A Case of Adrenal Cavernous Hemangioma in which a Massive Pleural Effusion was Observed following Intratumoral Hemorrhage

Abstract

Adrenal cavernous hemangioma is a relatively rare type of tumor. While 63 cases have been reported in Japan, none has involved a massive pleural effusion resulting from intratumoral hemorrhage that required resection. The present patient was a 38-year-old man who sought emergency help after having difficulty moving due to back pain that had developed 3 days earlier. A tumorous lesion, 8.5 cm in size, appearing to compress the liver was seen superior to the right kidney on computed tomography (CT) and magnetic resonance imaging (MRI), accompanied by a massive pleural effusion. The patient was admitted with suspected intratumoral hemorrhage of a right adrenal tumor. The inflammatory pleural effusion was alleviated with conservative treatment, and on day 20, the right adrenal tumor was resected through an incision below the right costal arch. The resected sample was a fragile, bleeding tumor with a maximum diameter of 8 cm that had a partially calcified capsule and a light to dark brown cross-section. The histopathological diagnosis was adrenal cavernous hemangioma. Most adrenal hemangiomas are non-functional benign tumors, but two malignant cases have been reported. Differentiation from adrenal cancer is necessary in cases of large tumors, and resection is desirable given the risks of hemorrhage and rupture.