Endocrine Abstracts

69-year-old male, with a history of bipolar disorder under treatment, smoker and high blood pressure. He is referred for left adrenal injury detected incidentally by secondary hypertension study. Abdominal CT shows a mass of 67.7×51.8×52.3 mm in the left adrenal area, with radiological characteristics of malignancy and aggressive behavior, contacting the left renal pole and upper splenic pole, compatible with adrenal carcinoma vs. metastasis. The functional study is negative. In the extension study, a 10.2-mm right apical pulmonary nodule with nonspecific characteristics and a high-density lesion in the spinal canal at the level of the 9th costal arch compatible with a tumor lesion were detected. The PET-CT does not rule out the malignancy of both lesions. To differentiate whether the adrenal lesion is a primary or metastatic lesion, it was decided to perform FNA, which was inconclusive on 2 occasions. Finally, surgical intervention of the mass was chosen, with an initial approach of en bloc removal of the left adrenal gland, spleen and left kidney, although it was finally possible to perform an isolated left adrenalectomy as no invasion of neighboring organs was observed during the surgical act. The definitive pathological anatomy is compatible with anastomosing hemangioma, an exceptional variant of adrenal tumor, difficult to differentiate radiologically from adrenal carcinoma but that presents benign behavior, which completely changes management and prognosis.