are nonfunctional cortical adenomas, hormonally active tumors and adrenocortical carcinoma must also be considered in the differential diagnosis. Rarely, retroperitoneal tumors may mimic an adrenal mass. We report a case of a 49-year-old man with anemia and weight loss who was found to have a large retroperitoneal mass arising from the adrenal gland. Surgical treatment involved en bloc resection of the right kidney, adrenal gland, segments 7 and 8 of the liver, and a portion of the right hemidiaphragm. Final pathology revealed a low-grade myofibrosarcoma. We believe that this is the first case report of a myofibrosarcoma of the adrenal gland. Myofibrosarcomas are rare malignant tumors composed of myofibroblasts that arise from the deep soft tissues. These tumors have a predilection for the head and neck, trunk, or extremities. Myofibrosarcomas can be differentiated from other sarcomas by immunohistochemical staining and pathologic features. We will briefly discuss the workup of an adrenal mass and focus on the diagnosis of myofibrosarcoma.     

Adenomatoid of the adrenal gland

Adenomatoid tumors are common in the genital tract but rare in the adrenal gland. These tumors can be difficult to diagnose when present in extragenital sites. This type of adrenal tumor lacks specific radiographic features and can be confused preoperatively with more common adrenal gland tumors. We present the case of a 54-year-old man with an incidental right adrenal mass with calcified components and elevated urinary levels of homovanillic acid that was found to be an adenomatoid tumor of the adrenal gland.     

Xanthofibroma of the adrenal gland

The authors report on a 43-year-old woman who had undergone unilateral adrenalectomy for a right suprarenal mass. The removed specimen was histopathologically defined as xanthofibroma, a hitherto unpublished adrenal tumour. The connective tissue protein of this rare tumour contained great amounts of collagen, noncollagenous protein and elastin. The significance of such abnormal proliferation of fibrous tissue and the conventional sonographic and CT features of this neoplasm are discussed.     

Cysts of the adrenal gland

3 cases of adrenal cysts are reported. The incidence of cyst originating in the adrenal gland was found to be 0.02-0.06% in autopsies. Adrenal cysts are usually symptomless making the diagnosis difficult. The cases described here were diagnosed and removed at operation. One of them was associated with hypertension, and another with pregnancy, considered to be exceptional. Two of these cysts were calcified. All of them were benign. The definite preoperative diagnosis is difficult and the surgical procedure recommended is resection of the cyst with preservation of as much adrenal tissue as possible if malignancy is excluded by frozen section. Since the number of operated cases diagnosed preoperatively are too small, the possibility of treating adrenal cyst by percutaneous aspiration and injection of opaque material to eventually avoid surgery could not be established.     

Imaging of the adrenal gland

Summary Clinically, the development of highly accurate imaging techniques that define adrenal anatomy and give information concerning adrenal physiology have revolutionized our approach to adrenal disorders [1, 2]. These techniques complement the highly accurate hormonal analyses that lead to the diagnosis of primary hyperaldosteronism, Cushing's syndrome, and pheochromocytoma. In addition, they help distinguish these entities from other adrenal disorders as well as other retroperitoneal processes. Thus, imaging techniques presently play a critical role in confirming the hormonal diagnosis and precisely localizing the specific adrenal lesion.This article reviews the imaging techniques available and attempts to direct the reader to the procedure of choice for each adrenal disorder.     

Myelolipoma of the adrenal gland

Adrenal myelolipomas are rare, nonfunctioning, benign neoplasms of the adrenal gland. The authors describe their experience of a case and they report the review of the literature. They illustrate what's etiopathogenetic theories, modern diagnostic technology "of imaging" and different surgical approaches need to be adapted to the excision of the adrenal myelolipomas.     

Myelolipoma of the adrenal gland

We report the 14th case of myelolipoma of the adrenal gland. Recommendations for appropriate diagnostic and therapeutic methods are made. Myelolipoma of the adrenal gland is a rare nonfunctioning tumor composed of lipoid and hematopoietic elements. The most consistent complaint is abdominal pain caused by hemorrhage within the tumor. We identified an association with obesity and hypertension. Ultrasound combined with computed tomography is useful in diagnosis. With expanded use of these studies, myelolipoma will be recognized more frequently. Definitive diagnosis and treatment are accomplished by simple excision; radical surgery is unnecessary.     

Myelolipoma of adrenal gland

Myelolipoma of the adrenal gland is a rare, benign tumor of which only 17 clinical cases have been reported previously in the literature. We document 1 additional case and review the pathogenesis of the tumor, with emphasis on the theory of the tissue necrosis as the major stimulus of the myelolipomatous changes in the adrenals.     

Cystic lymphangioma of the adrenal gland

Cystic lymphangioma of the adrenal gland is a rare tumor, which is often sub-clinical. Preoperative diagnosis is difficult. We present a case of a 47 year-old female in whom an incidental left cystic mass of 12 cm by 10 cm with no features of malignancy was discovered by ultrasound scan. A further computed tomography scan confirmed the ultrasound findings. Biochemical screening ruled out a secreting adrenal tumor. Because of the size of the cyst, the lesion was resected and the diagnosis of benign adrenal cystic lymphangioma was histologically confirmed. Computed tomography is the reference examination for delineating the topography and extent of the lesion, especially when it is large. Although imaging can characterize the cystic nature of a lesion, it sometimes fails to establish a specific diagnosis, so surgery or fine needle aspiration should be done for a definitive diagnosis. The characteristic features of cystic adrenal lymphangioma are discussed together with a review of the recent literature.