Background: Adrenal cavernous hemangiomas are very rare benign tumors that usually present as incidental\nfindings on abdominal imaging. Preoperative differential diagnosis from other benign or malignant adrenal\nneoplasms may be challenging.\nCase presentation: A 70-year old man was referred for an 8-cm abdominal mass incidentally discovered on\na contrast-enhanced computed tomography (CT) performed to investigate a pulmonary nodule. Biochemical\ntests ruled out any endocrine dysfunction and iodine 123 metaiodobenzylguanidine whole body scintiscan\nsingle-photon emission CT excluded a pheocromocitoma. Findings on magnetic resonance imaging were non-specific\nand the patient was elected for a left adrenalectomy. Histopathological diagnosis revealed a cavernous hemangioma.\nA portion of the resected tissue was tested for drug sensitivity to mitotane, doxorubicin, and sunitinib.\nConclusions: Adrenal hemangioma is a rare disease but should be included in the differential diagnosis of adrenal\ntumors. The surgical resection is generally required to exclude malignant disease, resolve pressure-related symptoms,\nand prevent retroperitoneal hemorrhage. Although specific features in diagnostic imaging are often lacking, if the\ndiagnosis is established preoperatively a laparoscopic adrenalectomy can be performed due to the benign\nnature of the lesion. Doxorubicin and sunitinib were both capable of reducing primary culture cell viability, this\nsuggest that similar drugs may be useful in the medical treatment of adrenal hemangiomas.
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