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EnglishIntroduction: Cavernous hemangioma of the adrenal gland is a rare benign tumor characterized by the presence of blood-fil- led, dilated vascular spaces. These adrenal masses are usually non-functioning and the patients have no symptoms so the diagnosis is incidental. Methods: We performed a systematic literature review for all articles published until April 2015. The initial search identified 98 publications. We considered some characteristics: the mean age of the patients at diagnosis was 59 years (range 19 - 84); there were approximately 1.7 times more female patients than male patients; mean diameter of the lesions was 10.3 cm (range 2 - 25). Surgical treatment was more often open with midline or subcostal incision. Results: From literature analysis we know that small adrenal hemangiomas are usually asymptomatic. Only four patients in our literature review show endocrinologic disturbances with three cases of subclinical Cushing’s syndrome and a case of hyperaldo- steronism. The pre-operative radiologic features play a fundamental role for correct surgical approach. On enhanced Computed Tomography (CT) scan adrenal hemangiomas tend to be heterogeneous, hypodense lesions with high-density rim of tissue at the periphery. On Magnetic Resonance Imaging (MRI) common findings associated with adrenal hemangiomas are hypointense inhomo- geneous masses with central hyperintensity on T1 images and a high intensity peripheral rim on T2 images due to hemorrhage or necrosis. Conclusion: Laparoscopic adrenalectomy is considered the standard treatment in case of benign lesions. Some authors sugge- st that the main limitation during laparoscopic dissection for large and potentially malign adrenal tumors is incomplete resection and capsular disruption with increased risk of local recurrence and intra-abdominal neoplastic dissemination. We recommend for these patients an integrated multidisciplinary approach that considers endocrine studies, preoperative radiologic findings and the expe- rience of surgical team.
Agrusa, A., Romano, G., Dominguez Rodriguez, L.J., Amato, G., Citarrella, R., Vernuccio, L., et al. (2016). Adrenal cavernous hemangioma: which correct decision making process?. ACTA MEDICA MEDITERRANEA, 32(2), 385-389 [10.19193/0393-6384_2016_2_58].
| Data di pubblicazione: | 2016 | |
| Titolo: | Adrenal cavernous hemangioma: which correct decision making process? | |
| Autori: | ||
| Citazione: | Agrusa, A., Romano, G., Dominguez Rodriguez, L.J., Amato, G., Citarrella, R., Vernuccio, L., et al. (2016). Adrenal cavernous hemangioma: which correct decision making process?. ACTA MEDICA MEDITERRANEA, 32(2), 385-389 [10.19193/0393-6384_2016_2_58]. | |
| Rivista: | ||
| Digital Object Identifier (DOI): | http://dx.doi.org/10.19193/0393-6384_2016_2_58 | |
| Abstract: | Introduction: Cavernous hemangioma of the adrenal gland is a rare benign tumor characterized by the presence of blood-fil- led, dilated vascular spaces. These adrenal masses are usually non-functioning and the patients have no symptoms so the diagnosis is incidental. Methods: We performed a systematic literature review for all articles published until April 2015. The initial search identified 98 publications. We considered some characteristics: the mean age of the patients at diagnosis was 59 years (range 19 - 84); there were approximately 1.7 times more female patients than male patients; mean diameter of the lesions was 10.3 cm (range 2 - 25). Surgical treatment was more often open with midline or subcostal incision. Results: From literature analysis we know that small adrenal hemangiomas are usually asymptomatic. Only four patients in our literature review show endocrinologic disturbances with three cases of subclinical Cushing’s syndrome and a case of hyperaldo- steronism. The pre-operative radiologic features play a fundamental role for correct surgical approach. On enhanced Computed Tomography (CT) scan adrenal hemangiomas tend to be heterogeneous, hypodense lesions with high-density rim of tissue at the periphery. On Magnetic Resonance Imaging (MRI) common findings associated with adrenal hemangiomas are hypointense inhomo- geneous masses with central hyperintensity on T1 images and a high intensity peripheral rim on T2 images due to hemorrhage or necrosis. Conclusion: Laparoscopic adrenalectomy is considered the standard treatment in case of benign lesions. Some authors sugge- st that the main limitation during laparoscopic dissection for large and potentially malign adrenal tumors is incomplete resection and capsular disruption with increased risk of local recurrence and intra-abdominal neoplastic dissemination. We recommend for these patients an integrated multidisciplinary approach that considers endocrine studies, preoperative radiologic findings and the expe- rience of surgical team. | |
| Settore Scientifico Disciplinare: | Settore MED/09 - Medicina Interna Settore MED/18 - Chirurgia Generale Settore MED/13 - Endocrinologia | |
| Appare nelle tipologie: | 1.01 Articolo in rivista |
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| File | Descrizione | Tipologia | Licenza | |
|---|---|---|---|---|
| adrenal hemangioma review.pdf | full text | Versione Editoriale | Open Access Visualizza/Apri |
http://hdl.handle.net/10447/177822
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