Adrenal Lymphangiomas: Clinicopathologic Review of a Rare Lesion
P Banerjee, GJ Netto. Johns Hopkins University, Baltimore, MD
Background: Adrenal lymphangiomas (AL), also known as a cystic adrenal lymphangioma, are rare benign vascular lesions that remain asymptomatic even upon reaching a large size. Although previously AL were mostly found during autopsy, currently they are more frequently detected during imaging work up and therefore likely to immitate other adrenocortical or adrenal medullary neoplasms. We aimed to retrospectively review all AL cases at our hospital and further document their lymphatic origin by immunohistochemical staining with D2-40 antibody.
Design: A search of surgical pathology records (1984-2008) was conducted. All H&E sections were retreived from archives and reviewed by both pathologists on the study. Clinical information was gathered from electronic medical records. Representative paraffin embedded section from each case was selected for immunohistochemical analysis using monoclonal antibody D2-40 (DakoCytomation, Denmark).
Results: A total of 9 AL cases were identified (6 female and 3 male patients). All 9 patients were adults at time of diagnosis with a mean age of 42 years (range: 28-56 years). There were 7 Caucasian patients, 1 African American and 1 Asian patient. The average size of AL lesions was 4.9 cm (range: 2.0 to 13.5 cm). AL were twice more frequently located on the right side (6 right-sided and 3 left-sided). Clinically, 7/9 (77%) of lesions were asymptomatic and incidentally found during imaging studies for unrelated causes. One lymphangioma was associated with an atypical B cell proliferation that lead to its clinical discovery. The remaining AL was found during a gynecological exploration for endometriosis. Surgical removal was achieved by total adrenalectomy in 8 of the 9 lesions and partial adrenalectomy in the remaining case. No evidence of recurrence or development of contralateral lesion was encountered in any of the patients. Histologically, our adrenal lymphangiomas showed a typical multicystic architecture with dilated spaces lined by flattened, bland simple lining. The cystic channels/spaces occasionally contained protinaceous material and lacked red blood cell content. On immunostains, D2-40 cytoplasmic staining was positive in all 9 examined lesions confirming their lymphatic nature. D2-40 staining was diffuse in 7 and patchy in the 2 remaining lesions.
Conclusions: Adrenal lymphangioma are very rare benign lymphatic neoplasms with a female, right sided predominance. AL is usually found incidentally during adulthood as a large size mass (mean 4.9 cm) necessitating surgical removal to rule out other adrenal neoplasms.
Category: Genitourinary (including renal tumors)
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 107, Wednesday Afternoon