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A 69-year-old man with treated melanoma and prostate cancer presented for cancer restaging. Magnetic resonance imaging demonstrated a markedly enhancing, well-circumscribed 2.3-cm left adrenal mass (Fig. 1A). The mass retained contrast on venous and delayed phases (Fig. 1B and 1C), which is atypical for a benign adenoma. Thus, the lesion was considered indeterminate and suspicious for metastasis given the history of malignancy. After a negative hormonal evaluation, tissue biopsy revealed a hemangioma, with collections of small blood vessels within loose myxoid stroma. The patient had no biopsy-related complications, including bleeding. Retrospectively, some imaging features were characteristic of hemangioma: enhancement pattern following the blood pool and markedly increased signal intensity on T2-weighted images (Fig. 1D). Adrenal hemangioma is a rare, benign tumor representing less than 1% of adrenal tumors. They can be misdiagnosed as pheochromocytoma or metastasis (1, 2). Adrenal hemangiomas are usually nonfunctional and asymptomatic but can rarely present with symptoms of mass effect or hemorrhage (2). The diagnosis is usually made after tissue sampling or surgical resection, which may be necessary for symptomatic treatment, diagnostic purposes, or treatment of endocrine hyperfunction. In conclusion, adrenal hemangioma may portray classic imaging features; its diagnosis should be considered depending on the clinical context.
Contributor Information
Ahmed K Elsayes, Department of Radiology, University of Texas Medical Branch Galveston, Galveston, TX 77555, USA.
Steven G Waguespack, Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Eduardo J Matta, Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
Mindy X Wang, Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Funding
No public or commercial funding.
Disclosures
S.G.W. is an editorial board member for JCEM Case Reports and played no role in the journal's evaluation of the manuscript. All other authors: none declared.
Informed Patient Consent for Publication
Signed informed consent could not be obtained from the patient or a proxy but has been approved by the treating institution.
Data Availability Statement
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.