Diagnosis and treatment of the adrenal lymphangioma / 中华泌尿外科杂志

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.