Lymphoid Structure Presenting as a Hypermetabolic Adrenal Incidentaloma.

Area of Science:

• Endocrinology
• Pathology
• Radiology

Background:

• Adrenal incidentalomas require evaluation for hormonal activity and malignancy.
• Guidelines exist for assessing adrenal lesions using imaging techniques.

Observation:

• A 53-year-old woman had an adrenal incidentaloma meeting malignancy criteria on CT and PET-CT.
• The lesion was surgically removed (left adrenalectomy).

Findings:

• Histopathology revealed a 15-mm benign, well-organized intra-adrenal ectopic lymphoid organ in the medulla.
• No cellular atypia or surrounding adrenal abnormality was noted.
• The patient remained disease-free for two years post-surgery.

Implications:

• This is the first reported case of an intra-adrenal ectopic lymphoid organ without a clear stimulus.
• Highlights the importance of histopathology in diagnosing adrenal incidentalomas.
• May refine understanding of ectopic lymphoid tissue formation.