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Glushko T, Chumbalkar V, Honarmand AR, Araujo C, McGettigan M, Jeong D. Adrenal hemangiomas versus adrenal pheochromocytomas with radiologic-pathologic correlation. Eur J Radiol 2025; 188:112122. [PMID: 40318501 DOI: 10.1016/j.ejrad.2025.112122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2025] [Revised: 03/23/2025] [Accepted: 04/15/2025] [Indexed: 05/07/2025]
Abstract
Adrenal hemangiomas present a significant diagnostic challenge due to their rarity and overlapping imaging features with more commonly encountered adrenal tumors, such as pheochromocytomas. In this article, we present imaging characteristics of adrenal hemangiomas and differentiate them from pheochromocytomas and other adrenal neoplasms with similar radiologic appearances. This article is based on real clinical conundrum that the authors aim to share with readers.
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Affiliation(s)
- Tetiana Glushko
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
| | - Vaibhav Chumbalkar
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Cyrillo Araujo
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Melissa McGettigan
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Daniel Jeong
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Coscia K, Ravaioli C, Tucci L, Colombin G, Donnarumma F, Mosconi C, Balacchi C, Nanni C, Alberici L, Selva S, Pagotto U, Santini D, Tallini G, Di Dalmazi G, Vicennati V, De Leo A. The diagnostic dilemma of adrenal vascular tumors: analysis of 21 cases and systematic review of the literature. Endocrine 2025; 87:1291-1304. [PMID: 39825193 PMCID: PMC11845438 DOI: 10.1007/s12020-024-04123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 11/25/2024] [Indexed: 01/20/2025]
Abstract
PURPOSE Adrenal vascular tumors are mainly represented by adrenal cavernous hemangiomas (ACHs) and adrenal cystic lymphangiomas (ACLs). Their radiological features often overlap with malignant tumors, therefore ruling out malignancy becomes mandatory. We analyzed clinical, radiological, and histopathological data to identify specific characteristics of these tumors. METHODS We reviewed 21 patients with ACHs (n = 12), ACLs (n = 8), or adrenal cysts (n = 1) confirmed by histopathology. We selected 82 papers from PubMed to provide a systematic review of the literature. RESULTS In our cohort, median age at diagnosis was 58 years, with sex evenly distributed. All tumors were unilateral (median size = 44 mm), with 6 cases of increasing tumor size. All tumors exhibited non-contrast CT density > 10 Hounsfield Unit (HU). Calcifications were found in 5 cases. Hormonal studies revealed 11 non-functioning tumors and 2 cortisol-secreting tumors. Elevated urinary metanephrines were found in 2 cases. Immunostaining showed CD31/CD34/factor VIII expression in ACHs (n = 5, 24%) and podoplanin expression in ACLs (n = 6, 29%). The literature review revealed 71 reported cases of ACHs and 104 reported cases of ACLs. Median age at diagnosis was 46 years, with slightly female prevalence (63%). Median tumor size was 48 mm. 84 cases were symptomatic, with life-threatening hemorrhage reported in only 3 patients. Calcifications were found in 23% of cases. Surgical approaches varied, with open and laparoscopic adrenalectomy performed in 55 and 42 patients respectively. CONCLUSIONS ACHs and ACLs represent a diagnostic dilemma in clinical practice due to their rarity and their misleading imaging features.
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Affiliation(s)
- Kimberly Coscia
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Caterina Ravaioli
- Anatomic Pathology - Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Solid Tumor Molecular Pathology Laboratory, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Tucci
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giacomo Colombin
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesca Donnarumma
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cristina Mosconi
- Department of Specialized, Radiology Unit, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Caterina Balacchi
- Department of Specialized, Radiology Unit, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Laura Alberici
- Division of Pancreatic and Endocrine Surgical Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Saverio Selva
- Division of Pancreatic and Endocrine Surgical Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Uberto Pagotto
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Donatella Santini
- Anatomic Pathology - Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Giovanni Tallini
- Anatomic Pathology - Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Solid Tumor Molecular Pathology Laboratory, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Guido Di Dalmazi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Valentina Vicennati
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Antonio De Leo
- Anatomic Pathology - Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Solid Tumor Molecular Pathology Laboratory, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Sage H, Jones E, Neychev V. Cavernous Hemangioma: A Rare Adrenal Tumor Associated With Hyperaldosteronism. Cureus 2025; 17:e79251. [PMID: 40125193 PMCID: PMC11929149 DOI: 10.7759/cureus.79251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2024] [Indexed: 03/25/2025] Open
Abstract
Adrenal cavernous hemangiomas are rare benign venous malformations characterized by vascular dysmorphogenesis. A 53-year-old male patient was referred for a surgical consultation with a 5 cm heterogeneous, lipid-poor, incidental left adrenal mass. It was detected on a computed tomography (CT) scan performed for left upper quadrant pain. His past medical history was significant for poorly-controlled hypertension on a multi-drug regimen, anxiety, headaches, insomnia, and palpitations. Laboratory testing performed by his primary care physician revealed elevated plasma catecholamines, which were concerning for pheochromocytoma. A repeat workup by endocrinology and endocrine surgery showed biochemical evidence of primary hyperaldosteronism with an aldosterone/plasma renin ratio of 36.8 and normal plasma catecholamines and metanephrines. Due to the biochemical workup, size, and radiological features of the mass, a decision to proceed with a left adrenalectomy was made. The patient was started on phenoxybenzamine two weeks before surgery due to a high index of clinical suspicion for a pheochromocytoma, despite the equivocal biochemical workup. Surgical pathology revealed a cavernous hemangioma with pseudonodular thickening of the adrenal cortex without evidence of malignancy, adrenal adenoma, or pheochromocytoma. On follow-up, the patient was on fewer antihypertensive medications with normal blood pressure and a normalized aldosterone/plasma renin ratio. A diagnosis of cavernous hemangioma should be considered for adrenal masses of uncertain biology and biochemical activity.
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Affiliation(s)
- Hannah Sage
- Surgery, University of Central Florida College of Medicine, Orlando, USA
| | | | - Vladimir Neychev
- Surgery, University of Central Florida College of Medicine, Orlando, USA
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Elsayes AK, Waguespack SG, Matta EJ, Wang MX. Adrenal Hemangioma. JCEM CASE REPORTS 2024; 2:luae162. [PMID: 39286519 PMCID: PMC11402794 DOI: 10.1210/jcemcr/luae162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Indexed: 09/19/2024]
Affiliation(s)
- Ahmed K Elsayes
- Department of Radiology, University of Texas Medical Branch Galveston, Galveston, TX 77555, USA
| | - Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Eduardo J Matta
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Mindy X Wang
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Almajed EH, Alshamrani AM, Alqahtani AS, Alzahrani AJ, Alahmadi T, Asiri SM. Rare Case of Adrenal Hemangioma Discovered Incidentally during Renal Colic Investigation. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943826. [PMID: 38965761 PMCID: PMC11322789 DOI: 10.12659/ajcr.943826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/23/2024] [Accepted: 05/12/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Hemangiomas of the adrenal gland are rare benign non-functional tumors arising from the gland's vascular endothelium. Adrenal hemangiomas are rare in clinical settings, often discovered incidentally during an unrelated diagnostic investigation. CASE REPORT A 39-year-old man presented with a heterogeneous, enhancing 4.56×4.24×3.9-cm mass originating from the right adrenal gland's lateral limb, discovered incidentally on computed tomography (CT) to investigate renal colic. He was routinely followed up for 2 years with serial CT scans; the mass exhibited considerable growth compared with baseline, with a relatively stable appearance with hyperdense soft tissue component, fat, and foci of calcification. Dexamethasone suppression test demonstrated suppressed cortisol response, indicating a non-functional mass. Therefore, laparoscopic right adrenalectomy was performed, owing to the benign nature of the preoperative diagnosis of myelolipoma and mass size. The patient experienced an uneventful recovery, with no perioperative complications. The resected mass was 5×4×4 cm in size and weighed 30 g. Histopathology confirmed adrenal hemangioma. Serial sectioning revealed an encapsulated lesion with heterogeneous solid and cystic surfaces. Light microscopy examination showed dilated and congested vascular channels lined by flattened endothelium. Focal mature adipose tissue was seen. CONCLUSIONS The infrequent occurrence of adrenal hemangiomas and their nonspecific clinical and radiological presentation results in a considerable diagnostic challenge and, often, misdiagnosis. Surgical resection is usually necessary to exclude malignant disease, alleviate pressure-related symptoms, and decrease risk of retroperitoneum hemorrhage. These lesions are associated with a good prognosis. One limitation of this report is the lack of preoperative adrenal magnetic resonance imaging of the incidental adrenal mass.
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Affiliation(s)
- Ebtesam H. Almajed
- Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Adel S. Alqahtani
- Department of General Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | | | - Thamer Alahmadi
- Department of General Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Shuaa M. Asiri
- Department of Pathology, Security Forces Hospital, Riyadh, Saudi Arabia
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Tan T, Diab J, Chia P, Singh A, Campbell P, Guevara R. An imaging and diagnostic conundrum-the adrenal haemangioma. J Surg Case Rep 2024; 2024:rjae286. [PMID: 38706490 PMCID: PMC11068444 DOI: 10.1093/jscr/rjae286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 05/07/2024] Open
Abstract
The adrenal haemangioma, a rare benign vascular tumour, is increasingly detected through abdominal imaging. Just over 70 surgical cases have been reported since 1955. Their potential large size and overlapping imaging features with adrenocortical carcinoma poses a diagnostic challenge. Adrenalectomy is often needed for a definitive diagnosis due to inconclusive imaging. We report the case of a 61-year-old female presenting with an incidental finding of a right-sided 9.5-cm adrenal mass on imaging. Due to the risk of adrenocortical carcinoma with inconclusive imaging findings, an open right adrenalectomy was performed. The patient was discharged after 6 days with no complications. Post-surgical histopathology confirmed a diagnosis of adrenal haemangioma with a secondary adrenal pseudocyst. The presence of an adrenal incidentaloma with discordant radiological features proves to be a diagnostic conundrum. Therefore, in the setting of contradictory radiology and concerning mass size, we recommend adrenalectomy for definitive diagnosis of an adrenal haemangioma.
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Affiliation(s)
- Tiffany Tan
- Department of Endocrine Surgery, Liverpool Hospital, Liverpool, NSW 2170, Australia
| | - Jason Diab
- Department of Endocrine Surgery, Liverpool Hospital, Liverpool, NSW 2170, Australia
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- School of Medicine, University of Notre Dame, Darlinghurst, NSW 2010, Australia
| | - Philip Chia
- Department of Endocrine Surgery, Liverpool Hospital, Liverpool, NSW 2170, Australia
- School of Medicine, University of Sydney, NSW 2052, Australia
| | - Amandeep Singh
- Department of Endocrine Surgery, Liverpool Hospital, Liverpool, NSW 2170, Australia
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Anatomical Pathology, Liverpool Hospital, Liverpool, NSW 2170, Australia
| | - Peter Campbell
- Department of Endocrine Surgery, Liverpool Hospital, Liverpool, NSW 2170, Australia
- School of Medicine, University of Sydney, NSW 2052, Australia
| | - Ronald Guevara
- Department of Endocrine Surgery, Liverpool Hospital, Liverpool, NSW 2170, Australia
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Hou XF, Zhao ZX, Liu LX, Zhang H. Retroperitoneal cavernous hemangioma misdiagnosed as lymphatic cyst: A case report and review of the literature. World J Clin Cases 2023; 11:3560-3570. [PMID: 37383918 PMCID: PMC10294187 DOI: 10.12998/wjcc.v11.i15.3560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Primary abdominal and retroperitoneal cavernous hemangioma is a vascular tumor and rarely seen in the clinic. Due to the lack of specific imaging features, retroperitoneal cavernous hemangioma cannot be diagnosed accurately. Some symptoms may develop with the enlargement of lesion volume or the occurrence of complications such as rupture or oppression. We report here a special case who was admitted with chronic abdominal pain. Admission examination suggested a retroperitoneal lymphatic duct cyst. Laparoscopic resection of the retroperitoneal mass was performed, and histological examination confirmed retroperitoneal cavernous hemangioma.
CASE SUMMARY The patient was a 43-year-old Tibetan woman with intermittent left lower abdominal pain and discomfort 3 years ago. Ultrasonography revealed a cystic mass in the retroperitoneum with clear boundaries, internal septa, and no blood flow signal. Computed tomography (CT) and magnetic resonance imaging (MRI) showed an irregular space-occupying mass in the retroperitoneum, and retroperitoneal lymphatic cyst was considered. Plain CT scanning showed multiple cyst-like hypo-intense shadows in the retroperitoneum, partially fused into a mass, and no obvious enhancement was found on enhanced scanning. MRI showed multiple irregular clump-like long T1 and long T2 signal shadows above the pancreas, within which linear short T2 signal shadows were seen. Diffusion-weighted imaging sequence showed hypo-signal shadows, without obvious enhancement on enhanced scanning. Ultrasound, CT, and MRI all suggested the possibility of retroperitoneal lymphatic cyst. However, the patient was finally diagnosed with retroperitoneal cavernous hemangioma by pathological examination.
CONCLUSION Retroperitoneal cavernous hemangioma is a benign lesion, and it is difficult to make a diagnosis preoperatively. Surgical resection may be the only treatment, which not only allows histopathological confirmation as a diagnostic purpose and excludes any risk of malignancy, but also avoids invasion of adjacent tissues, oppression, and other complications as a therapeutic goal.
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Affiliation(s)
- Xiao-Fan Hou
- Medical College, Qinghai University, Xining 810000, Qinghai Province, China
| | - Zhan-Xue Zhao
- Department of General Surgery, Qinghai Provincial People's Hospital, Xining 810000, Qinghai Province, China
| | - Lin-Xun Liu
- Department of General Surgery, Qinghai Provincial People's Hospital, Xining 810000, Qinghai Province, China
| | - Hao Zhang
- Medical College, Qinghai University, Xining 810000, Qinghai Province, China
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Toklu A, Mesa H, Collins K. Incidental adrenal hemangioma clinically suspicious for malignancy: diagnostic considerations and review of the literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2022; 15:444-458. [PMID: 36507066 PMCID: PMC9729942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/15/2022] [Indexed: 12/15/2022]
Abstract
Adrenal hemangiomas are rare lesions often found incidentally during unrelated diagnostic work-up. We report a case of a 67-year-old man with history of hypertension, hyperlipidemia, anemia, arthralgia, joint swelling and unexplained weight loss, which prompted imaging studies. Computed tomography scan revealed a 5.4 cm adrenal mass. The patient had no clinical manifestations of adrenal medullary or cortical hyperfunction. Urine and plasma metanephrines and aldosterone/renin ratio were within normal range. The patient was taking prednisone for hand and ankle swelling, precluding assessment for Cushing syndrome. Given the size of the lesion, the possibility of malignancy was considered, and the patient elected for surgical management. The left adrenalectomy specimen weighed 54 g and revealed a 4.9 cm tan-brown mass with congested cut surface and a thin rim of residual adrenal gland parenchyma. Histologic examination showed thick and thin-walled vessels intermingled with adrenocortical elements at the periphery characteristic of a hemangioma. Surgical resection is the mainstay treatment for large, isolated adrenal masses to exclude malignancy and prevent retroperitoneal hemorrhage. Herein, we report a case of adrenal hemangioma, review a variety of other diagnostic considerations occurring in the adrenal gland, and highlight useful distinguishing features to assist in accurate diagnosis.
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Chua Y, Quake S, Prasad K, Elsaify W. A Rare Case of Cavernous Haemangioma of the Adrenal Gland: A Case Report and Review of Literature. Cureus 2022; 14:e29917. [DOI: 10.7759/cureus.29917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
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Fujinami H, Kai T, Ando T, Shin T, Mimata H. A case of retroperitoneal venous malformation resected by laparoscopic surgery. IJU Case Rep 2022; 5:369-372. [PMID: 36090936 PMCID: PMC9436689 DOI: 10.1002/iju5.12491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/15/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Among vascular malformations, venous malformations are the most common type. Among these, retroperitoneal venous malformations are extremely rare. Case presentation A 60‐year‐old woman was diagnosed with a retroperitoneal tumor 4.5 cm in diameter by abdominal computed tomographic scan. We had difficulty judging whether the tumor was benign or malignant. We performed laparoscopic surgery in order to remove the tumor and make a precise diagnosis. The pathological diagnosis was a venous malformation. Conclusion Venous malformation located in the retroperitoneum is very rare, and there were few cases that could be removed by laparoscopic surgery. Laparoscopic surgery may be beneficial both for treatment and diagnosis of patients with a small retroperitoneal venous malformation.
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Affiliation(s)
- Hiroyuki Fujinami
- Department of Urology Oita Red Cross Hospital Oita Japan
- Department of Urology Oita University Faculty of Medicine Yufu Oita Japan
| | - Tomoki Kai
- Department of Urology Oita University Faculty of Medicine Yufu Oita Japan
| | - Tadasuke Ando
- Department of Urology Oita University Faculty of Medicine Yufu Oita Japan
| | - Toshitaka Shin
- Department of Urology Oita University Faculty of Medicine Yufu Oita Japan
| | - Hiromitsu Mimata
- Department of Urology Oita University Faculty of Medicine Yufu Oita Japan
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