Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 3  |  Issue : 2  |  Page : 75-76

Vascular Cyst of Adrenal: A Report of Two Cases


Department of Pathology, All Institute of Medical Sciences, New Delhi, India

Date of Web Publication8-Jun-2016

Correspondence Address:
Sudheer Arava
Department of Pathology, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0820.183646

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  Abstract 


Vascular cysts of the adrenal gland are rare heterogeneous group of lesions with an autopsy incidence of 0.06%. They have female preponderance with most common presentation being pain abdomen. Cysts of the adrenal glands are classified as (a) parasitic cysts (b) epithelial cyst (c) pseudocyst and (d) endothelial cysts. Out of these endothelial cysts constitute about 84% of the cases. As the clinical features and radiological findings of these lesions are nonspecific, a proper histological examination along with immunohistochemistry are necessary for a definitive diagnosis. Here, we report two cases of vascular endothelial cyst of the adrenal gland to emphasize the histomorphological and immunohistochemical features of these lesions.

Keywords: Adrenal, endothelial cyst, vascular cyst


How to cite this article:
Ranjan R, Nath D, Arava S. Vascular Cyst of Adrenal: A Report of Two Cases. Indian J Vasc Endovasc Surg 2016;3:75-6

How to cite this URL:
Ranjan R, Nath D, Arava S. Vascular Cyst of Adrenal: A Report of Two Cases. Indian J Vasc Endovasc Surg [serial online] 2016 [cited 2019 Dec 16];3:75-6. Available from: http://www.indjvascsurg.org/text.asp?2016/3/2/75/183646




  Introduction Top


Vascular cysts of the adrenal gland are rare [1]. Here, we report two cases of vascular endothelial cyst of the adrenal gland.


  Case Reports Top


Case 1

A 30-year-old female presented with history of pain abdomen of 1-month duration. Ultrasonographic (USG) revealed a large 10 cm × 8 cm cystic mass in the right adrenal gland, which was subsequently removed and sent for histopathological examination. Grossly the adrenal was replaced with multiple thin-walled cystic spaces of varying sizes. As the gland was cut open the content of the cyst could not be evaluated.

Case 2

A 20-year-old female presented with a similar history, of pain abdomen of 1½ month duration. USG in this case showed a multiloculated cyst measuring 10 cm × 4 cm. Grossly the cysts were similar to that of the previous case.

Microscopic examination in both the cases showed multiple thin-walled cysts with fibrocollagenous wall and lined by flattened cells. Normal adrenal gland tissue was present at the periphery [Figure 1]a. Immunochemical staining with CD34 antibody was positive in the lining cells confirming their endothelial nature [Figure 1]b. Immunohistochemistry for cytokeratin was negative, ruling out an epithelial cyst. Based on the above features, a diagnosis of vascular endothelial cyst of the adrenal glands was made.
Figure 1: (a) Microphotograph showing varying sized cysts along with normal adrenal tissue (b) immunohistochemical positivity for CD34 in the cyst lining

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Cysts of the adrenal glands, as brought out previously can have varied etiology and presentation, the commonest being abdominal pain (35%) followed by incidental detection (32%) during routine USG. A few patients presenting with hypertension, which normalized on removal of the cyst, have been reported.[2] Acute abdomen and shock a consequence of a ruptured cyst can also occur. On imaging, calcification can be seen in 15–30% of vascular origin cysts. Grossly they may be unilocular or multilocular with size range of 1.4–33 cm in diameter. Majority of cases are unilateral though bilateral cases are on record. The differentiating features of varying types of cysts are given in [Table 1].[3]
Table 1: Comparison of adrenal cysts

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Since some of the entities like cystically degenerated adrenal neoplasm both primary (pheochromocytoma, adrenal cortical adenoma and carcinoma) and metastatic tumors come in the clinical and radiological differential, a thorough knowledge regarding the adrenal cysts is necessary for the proper diagnosis and further patient management.

As the vascular endothelial cysts are benign, laparoscopic surgical excision is the treatment of choice and the prognosis is excellent.[4]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Carvounis E, Marinis A, Arkadopoulos N, Theodosopoulos T, Smyrniotis V. Vascular adrenal cysts: A brief review of the literature. Arch Pathol Lab Med 2006;130:1722-4.  Back to cited text no. 1
    
2.
Nigawara T, Sakihara S, Kageyama K, Terui K, Takayasu S, Hatakeyama S, et al. Endothelial cyst of the adrenal gland associated with adrenocortical adenoma: Preoperative images simulate carcinoma. Intern Med 2009;48:235-40.  Back to cited text no. 2
    
3.
Medeiros LJ, Lewandrowski KB, Vickery AL Jr. Adrenal pseudocyst: A clinical and pathologic study of eight cases. Hum Pathol 1989;20:660-5.  Back to cited text no. 3
    
4.
Bellantone R, Ferrante A, Raffaelli M, Boscherini M, Lombardi CP, Crucitti F. Adrenal cystic lesions: Report of 12 surgically treated cases and review of the literature. J Endocrinol Invest 1998;21:109-14.  Back to cited text no. 4
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1]



 

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