Endocrine Abstracts

Background: The increase use of abdominal imaging have given rise in incidental discovery of adrenal masses. We report a case of a localized Castleman’s Disease(CD), mimicking an adrenal mass.

Case report: A 29-year-old woman was found to have a 6 cm, well-circumscribed and hypoechoic, right adrenal incidentaloma during an abdominopelvic ultrasonography. The CT scan confirmed a suprarenal mass with heterogenous contrast enhancement. Adrenal gland could not be identified. Abdominal MRI confirmed the lesion, well-detached from the right kidney. On T2-weighted image, the lesion exhibits iso-hypointensity and small cystic spots inside; fat-suppression sequences showed no lipids contains; liquid contrast displayed mild wash-in and delayed wash-out. Clinically, the patient was asymptomatic. Androgens, aldosterone/renin ratio, 1-mg Dexametasone test and urinary metanephrine were normal. The lesion was successfully removed through laparoscopic approach. Macroscopically, the lesion consisted with the diagnoses of lymph node mass, completely removed together with the right adrenal gland. Histology revealed a giant lymph node hyperplasia (so called Castleman’s Disease), hyaline vascular type. At 9-months follow-up, no complications or recurrence were found. We performed a systematic review of the literature on CD specifically found in adrenal region. We found 19 cases(5 males): the mean age was 39.1±12.9 years and mean lesion diameter 5.1±1.2 cm. Only 3 cases described MRI density, all showing T2 hyperintensity of the mass. Our case is the first presenting T2 iso-hypointensity.

Conclusions: Localized CD is a rare benign lymphoproliferative disorder usually occuring in mediastinum. The etiology is still unclear. Suprarenal and para-adrenal solitary location of CD, although very rare, may be mistaken for adrenal tumor. When the imaging is not clear, CD should be considered in the evaluation of a large nonfunctional adrenal mass, especially in asymptomatic young patients.