case_images: PMC10667707_01
case_images: Coronal and sagittal views of CT abdomen with contrast, showing 4.4 cm left adrenal mass with peripheral enhancement and central heterogeneous hypoenhancement, July 2022.
case_images: fsurg-10-1293925-g001.jpg
case_images: PMC10667707_01_fsurg-10-1293925-g001.jpg
case_images: F1
case_images: Abdomen from the month prior (Figure 1).
case_images: Pathology findings of left adrenal mass: macroscopic. The specimen consists of a yellow-tan unoriented left adrenalectomy weighing 55 g and measuring 7.5 x 6.5 x 3.7 cm. The specimen is inked green and serially sectioned to reveal a tan to yellow-orange circumscribed hemorrhagic 7.0 x 4.1 x 3.6 cm mass.
case_images: fsurg-10-1293925-g002.jpg
case_images: PMC10667707_01_fsurg-10-1293925-g002.jpg
case_images: F2
case_images: The surgical specimen submitted as a left adrenal mass (Figure 2) was examined microscopically to reveal a blood-filled vascular proliferation of thin-walled vessels with intervening stroma with focal thrombosis, consistent with a cavernous hemangioma (Figure 3).
case_images: Pathology findings of left adrenal mass: microscopic. (A-C) Well-circumscribed vascular lesion (note demarcation from normal adrenal*) consisting of variously sized dilated thin-walled vascular channels lined by a single layer of flattened endothelial cells. (D) CD31/PECAM1 (a highly sensitive and specific marker of vascular differentiation) is positive in the lesional cells (but negative in normal adrenal* except for normal vasculature within the adrenal). (E,F) Focal areas of calcification (E) and thrombosis with hemosiderin-laden macrophages (F) are noted and are chronic features in the development of this lesion. (G) Few areas of eosinophilic amorphous material (*) around vessels are identified concerning for amyloid deposition. Not shown here is the Congo Red special stain, which was performed with adequate controls and negative.
case_images: fsurg-10-1293925-g003.jpg
case_images: PMC10667707_01_fsurg-10-1293925-g003.jpg
case_images: F3
case_images: The surgical specimen submitted as a left adrenal mass (Figure 2) was examined microscopically to reveal a blood-filled vascular proliferation of thin-walled vessels with intervening stroma with focal thrombosis, consistent with a cavernous hemangioma (Figure 3). Thrombosis and calcifications most likely represent features of chronicity (Figures 3E,F). CD31 (vascular marker) to be positive in the lesional cells and Ki-67 (proliferation marker) as low. Congo red special stain was also performed to rule out amyloid deposition (Figure 3G).