Mancini Mariangela, Leone Nicolò, Iafrate Massimo, Fassina Ambrogio, Zattoni Filiberto
Urological Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, 35121 Padua, Italy.
Department of Medicine, Section of Pathology, University of Padua, 35121 Padua, Italy.
J Surg Case Rep. 2020 Jun 19;2020(6):rjaa185. doi: 10.1093/jscr/rjaa185. eCollection 2020 Jun.
The spontaneous adrenal hematoma is a rare event. An 83-year-old male patient presented a 26-cm asymptomatic retroperitoneal mass of doubtful renal-adrenal origin. He had been evaluated 10 years before for an adrenal incidentaloma of 2.3 cm and had refused surgery when it had reached 7 cm. Later, the mass enlarged to 26 cm and was surgically removed through an open anterior approach. The histopathology showed a solid 4 kg mass of fibrinoid-hemorrhagic material, partially necrotic, mixed with adrenal tissue, with a well-vascularized capsule. No relapse is present at 6-month follow-up. This is the largest case described of spontaneous intra-adrenal hematoma in a case with previous non-secreting adrenal adenoma. The hematoma (a 4 kg mass) developed 10 years after the first diagnosis and exposed the patient to potential damage of the surrounding organs and to high-risk abdominal surgery. Long-term follow-up of non-secreting adrenal adenomas should be recommended.
自发性肾上腺血肿是一种罕见的病症。一名83岁男性患者出现了一个26厘米大小的无症状腹膜后肿块，其肾-肾上腺起源存疑。10年前他曾因一个2.3厘米的肾上腺偶发瘤接受评估，当肿瘤长到7厘米时他拒绝了手术。后来，肿块增大到26厘米，并通过开放前路手术切除。组织病理学显示有一个4千克的实性纤维蛋白样出血性肿块，部分坏死，与肾上腺组织混合，有血管丰富的包膜。6个月随访时未见复发。这是有既往非分泌性肾上腺腺瘤病例中所描述的最大的自发性肾上腺内血肿病例。血肿（一个4千克的肿块）在首次诊断10年后出现，使患者面临周围器官潜在损伤和高风险腹部手术的风险。对于非分泌性肾上腺腺瘤应建议进行长期随访。
