Benign vascular tumors, cysts, and pseudocysts of the adrenal gland: a contemporary multi-institutional clinicopathological analysis of 55 cases

Abstract

Benign adrenal vascular tumors, cysts and pseudocysts are a heterogeneous group of relatively uncommon entities that may pose diagnostic challenges radiologically and pathologically. However, there are only a few small cases series, systematically characterizing the clinicopathologic features of these lesions. We identified 55 cases of benign adrenal vascular tumors, cysts and pseudocysts (23 pseudocysts, 17 hemangiomas, 8 lymphangiomas, 6 angiomatous endothelial cysts and 1 arteriovenous malformation) from a multi-institutional Urologic Pathology database between 2000-2017, and retrospectively analyzed their clinicopathologic features. We found that these lesions have a female predominance and the majority are right-sided. These lesions may occur simultaneously with other adrenal tumors associated with hormonal hypersecretion. A substantial portion of pseudocysts were semi-solid or solid with no fluid collection, mimicking a solid adrenal tumor, and resulting in adrenalectomy. In addition, a small proportion of benign vascular lesions may have coexisting epithelial tumors, requiring extensive specimen sampling and thorough microscopic examination.

Haemorrhagic suprarenal pseudocysts: a systematic review of a rare condition from family physicians’ perspective during the COVID-19 global pandemic

“…There are four classes of adrenal gland cysts: epithelial, endothelial, and parasitic and pseudocysts but they can also become haemorrhagic 2 . A review of 8 cases in a study in the United States revealed lesion sizes ranging from 1.8-10cm, though the size of the lesion does not correlate with symptoms, but in our case report the lesion was larger 3 . They are often seen in the 5th and the 6th decades of life, but can also be diagnosed during pregnancy 13,14,16 .…”

“…Haemorrhagic adrenal cysts are rarely symptomatic and often found incidentally during surgery for other conditions or at autopsy, except when they are large as in the case of a giant adrenal pseudocyst which was surgically removed 1,3 . The search on pseudocysts also revealed only a few cases documented over several years, often detected at pathological examinations.…”

“…A clinicopathologic analysis of 55 cases of adrenal lesions revealed they were mostly right sided with a female predominance, though our index patient is male and had a left sided lesion. They also discovered that they are often associated with hormonal hypersecretions and endocrinological abnormalities 3,4 . Intracystic haemorrhage is one of the complications of adrenal pseudocysts, which our patient had 4 .…”

Adrenal Cyst

“…Endothelial cysts are lined by a single layer of bland, flattened endothelial cells and are subcategorized into lymphangiomatous and angiomatous types. Immunohistochemically, all endothelial cysts are positive for CD31, CD34, and ERG, while lymphangiomatous cysts selectively stain for D2-40 (Zheng et al 2018) (Fig. 1).…”

Incidentally found cystic lymphangioma of the adrenal gland in an elderly male cadaver

“…Benign adrenal vascular pathologies, including tumors, cysts, and pseudocysts, are relatively rare entities that are mostly right-sided and predominantly observed in females [1]. These lesions may occur concomitantly with other adrenal tumors associated with hormone secretion.…”