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Images in Clinical Urology
Anastomosing HemangiomaArising From the Adrenal GlandMichael Ross, Anthony Polcari, Maria Picken, Howard Sankary, and John Milner
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Adrenal hemangiomas are rare, nonfunctionalvascular tumors. Of the 60 reported cases frompublished studies, nearly all have been of the
cavernous subtype. Cavernous hemangiomas are charac-terized histologically by enlarged blood-filled vascularchannels that erode and displace normal tissue. Charac-teristic computed tomography findings include low-atten-uation centrally, patchy peripheral enhancement, anddiffuse calcification.1-4 Anastomosing hemangiomas areistinguished from their cavernous counterparts by thenastomosing sinusoidal-like pattern of tightly packedapillary channels. The imaging findings for this novelubtype have not yet been described. We report the firstase of anastomosing hemangioma of adrenal origin.
A 49-year-old, asymptomatic, Hispanic man with end-tage renal disease presented for a renal transplant eval-ation. Renal ultrasonography showed bilateral renal
Financial Disclosure: The authors declare that they have no relevant financialinterests.
From the Department of Urology, Loyola University Medical Center, Maywood, ILReprint requests: Michael Ross, M.D., Department of Urology, Loyola University
Figure 1. Unenhanced axial computed tomography imageshowing a heterogeneous low-density mass (white arrow) inthe right retroperitoneum, abutting the right adrenal glandand lacking diffuse calcification, suggesting the mass wasnot cavernous hemangioma.
aMedical Center, Maywood, IL 60153. E-mail: [email protected]
Submitted: April 7, 2012, accepted (with revisions): May 23, 2012
© 2012 Elsevier Inc.All Rights Reserved
ysts and a complex cystic structure adjacent to the rightidney. Follow-up abdominal computed tomography with.5-mm slices and coronal reformatting was obtained fordditional characterization. Noncontrast-enhanced im-
Figure 2. Contrast-enhanced coronal computed tomogra-phy image showing a heterogeneous, 3.3 � 3.7-cm, rightadrenal mass, discrete from the kidney (K). The mass hadperipheral enhancement (white arrow), central cysts (blackarrow), and adjacent fat stranding.
Figure 3. Anastomosing hemangioma (left side) adjacentto adrenal cortex (AC). Tightly packed capillary channelswith focal anastomosing sinusoidal pattern are visible(white arrows). Hematoxylin-eosin stain, original magnifica-tion �250.
ges revealed a 3.7-cm, right adrenal mass without calci-
0090-4295/12/$36.00 e27http://dx.doi.org/10.1016/j.urology.2012.05.032
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fication (Fig. 1). Contrast-enhanced images demon-strated heterogeneity with central cystic spaces andperipheral enhancement concerning for adrenal mal-ignancy (Fig. 2). The functional workup, including acomplete metabolic panel and 24-hour urinary cortisol/vanillymandelic acid/metanephrine determination, wasnegative. Given his end-stage renal disease, renal cysts,and desire for a kidney transplant, the patient underwentuneventful laparoscopic radical nephrectomy/adrenalec-tomy.
The gross pathologic examination showed a red-tan,nonencapsulated, hemorrhagic, 2.0-cm mass arising fromthe adrenal cortex and extending into the right kidney.On microscopic examination, tightly packed capillarychannels with a focal anastomosing sinusoidal patternwere seen. The vascular channels were lined by blandendothelial cells (Fig. 3). These features confirmed anas-tomosing hemangioma of adrenal origin.
Adrenal hemangioma is a rare, benign, vascular tumor
with fewer than 60 reported cases. Of these, cavernouse28
hemangiomas have predominated.1,2 To date, anastomos-ing hemangiomas have only been described in the kid-ney, testis, and ovary.5,6 The present case represents therst case of anastomosing hemangioma arising within thedrenal gland.
eferences1. Alexander JK, Nikolaidis P, Casalino DD. Adrenal gland hemangi-
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adrenal gland. Int J Urol. 2009;16:424-424.3. Thiele JW, Bodie B. Adrenal hemangioma. Surgery. 2001;129:373-
374.4. Oh BR, Jeong YY, Ryu SB, et al. A case of adrenal cavernous
hemangioma. Int J Urol. 1997;4:608-610.5. Montgomery E, Epstein JI. Anastomosing hemangioma of the gen-
itourinary tract: a lesion mimicking angiosarcoma. Am J Surg Pathol.2009;33:1364-1369.
6. Kryvenko ON, Gupta NS, Meier FA, et al. Anastomosing heman-gioma of the genitourinary system: eight cases in the kidney andovary with immunohistochemical and ultrastructural analysis. Am J
Clin Pathol. 2011;136:450-457.UROLOGY 80 (3), 2012
