Inflammatory myofibroblastic tumor of the adrenal gland: A case report

Inflammatory myofibroblastic tumor (IMT) is an extremely rare sarcoma mainly reported in the lung. The adrenal gland, however, is an extremely rare site of occurrence. Herein, we report a case of a large adrenal mass with no contributory imaging features presenting a challenging pathological diagnosis.

A healthy 32-year-old male patient, with no personal nor family history, presented with loss of body weight and condition developing for two months. Physical examination revealed no abnormalities with a soft and depressible abdomen and absence of palpable lump. Circulating Chromogranin A and catecholamine metabolites were within normal range. The preoperative imaging features were noncontributory. The pathological examination on biopsy specimen concluded to a spindle cell proliferation set in a chronically inflamed background suggesting the diagnosis of IMT. The patient, subsequently, underwent radical nephrectomy unveiling a 25 cm adrenal mass. Pathological findings on resection specimen confirmed the diagnosis of IMT of the left adrenal gland.

Due to their rarity in the adrenal gland and their noncontributory radiological features, IMTs are typically not considered as a potential diagnosis in this location. As a result, this condition is often underdiagnosed. In this setting, suspicion for IMT should be raised when spindle cell histology is observed.

It is fundamental for practicians to keep this entity in mind as the treatment consists of complete tumor extirpation. The latter being the only guarantee of recurrence free follow up.