Adrenal leiomyosarcoma: a case report and literature review

Thamboo, Thomas Paulraj; Liew, L C H; Raju, Gangaraju C.

doi:10.1080/0031302021000062325

Cited by 8 publications

(8 citation statements)

References 3 publications

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“…Only 18 cases of primary adrenal leiomyosarcoma were reported in the literature in 2009 [36]. The source of these rare tumors remains unknown, with origin being suggested from the smooth muscle layer of the adrenal blood vessel [37]. Patient ages ranged from 30 to 68 years, with no laterality or sex predilection [38].…”

Section: Discussionmentioning

confidence: 99%

Three uncommon adrenal incidentalomas: a 13-year surgical pathology review

2012

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BackgroundThe discovery of adrenal incidentalomas due to the widespread use of sophisticated abdominal imaging techniques has resulted in an increasing trend of adrenal gland specimens being received in the pathology laboratory. In this context, we encountered three uncommon adrenal incidentalomas.The aim of this manuscript is to report in detail the three index cases of adrenal incidentalomas in the context of a 13-year retrospective surgical pathology review.MethodsThe three index cases were investigated and analyzed in detail with relevant review of the English literature as available in PubMed and Medline. A 13-year retrospective computer-based histopathological surgical review was conducted in our laboratory and the results were analyzed in the context of evidence-based literature on adrenal incidentalomas.ResultsA total of 94 adrenal specimens from incidentalomas were identified, accounting for 0.025% of all surgical pathology cases. In all 76.6% were benign and 23.4% were malignant. A total of 53 females (56.4%) and 41 males (43.6%) aged 4 to 85 years were identified. The benign lesions included cortical adenoma (43.1%), pheochromocytoma (29.3%) and inflammation/fibrosis/hemorrhage (8.3%). Metastatic neoplasms were the most common malignant lesions (50%) followed by primary adrenocortical carcinomas (31.8%) and neuroblastoma (13.6%). These cases were discovered as adrenal incidentalomas that led to surgical exploration.The three index cases of adrenal incidentalomas with unusual pathologies were encountered that included (a) adrenal ganglioneuroma, (b) periadrenal schwannoma and (c) primary adrenal pleomorphic leiomyosarcoma. These cases are discussed, with a literature and clinicopathological review.ConclusionsAdrenal lesions are uncommon surgical specimens in the pathology laboratory. However, higher detection rates of adrenal incidentalomas aided by the ease of laparoscopic adrenalectomy has resulted in increased adrenal surgical specimens leading to unsuspected diagnostic and management dilemmas. Accurate pathological identification of common and uncommon adrenal incidentalomas is essential for optimal patient management.

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Section: Discussionmentioning

confidence: 99%

Three uncommon adrenal incidentalomas: a 13-year surgical pathology review

2012

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“…A total of 71.11% of the cases presented with abdominal or flank pain/discomfort (32,33,. 13.33% of the cases presented with weight loss and/or anorexia, (34,39,47,51,56,59). A total of 3 cases out of 45 presented as an enlarging abdomen mass (32,65,66), 4 presented with dyspnoea or chest discomfort (32)(33)(34)67), 2 cases had fever at the time of diagnosis (33,56) and nausea (50,68).…”

Section: Symptoms Diagnosismentioning

confidence: 99%

“…13.33% of the cases presented with weight loss and/or anorexia, (34,39,47,51,56,59). A total of 3 cases out of 45 presented as an enlarging abdomen mass (32,65,66), 4 presented with dyspnoea or chest discomfort (32)(33)(34)67), 2 cases had fever at the time of diagnosis (33,56) and nausea (50,68). Five cases out of 45 presented with leg swelling (32,49,59,67,69) 1 with cold feet sensation (35) and 2 cases had skin varices at the time of diagnosis (67,69).…”

Section: Symptoms Diagnosismentioning

confidence: 99%

“…From the remaining literature 6 cases were tested negative for HIV infection (44,49,58,61,66,71). From these, one case was also tested for EBV in situ hybridization of the surgical specimen and was found negative (71) and another case was found negative for EBV LMP1 in the tumor cells (56). None of the LMS patients was tested for plasma EBV antibodies.…”

Section: Risk Factorsmentioning

confidence: 99%

“…The median surgical specimen's size measured was 10.5 cm (average=11.22 cm, minimum=0.8 cm, maximum=27 cm) out of 27 unilateral (37, 39, 40, 43-45, 47, 49, 50, 52, 54-58, 60-62, 64-67, 69-73) and 3 autopsy specimens (3, 59) that provided size and weighted in median 482 g (average=692 g, minimum=47 g, maximum=2400 g) out of 10 unilateral tumors that provided weight (37,39,40,47,50,52,56,70,72,73), 3 cases that provided the weight of the surgical specimen containing en bloc the resected kidney were not included (43)(44)(45).…”

Section: Risk Factorsmentioning

confidence: 99%

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Review of the Literature on Leiomyoma and Leiomyosarcoma of the Adrenal Gland: A Systematic Analysis of Case Reports

Σακελλαρίου

Dellaportas

Peppa

et al. 2020

In Vivo

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Background/Aim: To date few cases of smooth muscle-derived tumors of the adrenal gland have been reported and their treatment remains a medical challenge. The aim of this manuscript was to systematically review the literature and present the tumor characteristics and their management in order to provide a standardized approach to their diagnosis and management. Materials and Methods: We searched five databases (PubMed, Scopus, Elsevier, ResearchGate, Google scholar) for relevant articles published until March 2020. Results: Twenty-two cases of adrenal leiomyoma, four cases of adrenal smooth muscle tumor and forty-five cases of adrenal leiomyosarcoma were included. Conclusion: We present the demographic, clinical, radiological, pathological and oncological characteristics and prognosis of tumors of the adrenal gland arising from smooth muscle cells, as well as describe the common clinical investigations and therapeutic modalities that have been reported as part of their management.Adrenal tumors can be detected either incidentally or after investigation of signs and symptoms that they evoke. Generally, they can be histologically categorized as primary tumors of the adrenal cortex or medulla, metastases from other primary malignancies and other tumors of the adrenal gland which originate from connective tissue cells. Adrenal cortical tumors are comprised by (asymmetric) adrenal cortical hyperplasia, adenoma, myelolipoma, adrenocortical carcinoma, oncocytic adrenocortical neoplasms; medullary tumors are comprised by pheochromocytoma, ganglioneuroma, neuroblastoma, ganglioneuroblastoma and teratoma. Connective tissue origin tumors are rarer and are comprised mainly by haemangioma and lymphangioma with a few cases of leiomyoma, lipoma, hemangiosarcoma, lymphoma, leiomyosarcoma and liposarcoma, as reported in the literature. Patients with primary malignancies in lung, breast, kidney, colon, oesophagus, pancreas, liver, stomach or with melanoma can present with adrenal metastases spread from these tumors, which can commonly be found bilaterally (1).Leiomyomas (LM) and leiomyosarcomas (LMS) are mesenchymal tumors that derive from smooth muscle cells. Their benign -leiomyoma or malignant -leiomyosarcoma characterization depends on nuclear atypia and/or pleomorphism, mitotic activity and tumor cell necrosis (2). Leiomyomas and leiomyosarcomas of the adrenal gland comprise a very small percentage of the gland's pathology with very little data available in the literature. The aim of this manuscript was to systematically review the literature and present demographic, clinical, radiological, pathological and oncological characteristics and prognosis of tumors of the adrenal gland arising from smooth muscle cells, as well as describe the common clinical investigations and therapeutic modalities that have been reported as part of their management.

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Tumoren der Nebenniere

Saeger

Komminoth

2019

Pathologe

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Adrenal leiomyosarcoma: a case report and literature review

Cited by 8 publications

References 3 publications

Three uncommon adrenal incidentalomas: a 13-year surgical pathology review

Three uncommon adrenal incidentalomas: a 13-year surgical pathology review

Review of the Literature on Leiomyoma and Leiomyosarcoma of the Adrenal Gland: A Systematic Analysis of Case Reports

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