ABSTRACT
Objective:
To analyze the
diagnosis and
treatment of adrenal
lymphangioma.
Methods:
From September 2011 to March 2019, 16 case of adrenal
lymphangioma (8
males, 8
females),
aged from 15 to 65 years were retrospectively analyzed. Eleven cases were discovered accidentally by
physical examination or imaging examination when treating other
diseases, with 2
patients presenting
lumbago, 2
patients presenting
abdominal pain and 1 presenting weakness. CT showed that the
tumors were cystic or cystic solid low density mass without enhancement (9 cases in the right, 7 cases in the left) and some had calcified lesions. The maximum diameter of the
tumors was 2.5-16.0 cm. The endocrine examination was abnormal in 6
patients, including 2
patients with elevated 24-hour urinary vanillic mandelic
acid (VMA) and
adrenaline, 1
patient with elevated 24-hour urinary free
cortisol (UFC) and elevated
blood cortisol, and 3
patients with increased
aldosterone. They were considered sub-clinical adrenal
tumors. All
patients were monitored for
blood pressure, and
patients with elevated VMA were given terazosin for volume expansion;
Patients with elevated UFC are given
hydrocortisone 200 mg intravenously during operation,
hormone dosage is adjusted in
time according to
blood cortisol levels, and
patients with elevated
aldosterone were monitored on
blood aldosterone and
potassium. All cases underwent
surgery, including 10 cases of laparoscopic
adrenalectomy, 3 cases of laparoscopic adrenal
tumor resection, 1 case of open
adrenalectomy, and 2 cases of open adrenal
tumor resection. One of the open
surgery was an
emergency exploratory
laparotomy for ruptured
lymphangioma.
Results:
The operations were successful, and there was no operation related
complications.Sixteen cases were diagnosed as adrenal
lymphangioma. The gross specimens were monocystic or multilocular
cyst, and the
cyst could be detected in the section. HE
staining showed that the mass was composed of irregular cystic cavity filled with lymphoid fluid. A single layer of flattened
endothelium lines the walls of lymphatic channels. Immunohistochemical
staining was positive in D2-40(7/7), CD34(6/6), CD31(6/6), SMA (3/3) and CR(2/2); negative in CK(7/7) and CK7(3/3). So far, no
recurrence has been detected after 6-95 months follow-up.
Conclusions:
Adrenal
lymphangioma is a rare benign lesion clinically, without typical clinical symptoms. Preoperative
diagnosis mainly depends on imaging examination. It is a non-functional lesion, whose endocrine examinations are mostly normal. Histopathology is reliable diagnostic modality. The
therapy can refer to the principle of
treatment for adrenal incidental
tumors.
Surgery is the first choice and
prognosis is good.