Hepatic growths mimicking adrenal tumors.

BACKGROUND/AIMS: The upper district of the perirenal space is widely open and compliant, especially on the right side. Hepatic growths can, therefore, easily invade the adrenal gland area, mimicking adrenal tumors and vice-versa for adrenal and renal tumors. Data on the nature and exact origin of a mass in this region are important for appropriate preoperative management, surgical approach and prognosis but, sometimes, even modern imaging fails in this design. METHODOLOGY: The records and imaging documentation of 42 patients with a mass exceeding 6 cm in the hepatorenal space, have been retrospectively reviewed and compared with surgical and histological findings. RESULTS: Among the 14 patients with "non-functioning adrenal tumors," the preoperative diagnosis had been accurate in all but 2 cases where the suspected adrenal lesion turned out, intraoperatively, to be liver growths. These 2 cases are discussed in detail. CONCLUSIONS: The distinction between an intrahepatic and extrahepatic mass challenges modern imaging techniques, and even invasive procedures sometimes fail. A deceptive diagnosis may lead to inappropriate preoperative management and surgical procedures.

[Hydatid cysts of the ovary. Description of a case]. / Le cisti di echinococco dell'ovario. Descrizione di un caso.

Hydatid cysts of the ovary are rare lesions usually secondary to the rupture of an hepatic cyst. They may remain asymptomatic for long periods of time and may be discovered incidentally or cause irritation or compression symptoms. The history and whole abdomen echography consent diagnosis also based on the detection of the primary lesion. A case of hydatid cyst of the ovary is reported.

Adrenal hemangiomas: two case reports with a review of the literature.

Hemangiomas, although frequently found elsewhere, are rarely encountered in the adrenal gland. Only 17 surgical cases of adrenal hemangiomas have been reported, with an additional case not surgically treated. The pertinent literature has been reviewed. Two additional cases, one identified preoperatively and both removed surgically, are presented herein. Ultrasonograms and computed tomographs showed large, necrotic masses without calcifications. Preoperative angiograms taken for case 1 demonstrated pooling of contrast media within this mass, strongly suggesting a diagnosis of hemangioma; case 2 lacked similar angiographic findings. The radiologic finding of calcifications, when present, along with the characteristic angiographic appearance of a hemangioma, allows the radiologist to correctly diagnose this benign tumor preoperatively. Although rare, these tumors should be part of the differential diagnosis of adrenal neoplasms.

Myelolipoma of the adrenal gland: report of two cases with a review of the literature.

Myelolipomas are rare, nonfunctioning, benign lesions composed of varying proportions of fat and bone marrow elements. The clinical and pathologic features are described with a brief discussion of the possible etiology and pathogenesis. Forty-seven cases in the world literature are reviewed including two of our patients. Twenty-four patients were seen initially with pain, 19 had hypertension, 15 were obese, and seven had hematuria. These tumors can be diagnosed by their characteristic appearance on ultrasonography, computerized tomography, and angiography and by their lack of hormonal alterations.

[Adrenal cysts]. / Cisti surrenaliche.

Suprarenal cysts may be clinically silent and discovered by chance, or they may present clinically if they attain marked dimensions by means of compression of surrounding formations. Examinations that lead to precise diagnosis are: direct abdominal X-ray integrated with scanning, echoscanning, urography and selective arterial and especially venous vasography. Two clinical cases that may be considered typical of the two varieties, true cyst and pseudo-cyst, are reported.