Giant Hemangiomatous Adrenal Cyst Mimicking a Hemorrhagic Hepatic Cyst: A Case Report

Adrenal hemangiomatous cysts are rare. Giant cysts of the right adrenal gland may be difficult to distinguish from hepatic cysts owing to their close anatomical proximity to the liver. Here, we report a case of a hemangiomatous adrenal cyst mimicking a hemorrhagic hepatic cyst.

A 48-year-old woman presented with a 10-day history of abdominal pain and distention. The laboratory findings revealed marked inflammation and severe anemia. Contrast-enhanced CT demonstrated a 28-cm cystic lesion extending from the right hepatic lobe, with peripheral calcification and intralesional high-attenuation areas suggestive of a hemorrhage. A hemorrhagic hepatic cyst was initially suspected and percutaneous drainage was performed. However, the drained fluid became increasingly hemorrhagic, and anemia progressed despite repeated transfusions, indicating ongoing intracystic bleeding; therefore, exploratory laparotomy was undertaken. En bloc resection of the cyst, hepatic segment VI, and the right adrenal gland was performed. Histopathological examination revealed dilated vascular channels lined with endothelial cells that were CD34-positive and D2-40-negative and were contiguous with the adrenal cortex, confirming the diagnosis of a hemangiomatous adrenal cyst. The postoperative course was uneventful, and no recurrence was observed at 6-month follow-up.

Here, we report a rare case of a giant hemangiomatous adrenal cyst. Because large right adrenal cysts may be difficult to distinguish from hepatic cysts owing to their anatomical proximity, adrenal cysts should be considered in the differential diagnosis of large upper abdominal cystic lesions.