Significant growth of adrenal lymphangioma: A case report and review of the literature

INTRODUCTION: Adrenal lymphangiomas are benign malformations of lymphatic vessels of adrenal gland. Adrenal lymphangiomas are very rare, although lymphangiomas are most commonly located in the neck, axillary region and mediastinum. PRESENTATION OF CASE: A 44-year-old woman presented to the outpatient clinic with dizziness, headache during the last 2 year. We report a significant growth case of an adrenal lymphangioma removed by transperitoneal laparoscopy. At laparoscopy, a well-marginated multicystic lesion was found at suprarenal area with nonviscous, brown colored fluid. The cystic mass was measured as 5.5 × 3.0 cm and histopathological diagnosis was cystic lymphangioma in the right adrenal gland. On immunohistochemical examination, D2-40 cytoplastic staining was positive, whereas calretinin and CD34 were negative, thus, confirming their lymphatic nature. At 11 months of follow up, the patient was recurrence free. DISCUSSION: Lymphangiomas are benign malformations of lymphatic vessels and subtype of endothelial adrenal cysts. Adrenal cysts are histologically classified into four main groups: endothelial cysts (45%), pseudocysts (39%), epithelial cysts (9%), and parasitic cysts (7%). Endothelial cysts are divided into two subgroups: lymphangiomatous and angiomatous cysts. Lymphangiomatous adrenal cysts are also known as adrenal lymphangioma. Management of larger lesions or lesions causing symptoms may require surgical resection to determine diagnosis or relieve symptoms. CONCLUSION: Lymphangiomas are most commonly located in the neck, axillary region and mediastinum, which are rare at adrenal gland. Transperitoneal laparoscopic removal of the adrenal lymphangiomas is regarded as a safe, effective and minimally invasive approach. In our case, laparoscopic removal of the tumor was successfully performed via a transperitoneal approach.