The collection of five interesting cases of adrenal tumors from one medical center

Two patients were admitted to our hospital in order to examine the cause of muscle weakness headaches, perspiration, palpitation and facial redness. A 46-year-old male presented with hypertension of 15-months duration (case one). The patient’s family had no history of hypertension, cardiac arrhythmias or thyroid disorders.

A 34-year-old female was referred for the evaluation of palpitation and facial redness of one-year’s duration (case two). The patient’s parents and sister had no history of hypertension or other endocrine disorders.

On admission, there were no cushingoid signs. Paroxysmal hypertension had occurred, and was poorly controlled by antihypertensive drugs in both cases. Levels of urinary catecholamines were increased during the paroxysmal hypertension (see Table 1). Thyroid scans revealed normal-sized glands and their basic serum calcitonin level was normal. Computer tomography (CT) scans revealed left adrenal masses measuring: 10 mm (patient one - Figure 1) and 30 mm (patient two). Both patients underwent preoperative medical management to block effects of catecholamines released during surgery. The patients underwent laparoscopic total adrenalectomy, with no postoperative complications. Surgery resulted in the normalization of catecholamine hypersecretion and clinical improvement in both patients (Table 1). A light microscopy revealed diffuse enlargement of the adrenal medulla from the head to tail in both cases. The adrenal cortex was normal in both cases. The combined corticomedullary ratio varied between 2:1 (patient one) and 4:1 (patient two), compared with a ratio of 10:1 in a normal gland (Figures 2,3 and4). The histopathological examination of the specimens showed diffuse adrenal medullary hyperplasia (AMH).

We present the case of a woman with hydatid disease in her adrenal gland which was found incidentally in an ultrasonography (USG). A 47-year-old woman with two year history of arterial hypertension was referred to our department in 2003. A general examination revealed high blood pressure (180/100 mmHg). No other physical signs suggestive of hypercortisolism were noted. A blood analyses showed hypereosinophilia (see Table 1). A computed tomography (CT) scan of the abdomen demonstrated a sharply marginated, 55 × 58 × 68 mm right cystic mass with internal septa in the right adrenal gland. She underwent a laparoscopic adrenalectomy. In the surgical exploration, a solid cystic mass was defined, compressed against the right kidney’s upper pole. The entire mass, together with normal adrenal tissue, was removed. According to a histopathological examination, hydatid disease in adrenal gland was suspected (Figure 5). Eosinophilia was normalized after surgery (see Table 1). Our patient has continued to be followed up on for 11 years without recurrence of hydatid disease.

We present the case of a 64-year-old woman with a malignant-looking right adrenal tumor, 87 mm in diameter. She was referred to our department in 2001. She reported a 15 kg weight loss over the previous months and abdominal pain. Her medical history was hypertension and cholelithiasis for over 10 years previously. No other physical signs suggestive of hypercortisolism or pheochromocytoma were noted. A blood analyses showed anemia (see Table 1). As a part of the diagnostic procedures, her clinical examination was followed by an abdominal USG and CT scans. CT scans of the chest and abdomen showed a heterogenous mass of the right adrenal gland, 80 × 78 × 87 mm in diameter, without evidence of local tissue invasion or metastatic spread. Because of suspicion of malignancy, an open adrenalectomy was performed. After mobilization of the splenic flexure, a large mass was identified rising from the right adrenal gland. No obvious lymphadenopathy was seen. The mass was distinct and separate from the surrounding tissues. The entire right adrenal gland containing the tumor was excised. A histopathological examination showed a primary adrenal angiosarcoma (PAA) (Figure 6). Upon immunohistochemical analysis, vascular antigens including CD (cluster of differentiation) 31, CD34 and vimentin, were expressed (Figure 7). Six months after the surgery, a whole body CT scan revealed no other primary tumor site, nor metastases. She died two years later of rapid recurrence of the disease, which metastasized to the bilateral lungs and liver. The chemotherapy plan was doxorubicin and ifosfamide but she refused the treatment.

Here we present the case of a 40-year-old woman with an adenomatoid tumor (AT) of the adrenal gland, clinically suspected to be a malignant tumor. The right adrenal tumor was found incidentally on a routine medical examination in 1997. There was no family history of any endocrine pathology and she did not present with any symptoms of palpitations, diaphoresis or flushing. Laboratory examinations revealed that the urinary vanilinmandelic acid, catecholamine and cortisol levels all were within normal limits (see Table 1).The preoperative abdominal CT scan demonstrated a well-circumscribed, solid right adrenal mass measuring 88 × 80 × 90 mm. Based on the above findings, the primary diagnosis was non-functional adrenal carcinoma. Subsequently, an open total left adrenalectomy was performed and no lymphadenopathy was seen. On gross examination the tumor was a well-circumscribed solid mass. The histological appearance, together with the immunophenotype of this tumor, was consistent with the diagnosis of cystic lymphangioma-like AT of the adrenal gland (Figures 8 and9).