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Images in Clinical Urology Anastomosing Hemangioma Arising From the Adrenal Gland Michael Ross, Anthony Polcari, Maria Picken, Howard Sankary, and John Milner A drenal hemangiomas are rare, nonfunctional vascular tumors. Of the 60 reported cases from published studies, nearly all have been of the cavernous subtype. Cavernous hemangiomas are charac- terized histologically by enlarged blood-filled vascular channels that erode and displace normal tissue. Charac- teristic computed tomography findings include low-atten- uation centrally, patchy peripheral enhancement, and diffuse calcification. 1-4 Anastomosing hemangiomas are distinguished from their cavernous counterparts by the anastomosing sinusoidal-like pattern of tightly packed capillary channels. The imaging findings for this novel subtype have not yet been described. We report the first case of anastomosing hemangioma of adrenal origin. A 49-year-old, asymptomatic, Hispanic man with end- stage renal disease presented for a renal transplant eval- uation. Renal ultrasonography showed bilateral renal cysts and a complex cystic structure adjacent to the right kidney. Follow-up abdominal computed tomography with 2.5-mm slices and coronal reformatting was obtained for additional characterization. Noncontrast-enhanced im- ages revealed a 3.7-cm, right adrenal mass without calci- Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Urology, Loyola University Medical Center, Maywood, IL Reprint requests: Michael Ross, M.D., Department of Urology, Loyola University Medical Center, Maywood, IL 60153. E-mail: [email protected] Submitted: April 7, 2012, accepted (with revisions): May 23, 2012 Figure 1. Unenhanced axial computed tomography image showing a heterogeneous low-density mass (white arrow) in the right retroperitoneum, abutting the right adrenal gland and lacking diffuse calcification, suggesting the mass was not cavernous hemangioma. Figure 2. Contrast-enhanced coronal computed tomogra- phy image showing a heterogeneous, 3.3 3.7-cm, right adrenal mass, discrete from the kidney (K). The mass had peripheral enhancement (white arrow), central cysts (black arrow), and adjacent fat stranding. Figure 3. Anastomosing hemangioma (left side) adjacent to adrenal cortex (AC). Tightly packed capillary channels with focal anastomosing sinusoidal pattern are visible (white arrows). Hematoxylin-eosin stain, original magnifica- tion 250. © 2012 Elsevier Inc. 0090-4295/12/$36.00 e27 All Rights Reserved http://dx.doi.org/10.1016/j.urology.2012.05.032
