Spectrum of Vascular Lesions Involving the Adrenal Gland: A Clinicopathologic Study of 31 Cases
Marsha A Apushkin, Maria Tretiakova, Jonathan B McHugh, Dave R Lucas, Gladell P Paner, Rajiv M Patel. University of Chicago, Chicago, IL; University of Michigan, Ann Arbor, MI
Background: Primary vascular lesions of the adrenal gland are rare, and to date have not been systematically studied. Our aim was to better characterize benign and malignant vasoformative lesions involving the adrenal gland.
Design: Surgical pathology archives from two large academic institutions were searched for adrenal vascular lesions diagnosed from the years 1990 to 2012. Thirty-one cases were identified and detailed clinicopathological information including follow-up were tabulated.
Results: Of 31 cases, 22 (71%) were hemorrhagic pseudocysts, 3 (10%) lymphangiomas, 2 (6%) vascular cysts, 1 (3%) benign cyst, 1 (3%) vascular malformation and 2 (6%) epithelioid angiosarcomas. Patients included 19 females (mean age 45±13) and 12 males (mean age 52±19). Sixteen patients (52%) were asymptomatic and lesion was discovered incidentally, 12 (39%) presented with abdominal or back pain, and 2 (6%) with abdominal fullness. Size of adrenal vascular lesions ranged from 1.4 to 13 cm (average 6.1 cm) and were located equally between right (n=15) and left sides (n=16). The 2 angiosarcomas invaded peri-adrenal soft tissues, and the remaining lesions were confined within the adrenal capsule. Three pseudocysts and 1 vascular cyst were associated with cortical adenomas. In 1 case, juxtaposed adenoma and cyst imparted radiologic characteristics concerning for adrenal malignancy. Calcification was present in 4 pseudocysts and 1 vascular cyst, and calcified thrombi were found within the vascular malformations. Two pseudocysts were associated with myelolipomas. On follow-up (1-180 months, mean 46 months) 2 patients with pseudocysts developed recurrence, 1 patient with angiosarcoma was disease free after 60 months, and 1 angiosarcoma patient was alive with liver metastases 24 months after diagnosis. The remaining 27 patients were disease free with no evidence of recurrence.
Conclusions: 1) The spectrum of adrenal vascular lesions includes predominantly benign lesions such as vascular cyst, pseudocyst, lymphangioma, and vascular malformation. 2) The malignant vascular tumors are proportionally less, as corroborated by a prior series, and are predominantly epithelioid angiosarcomas. 3) Pseudocysts and vascular cysts are benign with no potential for malignant transformation, however, rare recurrences may occur. 4) Benign vascular lesions may occur concomitantly with other benign adrenal tumors such as cortical adenoma and myelolipoma, and this coexistence may be interpreted as malignancy on imaging studies.
Category: Genitourinary (including renal tumors)
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 162, Wednesday Morning