CR 48JACPAdrenalmediastinalcyst
CR 48JACPAdrenalmediastinalcyst
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mediastinal cystic and the entire tumor marker screen (CA 19‑9, CA‑125,
alpha‑fetoprotein (AFP), and carcinoembr yonic
lesion
antigen (CEA) was negative. The patient did not give
consent for the aspiration of the cyst for diagnostic
purpose. However, the characteristics of the cyst and
Dear Sir, the location lead us to the most probable diagnosis of
Cystic lesions of the adrenal grand are rarely seen in the lymphangioma. In view of the asymptomatic nature of
clinical practice and often pose a diagnostic dilemma. the cysts, we did not consider the option of therapeutic
The difficulties in the diagnosis are further compounded removal and the patient is under regular follow‑up for
by the presence of another cyst at a different anatomical further monitoring.
location.[1] We present a young adult with incidentally
discovered cystic lesions on either side of the diaphragm Cystic adrenal lymphangiomas are rare benign lesions and are
in the right adrenal gland and posterior mediastinum. reported in about 60 patients only till date. Lymphangiomas
are the result of developmental malformations of the
A 32‑year‑old male patient presented with nonspecific lymphatic system and are common in the neck and axilla.[2]
pain abdomen for 1 week duration. Clinical examination They are rarely seen in the chest and abdomen as observed in
was not contributory and he was given a course of our case. Adrenal lymphangioms are diagnosed incidentally
antacids and prokinetic agents. Ultrasonography abdomen and the symptoms are related to the structural alterations
revealed a cystic lesion over right adrenal and he was rather than functional changes. The differential diagnosis of
referred to our center. The patient denied history of adrenal cystic lesions involves hydatid cyst, lymphangioma,
weight gain, palpitations, and never recorded high blood cystic metastases, and pheochromocytoma with cystic
pressure in the past. Other history was not contributory. changes.[3] Our patient had no features to suggest other
Examination revealed normotensive individual with no etiologies except for lymphangioma. Lack of confirmation
neurocutaneous markers and positive findings. Computed by the histopathology is the main limitation of our report.
tomography (CT) scan of the abdomen revealed the
presence of a well‑defined lobulated cystic lesion seen The unusual feature in our patient is the combination
between the medial and lateral limbs of the right adrenal of an abdominal and intrathoracic lymphangioma. The
gland [Figure 1]. Similar lesion is seen in the left hemithorax concurrent existence of thoracic and abdominal lesions
in left lower dorsal paravertebral region without intraspinal suggests the systemic lymphatic origin of the tumor.[4] The
extension. The lesion showed small calcification specks treatment of lymphangiomasis complete surgical excision
without post‑contrast enhancement. whenever required. Indications for surgeryinclude large,
symptomatic cyst, complicated, functional cyst, and all
His investigations revealed normal hematological and cysts with probable features of malignancy. Our patient
biochemical parameters. Serum cortisol was 0.5 μg/dL did not have any indications for the surgical removal and
after overnight dexamethasone (normal <1.8 μg/dL) hence, we plan to follow conservatively.
REFERENCES
a c
1. Ellis CL, Banerjee P, Carney E, Sharma R, Netto GJ. Adrenal
Figure 1: Coronal (a) and axial (b and c) computed tomography (CT) lymphangioma: Clinicopathologic and immunohistochemical
scan abdomen showing the cystic lesion of right adrenal (black arrow) characteristics of a rare lesion. Hum Pathol 2011;42:1013‑8.
and the posterior mediastinum (white arrow) 2. Zadvinskis DP, Benson MT, Kerr HH, Cacciarelli AA, Madrazo BL,
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