Skip to main content

Advertisement

SpringerLink
Log in

Cross-sectional imaging features of unusual adrenal lesions: a radiopathological correlation

  • Review
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

The detection rates of adrenal masses are increasing with the common and widespread use of cross-sectional imaging. Adrenal adenomas, myelolipomas, metastases, pheochromocytomas, and adrenocortical tumors are well-known and relatively common adrenal tumors. However, there are many less-known neoplastic and nonneoplastic adrenal diseases that might affect the adrenal glands in addition to these common lesions. These rare entities include, but are not limited to, hydatid cysts, congenital adrenal hyperplasia, Wolman disease, adrenal tuberculosis, primary adrenal lymphoma. This article aims to present imaging findings of these unusual lesions in accordance with their pathologic characteristics. We think that the simultaneous presentation of the pathological findings with the imaging features may facilitate the learning process and may potentially enhance the recognition of these entities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22

Similar content being viewed by others

References

  1. Sebastiano C, Zhao X, Deng FM, Das K. Cystic lesions of the adrenal gland: our experience over the last 20 years. Hum Pathol. 2013;44(9):1797-803.

    Article  PubMed  Google Scholar 

  2. Abeshouse GA, Goldstein RB, Abeshouse BS. Adrenal cysts; review of the literature and report of three cases. J Urol. 1959;81(6):711-9.

    Article  CAS  PubMed  Google Scholar 

  3. Erbil Y, Salmaslioglu A, Barbaros U, Bozbora A, Mete O, Aral F, et al. Clinical and radiological features of adrenal cysts. Urol Int. 2008;80(1):31-6.

    Article  PubMed  Google Scholar 

  4. Ricci Z, Chernyak V, Hsu K, Mazzariol FS, Flusberg M, Oh S, et al. Adrenal cysts: natural history by long-term imaging follow-up. AJR Am J Roentgenol. 2013;201(5):1009-16.

    Article  PubMed  Google Scholar 

  5. Foster DG. Adrenal cysts. Review of literature and report of case. Arch Surg. 1966;92(1):131-43.

  6. 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(11):1722-4.

    Article  PubMed  Google Scholar 

  7. Akhan O, Canyigit M, Kaya D, Koksal A, Akgoz A, Yucesoy C, et al. Long-term follow-up of the percutaneous treatment of hydatid cyst in the adrenal gland: a case report and review of the literature. Cardiovasc Intervent Radiol. 2011;34 Suppl 2:S256-9.

    Article  PubMed  Google Scholar 

  8. 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(2):109-14.

    Article  CAS  PubMed  Google Scholar 

  9. Bastounis E, Pikoulis E, Leppaniemi A, Cyrochristos D. Hydatid disease: a rare cause of adrenal cyst. Am Surg. 1996;62(5):383-5.

    CAS  PubMed  Google Scholar 

  10. Dionigi G, Carrafiello G, Recaldini C, Sessa F, Boni L, Rovera F, et al. Laparoscopic resection of a primary hydatid cyst of the adrenal gland: a case report. J Med Case Rep. 2007;1:61.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Erickson LA, Lloyd RV, Hartman R, Thompson G. Cystic adrenal neoplasms. Cancer. 2004;101(7):1537-44.

    Article  PubMed  Google Scholar 

  12. Newhouse JH, Heffess CS, Wagner BJ, Imray TJ, Adair CF, Davidson AJ. Large degenerated adrenal adenomas: radiologic-pathologic correlation. Radiology. 1999;210(2):385-91.

    Article  CAS  PubMed  Google Scholar 

  13. Vaidya B, Chakera AJ, Dick C. Addison’s disease. BMJ. 2009;339:b2385.

    Article  PubMed  Google Scholar 

  14. Burton C, Cottrell E, Edwards J. Addison’s disease: identification and management in primary care. Br J Gen Pract. 2015;65(638):488-90.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Arlt W, Allolio B. Adrenal insufficiency. Lancet. 2003;361(9372):1881-93.

    Article  CAS  PubMed  Google Scholar 

  16. Guo YK, Yang ZG, Li Y, Ma ES, Deng YP, Min PQ, et al. Addison’s disease due to adrenal tuberculosis: contrast-enhanced CT features and clinical duration correlation. Eur J Radiol. 2007;62(1):126-31.

    Article  PubMed  Google Scholar 

  17. Oliveira D, Ventura M, Melo M, Paiva S, Carrilho F. Addison’s disease in antiphospholipid syndrome: a rare complication. Endocrinol Diabetes Metab Case Rep. 2018;2018.

  18. Espinosa G, Santos E, Cervera R, Piette JC, de la Red G, Gil V, et al. Adrenal involvement in the antiphospholipid syndrome: clinical and immunologic characteristics of 86 patients. Medicine (Baltimore). 2003;82(2):106-18.

    Article  PubMed  Google Scholar 

  19. Behera KK, Kapoor N, Seshadri MS, Rajaratnam S. Acute adrenal insufficiency due to primary antiphospholipid antibody syndrome. Indian J Endocrinol Metab. 2013;17(Suppl 1):S240-2.

    PubMed  PubMed Central  Google Scholar 

  20. Auchus RJ, Arlt W. Approach to the patient: the adult with congenital adrenal hyperplasia. J Clin Endocrinol Metab. 2013;98(7):2645-55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Merke DP, Poppas DP. Management of adolescents with congenital adrenal hyperplasia. Lancet Diabetes Endocrinol. 2013;1(4):341-52.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Antal Z, Zhou P. Congenital adrenal hyperplasia: diagnosis, evaluation, and management. Pediatr Rev. 2009;30(7):e49-57.

    Article  PubMed  Google Scholar 

  23. Nermoen I, Rorvik J, Holmedal SH, Hykkerud DL, Fougner KJ, Svartberg J, et al. High frequency of adrenal myelolipomas and testicular adrenal rest tumours in adult Norwegian patients with classical congenital adrenal hyperplasia because of 21-hydroxylase deficiency. Clin Endocrinol (Oxf). 2011;75(6):753-9.

    Article  CAS  PubMed  Google Scholar 

  24. Kok HK, Sherlock M, Healy NA, Doody O, Govender P, Torreggiani WC. Imaging features of poorly controlled congenital adrenal hyperplasia in adults. Br J Radiol. 2015;88(1053):20150352.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Taylor GA, Fallat ME, Eichelberger MR. Hypovolemic shock in children: abdominal CT manifestations. Radiology. 1987;164(2):479-81.

    Article  CAS  PubMed  Google Scholar 

  26. Udare A, Agarwal M, Siegelman E, Schieda N. CT and MR imaging of acute adrenal disorders. Abdom Radiol (NY). 2020.

  27. O’Hara SM, Donnelly LF. Intense contrast enhancement of the adrenal glands: another abdominal CT finding associated with hypoperfusion complex in children. AJR Am J Roentgenol. 1999;173(4):995-7.

    Article  PubMed  Google Scholar 

  28. Sivit CJ, Taylor GA, Bulas DI, Kushner DC, Potter BM, Eichelberger MR. Posttraumatic shock in children: CT findings associated with hemodynamic instability. Radiology. 1992;182(3):723-6.

    Article  CAS  PubMed  Google Scholar 

  29. Bollen TL, van Santvoort HC, Besselink MG, van Ramshorst B, van Es HW, Gooszen HG, et al. Intense adrenal enhancement in patients with acute pancreatitis and early organ failure. Emerg Radiol. 2007;14(5):317-22.

    Article  CAS  PubMed  Google Scholar 

  30. Cheung SC, Lee R, Tung HK, Chan FL. Persistent adrenal enhancement may be the earliest CT sign of significant hypovolaemic shock. Clin Radiol. 2003;58(4):315-8.

    Article  CAS  PubMed  Google Scholar 

  31. Manipadam MT, Abraham R, Sen S, Simon A. Primary pigmented nodular adrenocortical disease. J Indian Assoc Pediatr Surg. 2011;16(4):160-2.

    Article  PubMed  PubMed Central  Google Scholar 

  32. New MI, Wilson RC. Steroid disorders in children: congenital adrenal hyperplasia and apparent mineralocorticoid excess. Proc Natl Acad Sci U S A. 1999;96(22):12790-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Sen D, Satija L, Saxena S, Rastogi V, Singh M. A rare constellation of imaging findings in Wolman disease. Med J Armed Forces India. 2015;71(Suppl 2):S448-51.

    Article  PubMed  Google Scholar 

  34. Salvayre R, Negre A, Maret A, Radom J, Douste-Blazy L. Extracellular origin of the lipid lysosomal storage in cultured fibroblasts from Wolman’s disease. Eur J Biochem. 1987;170(1-2):453-8.

    Article  CAS  PubMed  Google Scholar 

  35. Fulcher AS, Das Narla L, Hingsbergen EA. Pediatric case of the day. Wolman disease (primary familial xanthomatosis with involvement and clacification of the adrenal glands). Radiographics. 1998;18(2):533-5.

  36. Wu T, Zhu P, Duan X, Yang X, Lu D. Calcifying fibrous pseudotumor of the adrenal gland: A rare case report. Mol Clin Oncol. 2016;5(3):252-4.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ling J, Wang H, Pan W, Li S, Guan J, Zhang X, et al. Clinical and imaging features of IgG4-related kidney disease. Abdom Radiol (NY). 2020;45(6):1915-21.

    Article  PubMed  Google Scholar 

  38. Paolo WF, Jr., Nosanchuk JD. Adrenal infections. Int J Infect Dis. 2006;10(5):343-53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Kawashima A, Sandler CM, Fishman EK, Charnsangavej C, Yasumori K, Honda H, et al. Spectrum of CT findings in nonmalignant disease of the adrenal gland. Radiographics. 1998;18(2):393-412.

    Article  CAS  PubMed  Google Scholar 

  40. Wilms GE, Baert AL, Kint EJ, Pringot JH, Goddeeris PG. Computed tomographic findings in bilateral adrenal tuberculosis. Radiology. 1983;146(3):729-30.

    Article  CAS  PubMed  Google Scholar 

  41. Kelestimur F. The endocrinology of adrenal tuberculosis: the effects of tuberculosis on the hypothalamo-pituitary-adrenal axis and adrenocortical function. J Endocrinol Invest. 2004;27(4):380-6.

    Article  CAS  PubMed  Google Scholar 

  42. Upadhyay J, Sudhindra P, Abraham G, Trivedi N. Tuberculosis of the adrenal gland: a case report and review of the literature of infections of the adrenal gland. Int J Endocrinol. 2014;2014:876037.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Johnson PT, Horton KM, Fishman EK. Adrenal imaging with MDCT: Nonneoplastic disease. AJR Am J Roentgenol. 2009;193(4):1128-35.

    Article  PubMed  Google Scholar 

  44. Yang ZG, Guo YK, Li Y, Min PQ, Yu JQ, Ma ES. Differentiation between tuberculosis and primary tumors in the adrenal gland: evaluation with contrast-enhanced CT. Eur Radiol. 2006;16(9):2031-6.

    Article  PubMed  Google Scholar 

  45. Liatsikos EN, Kalogeropoulou CP, Papathanassiou Z, Tsota I, Athanasopoulos A, Perimenis P, et al. Primary adrenal tuberculosis: role of computed tomography and CT-guided biopsy in diagnosis. Urol Int. 2006;76(3):285-7.

    Article  CAS  PubMed  Google Scholar 

  46. Albano D, Agnello F, Midiri F, Pecoraro G, Bruno A, Alongi P, et al. Imaging features of adrenal masses. Insights Imaging. 2019;10(1):1.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Mayo-Smith WW, Song JH, Boland GL, Francis IR, Israel GM, Mazzaglia PJ, et al. Management of Incidental Adrenal Masses: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2017;14(8):1038-44.

    Article  PubMed  Google Scholar 

  48. Tahar GT, Nejib KN, Sadok SS, Rachid LM. Adrenocortical oncocytoma: a case report and review of literature. J Pediatr Surg. 2008;43(5):E1-3.

    Article  PubMed  Google Scholar 

  49. Shah RK, Oto A, Ozkan OS, Ernst RD, Hernandez JA, Chaudhary HB, et al. Adrenal oncocytoma: US and CT findings. JBR-BTR. 2004;87(4):180-2.

    CAS  PubMed  Google Scholar 

  50. Leavitt JR, Harold DL, Robinson RB. Adrenal ganglioneuroma: a familial case. Urology. 2000;56(3):508.

    Article  CAS  PubMed  Google Scholar 

  51. Lonergan GJ, Schwab CM, Suarez ES, Carlson CL. Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: radiologic-pathologic correlation. Radiographics. 2002;22(4):911-34.

    Article  PubMed  Google Scholar 

  52. Majbar AM, Elmouhadi S, Elaloui M, Raiss M, Sabbah F, Hrora A, et al. Imaging features of adrenal ganglioneuroma: a case report. BMC Res Notes. 2014;7:791.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Dunnick NR, Korobkin M. Imaging of adrenal incidentalomas: current status. AJR Am J Roentgenol. 2002;179(3):559-68.

    Article  PubMed  Google Scholar 

  54. Kamoun M, Mnif MF, Rekik N, Belguith N, Charfi N, Mnif L, et al. Ganglioneuroma of adrenal gland in a patient with Turner syndrome. Ann Diagn Pathol. 2010;14(2):133-6.

    Article  PubMed  Google Scholar 

  55. Qing Y, Bin X, Jian W, Li G, Linhui W, Bing L, et al. Adrenal ganglioneuromas: a 10-year experience in a Chinese population. Surgery. 2010;147(6):854-60.

    Article  PubMed  Google Scholar 

  56. Zugor V, Schott GE, Kuhn R, Labanaris AP. Retroperitoneal ganglioneuroma in childhood–a presentation of two cases. Pediatr Neonatol. 2009;50(4):173-6.

    Article  PubMed  Google Scholar 

  57. Otal P, Mezghani S, Hassissene S, Maleux G, Colombier D, Rousseau H, et al. Imaging of retroperitoneal ganglioneuroma. Eur Radiol. 2001;11(6):940-5.

    Article  CAS  PubMed  Google Scholar 

  58. Ogawa K, Shimizu Y, Uketa S, Utsunomiya N, Kida K, Ishihara M, et al. Primary small cell neuroendocrine carcinoma of adrenal gland. Int Cancer Conf J. 2019;8(3):122-5.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Sung CT, Shetty A, Menias CO, Houshyar R, Chatterjee S, Lee TK, et al. Collision and composite tumors; radiologic and pathologic correlation. Abdom Radiol (NY). 2017;42(12):2909-26.

    Article  PubMed  Google Scholar 

  60. Katabathina VS, Flaherty E, Kaza R, Ojili V, Chintapalli KN, Prasad SR. Adrenal collision tumors and their mimics: multimodality imaging findings. Cancer Imaging. 2013;13(4):602-10.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Zemni I, Haddad S, Hlali A, Manai MH, Essoussi M. Adrenal gland hemangioma: A rare case of the incidentaloma: Case report. Int J Surg Case Rep. 2017;41:417-22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Arkadopoulos N, Kyriazi M, Yiallourou AI, Stafyla VK, Theodosopoulos T, Dafnios N, et al. A rare coexistence of adrenal cavernous hemangioma with extramedullar hemopoietic tissue: a case report and brief review of the literature. World J Surg Oncol. 2009;7:13.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Xu HX, Liu GJ. Huge cavernous hemangioma of the adrenal gland: sonographic, computed tomographic, and magnetic resonance imaging findings. J Ultrasound Med. 2003;22(5):523-6.

    Article  PubMed  Google Scholar 

  64. Thiele JW, Bodie B. Adrenal hemangioma. Surgery. 2001;129(3):373-4.

    Article  CAS  PubMed  Google Scholar 

  65. Abou El-Ghar M, Refaie H, El-Hefnawy A, El-Diasty T. Adrenal Hemangioma: Findings at Multidetector CT with Short Review of the Literature. Case Rep Radiol. 2011;2011:601803.

    PubMed  PubMed Central  Google Scholar 

  66. Holm J, Breum L, Stenfeldt K, Friberg Hitz M. Bilateral primary adrenal lymphoma presenting with adrenal insufficiency. Case Rep Endocrinol. 2012;2012:638298.

    PubMed  PubMed Central  Google Scholar 

  67. Aziz SA, Laway BA, Rangreze I, Lone MI, Ahmad SN. Primary adrenal lymphoma: Differential involvement with varying adrenal function. Indian J Endocrinol Metab. 2011;15(3):220-3.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Horiguchi K, Hashimoto K, Hashizume M, Masuo T, Suto M, Okajo J, et al. Primary bilateral adrenal diffuse large B-cell lymphoma demonstrating adrenal failure. Intern Med. 2010;49(20):2241-6.

    Article  PubMed  Google Scholar 

  69. Mozos A, Ye H, Chuang WY, Chu JS, Huang WT, Chen HK, et al. Most primary adrenal lymphomas are diffuse large B-cell lymphomas with non-germinal center B-cell phenotype, BCL6 gene rearrangement and poor prognosis. Mod Pathol. 2009;22(9):1210-7.

    Article  CAS  PubMed  Google Scholar 

  70. Guo YK, Yang ZG, Li Y, Deng YP, Ma ES, Min PQ, et al. Uncommon adrenal masses: CT and MRI features with histopathologic correlation. Eur J Radiol. 2007;62(3):359-70.

    Article  PubMed  Google Scholar 

  71. Elsayes KM, Mukundan G, Narra VR, Lewis JS, Jr., Shirkhoda A, Farooki A, et al. Adrenal masses: mr imaging features with pathologic correlation. Radiographics. 2004;24 Suppl 1:S73-86.

    Article  PubMed  Google Scholar 

  72. Fukushima A, Okada Y, Tanikawa T, Onaka T, Tanaka A, Higashi T, et al. Primary bilateral adrenal intravascular large B-cell lymphoma associated with adrenal failure. Intern Med. 2003;42(7):609-14.

    Article  PubMed  Google Scholar 

  73. He C, Yang Y, Yang Y, Wang F, Hu J, Zhang J, et al. Teratoma of the adrenal gland: clinical experience and literature review. Gland Surg. 2020;9(4):1056-64.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Ban A, Satapara J, Rathod K, Bahri N. Teratoma involving adrenal gland - A case report and review of literature. Indian J Radiol Imaging. 2019;29(4):472-6.

    PubMed  PubMed Central  Google Scholar 

  75. Lattin GE, Jr., Sturgill ED, Tujo CA, Marko J, Sanchez-Maldonado KW, Craig WD, et al. From the radiologic pathology archives: Adrenal tumors and tumor-like conditions in the adult: radiologic-pathologic correlation. Radiographics. 2014;34(3):805-29.

    Article  PubMed  Google Scholar 

  76. Ilias I, Sahdev A, Reznek RH, Grossman AB, Pacak K. The optimal imaging of adrenal tumours: a comparison of different methods. Endocr Relat Cancer. 2007;14(3):587-99.

    Article  PubMed  Google Scholar 

  77. Lee CW, Tsang YM, Liu KL. Primary adrenal leiomyosarcoma. Abdom Imaging. 2006;31(1):123-4.

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was received for this project.

Author information

Authors and Affiliations

  1. Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey

    Ali Devrim Karaosmanoglu, Omer Onder, Deniz Akata, Mustafa Nasuh Ozmen & Musturay Karcaaltincaba

  2. Department of Pathology, Hacettepe University School of Medicine, Ankara, 06100, Turkey

    Can Berk Leblebici & Cenk Sokmensuer

Authors
  1. Ali Devrim Karaosmanoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Omer Onder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Can Berk Leblebici
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cenk Sokmensuer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Deniz Akata
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mustafa Nasuh Ozmen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Musturay Karcaaltincaba
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ADK and OO wrote the manuscript. CBL and CS provided pathology images. DA, MNO and MK edited the text. All of the authors read and approved the final manuscript.

Corresponding author

Correspondence to Ali Devrim Karaosmanoglu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Karaosmanoglu, A.D., Onder, O., Leblebici, C.B. et al. Cross-sectional imaging features of unusual adrenal lesions: a radiopathological correlation. Abdom Radiol 46, 3974–3994 (2021). https://doi.org/10.1007/s00261-021-03041-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-021-03041-8

Keywords

Search

Navigation