Agrusa A, Romano G, Salamone G, Orlando E, Di Buono G, Chianetta D, Sorce V, Gulotta L, Galia M, Gulotta G
Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy.
Department of Human Pathology, Section of Anatomic Pathology, University of Palermo, Italy.
Int J Surg Case Rep. 2015;16:150-3. doi: 10.1016/j.ijscr.2015.09.040. Epub 2015 Oct 13.
Cavernous hemangioma of the adrenal gland is a rare benign tumor. The diagnosis is often postoperative on histological exam with the presence of blood-filled, dilated vascular spaces.
We report the clinical case of a 49 years-old woman who came to our observation with aspecific abdominal pain. A computed tomography (CT) abdominal scan revealed a 11cm right adrenal mass. This lesion was well circumscribed, round, encapsulated. After iodinated-contrast we observed a progressive, inhomogeneous enhancement without evidence of active bleeding and with pre-operative diagnosis of adrenal hemangioma. Laparoscopic adrenalectomy was performed by a transperitoneal flank approach. Pathological examination revealed a 11cm adrenal mass with extensive central necrotic areas mixed to sinusoidal dilation and fibrotic septa. Postoperative diagnosis was adrenal hemangioma.
Adrenal hemangiomas occur infrequently. Generally these adrenal masses are non-functioning and there is no specific symptoms. Recent records demonstrate that laparoscopic adrenalectomy is technically safe and feasible for large adrenal tumors, but controversy exists in cases of suspected malignancy. We choose laparoscopic approach to adrenal gland on the basis of preoperative CT abdominal scan that excludes radiological signs of adrenocortical carcinoma (ACC) such as peri-adrenal infiltration and vascular invasion.
Laparoscopic adrenalectomy is considered the standard treatment in case of diagnosis of benign lesions. In this case report we discussed a large adrenal cavernous hemangioma treated with laparoscopic approach. Fundamental is the study of preoperative endocrine disorders and radiologic findings to exclude signs of malignancy.
肾上腺海绵状血管瘤是一种罕见的良性肿瘤。诊断通常在术后通过组织学检查，发现存在充满血液的扩张血管腔隙。
我们报告一例49岁女性的临床病例，该患者因非特异性腹痛前来我院就诊。腹部计算机断层扫描（CT）显示右侧肾上腺有一个11厘米的肿块。该病变边界清晰，呈圆形，有包膜。注入碘造影剂后，我们观察到渐进性、不均匀强化，无活动性出血迹象，术前诊断为肾上腺血管瘤。通过经腹侧腰部入路进行了腹腔镜肾上腺切除术。病理检查显示一个11厘米的肾上腺肿块，伴有广泛的中央坏死区域，混合有窦状扩张和纤维间隔。术后诊断为肾上腺血管瘤。
肾上腺血管瘤很少见。一般来说，这些肾上腺肿块无功能，且没有特异性症状。最近的记录表明，腹腔镜肾上腺切除术对于大型肾上腺肿瘤在技术上是安全可行的，但在疑似恶性肿瘤的情况下存在争议。我们根据术前腹部CT扫描排除肾上腺皮质癌（ACC）的放射学征象，如肾上腺周围浸润和血管侵犯，选择了腹腔镜肾上腺手术入路。
对于诊断为良性病变的情况，腹腔镜肾上腺切除术被认为是标准治疗方法。在本病例报告中，我们讨论了一例采用腹腔镜手术治疗的大型肾上腺海绵状血管瘤。术前对内分泌紊乱和放射学检查结果进行研究以排除恶性征象至关重要。
