Saturday 3 September 2016

Adrenal Leiomyoma: A Rare Tumor Presented as an Incidentaloma in a Patient with AIDS

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Adrenal leiomyoma is an extremely rare and benign tumor, usually presents as an incidental finding. Generally, this tumor is a non-functional large adrenal mass. The majority of leiomyomas of the adrenal gland are called as “incidentalomas” because they are found in absence of clinical symptoms and represents an unexpected finding during an abdominal ultrasound or computed tomography (CT) scan. Here we describe a 40-year-old man seropositive for the human immunodeficiency virus (HIV), under highly active antiretroviral therapy who presents a heterogeneously left adrenal mass in the context of a routine ultrasound abdominal scan. A CT abdominal scan confirms this finding. Laboratory results revealed that the tumor was non-functional. Because the possibility of adrenal carcinoma, the patient underwent a successful left adrenalectomy. Histopathology examination and immunohistochemistry techniques confirm the diagnosis of leiomyoma. Adrenal leiomyoma should be included in the differential diagnosis of unilateral, non-functional adrenal tumors in HIV patients.

Incidental adrenal tumors are often diagnosed during abdominal ultrasonography or computerized tomography (CT) studies for other pathologies. In human immunodeficiency virus (HIV) infected patients, leiomyomas are described with more frequency than in the general population. Also, in AIDS patients, these tumors have been well described in association with Epstein-Barr virus (EBV) A 40-year-old HIV seropositive man with diagnosis of AIDS infection. HIV-seropositive male with an inci dental adrenal mass that was diagnosed as a leiomyoma on histopathological and immunohistochemical (IHQ) studies. A literature review on adrenal leiomyoma was also made, including Pub Med, Medline and Embase for articles published until December 2015. pheochromocytoma. The patient underwent a left adrenalectomy because of the size of the lesion and the radiological appearance; macroscopic pathological examination of the surgical piece showed a well-circumscribed and encapsulated large mass; histopathological analysis revealed the smooth muscle origin of the tumor. Histologic feature includes a mesenchymal tumor characterized by the fusocellular proliferation of spindle cells with cigarshaped nuclei, eosinophilic cytoplasm with areas of hyalinosis, compatible with the diagnosis of smooth muscle tumor.

Functional tests including a serum cortisol level at 08:00 h and at late-night were normal and ruled out the presence of a cortisol-producing adenoma. The patient was normotensive repeatedly during admission to exclude an asymptomaticDiagnosis was confirmed by a positive immunostaining for smooth muscle actin. The tumor cells showed strongly immunoreactive for specific antismooth muscle actin and partial desmin expressionLeiomyomas of the adrenal glands are very rare tumors except in AIDS population. They are benign tumors composed of smooth muscle cells. An adrenal incidentaloma is defined as a clinically unapparent adrenal tumor, generally of 1 cm or more, that is discovered during radiological studies performed for other causes. Adrenal incidentalomas are diagnosed in approximately 1% of abdominal CT scans. Also, in autopsy studies, asymptomatic adrenal masses are discovered in up to 9% of patients. Diagnosis criteria for adrenal incidentaloma have been well established and include test to determine the functional tumor status and the histopathology. Adrenal leiomyomas have a wide range of age at presentation, with a median of 38 years and female predominance (66, 6%). These tumors are typically an adrenal unilateral solitary mass lesion with a median size of 5 cm. 

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