Hemangiosarcoma of the adrenal glands: CT findings in two cases

Abstract

Hemangiosarcomas of the adrenal gland, both benign and malignant, are exceedingly rare; only a dozen of them have been reported in literature to our knowledge. We describe herein the findings at CT of 2 primary hemangiosarcomas of the adrenal glands. We also discuss their etiology, incidence, and differential diagnosis, particularly in relation to more frequent primary adrenal lesions, such as adrenal adenomas and carcinomas. CT will generally show a heterogeneous mass with frequent necrosis, contrast-enhancement, and occasional calcifications. A prospective diagnosis cannot be made by imaging alone, and pathology represents the discriminating method for a correct diagnosis.Key words: Adrenal gland, neoplasms-Adrenal gland, computed tomography.Primary malignant neoplasms of the adrenal gland are uncommon and may involve the adrenal cortex (adenocarcinoma) or the adrenal medulla (pheochromocytoma and neuroblastoma) [1,2]. The adenocarcinoma is the most frequent primary malignant tumor of the adrenal gland. Vascular tumors of the adrenal gland, both benign and malignant, are exceedingly rare. The angiosarcoma probably represents approximately 1-2% of these tumors.Angiosarcomas occur in the skin, breast, retroperitoneum, and visceral organs, with the liver being the most frequent site of visceral organ involvement [3]. Only a dozen primary angiosarcomas of the adrenal gland have been reported in the literature to our knowledge [1, 4 -8], the first case being described in 1988 by Kareti et al.Metastatic involvement of the adrenals by angiosarcomas is much more frequent.We describe the computed tomographic (CT) findings of two primary hemangiosarcomas of the adrenal glands. We also discuss their etiology, incidence, and differential diagnosis, particularly in relation to more frequent primary adrenal lesions, such as adrenal adenomas and carcinomas. Case reports Case 1A 67-year-old male, without a significant medical history, presented with left flank pain of 6 months' duration. The patient exhibited no hematuria or hypertension. An intra-

Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature

“…Angiosarcomas arising from the adrenals are exceedingly rare [133][134][135][136], and to date FDG PET/CT findings have not been described.…”

“…An adrenal hemangioma is a rare, benign tumor comprising closely adjacent vascular channels lined with a single layer of endothelium [133,134]. On CT, hemangiomas are seen as large, well-defined masses with soft-tissue density, often with calcifications due to phleboliths or prior hemorrhage on unenhanced images and demonstrate inhomogeneous contrast enhancement [185,186].…”

Chronic abdominal pain caused by a large haemangiosarcoma in the retroperitoneal space

“…Adrenal cortical carcinoma is the most important differential diagnosis to consider, but other neoplasms such as pheochromocytoma, metastatic malignancies, retroperitoneal mesenchymal tumours, and adrenal adenomas undergoing massive haemorrhage may simulate the appearance of an angiosarcoma [7]. Differentiation between these lesions cannot be obtained by imaging alone; resection or biopsy must be performed to reach the definitive diagnosis.…”

Computed tomography findings in diseases of the adrenal gland

“…However, they do not present central filling in the late stages, as seen in liver hemangiomas, because of the higher incidence of necrotic and fibrotic areas observed in adrenal hemangiomas [31]. Sarcomatous transformation may be seen in rare cases [42].…”