Alveolar Soft Part Sarcoma Presenting as Hypervascular Adrenal Metastasis

Area of Science:

• Oncology
• Radiology
• Pathology

Background:

• Hypervascular adrenal masses are typically associated with pheochromocytoma or metastases from clear renal cell carcinoma or hepatocellular carcinoma.
• Alveolar soft part sarcoma (ASPS) is a rare soft tissue malignancy with a predilection for young adults.
• The occurrence of ASPS presenting as a hypervascular adrenal metastasis has not been previously reported in the medical literature.

Observation:

• A 23-year-old male presented with incidental detection of a right adrenal mass during evaluation for abdominal pain.
• Computed tomography (CT) revealed a hyperenhancing adrenal mass with specific Hounsfield unit values in the arterial phase.
• 18-fluorodeoxyglucose positron emission tomography/CT demonstrated multiple metastatic lesions.

Findings:

• The adrenal mass and multiple lesions were histologically confirmed to be alveolar soft part sarcoma (ASPS).
• This case represents the first described instance of ASPS manifesting as a hypervascular adrenal metastasis.
• Radiological findings, including CT and PET/CT, were crucial in identifying the metastatic nature of the disease.

Implications:

• This case expands the spectrum of known presentations for alveolar soft part sarcoma (ASPS).
• It underscores the necessity of including ASPS in the differential diagnosis of hypervascular adrenal masses, particularly in younger patients.
• Enhanced cross-sectional imaging (CT and PET/CT) plays a vital role in the diagnosis and staging of ASPS metastases.