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    This document summarizes a case report of a 32-year-old male patient found to have cystic lesions in his right adrenal gland and posterior mediastinum. Imaging showed well-defined lobulated cystic lesions in both locations without enhancement or intraspinal extension. Differential diagnoses included hydatid cyst, lymphangioma, cystic metastases, and pheochromocytoma. Testing showed no abnormal hormone levels or tumor markers. The unusual presentation of concurrent abdominal and thoracic cysts, along with characteristics on imaging, led to a diagnosis of lymphangioma. Due to the asymptomatic nature of the cysts, the patient is being followed conservatively without surgical intervention.

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    This document summarizes a case report of a 32-year-old male patient found to have cystic lesions in his right adrenal gland and posterior mediastinum. Imaging showed well-defined lobulated cystic lesions in both locations without enhancement or intraspinal extension. Differential diagnoses included hydatid cyst, lymphangioma, cystic metastases, and pheochromocytoma. Testing showed no abnormal hormone levels or tumor markers. The unusual presentation of concurrent abdominal and thoracic cysts, along with characteristics on imaging, led to a diagnosis of lymphangioma. Due to the asymptomatic nature of the cysts, the patient is being followed conservatively without surgical intervention.

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    23 views4 pages

    CR 48JACPAdrenalmediastinalcyst

    Uploaded by

    Kartik Dutta
    This document summarizes a case report of a 32-year-old male patient found to have cystic lesions in his right adrenal gland and posterior mediastinum. Imaging showed well-defined lobulated cystic lesions in both locations without enhancement or intraspinal extension. Differential diagnoses included hydatid cyst, lymphangioma, cystic metastases, and pheochromocytoma. Testing showed no abnormal hormone levels or tumor markers. The unusual presentation of concurrent abdominal and thoracic cysts, along with characteristics on imaging, led to a diagnosis of lymphangioma. Due to the asymptomatic nature of the cysts, the patient is being followed conservatively without surgical intervention.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    net/publication/307783437

    Combined adrenal and mediastinal cystic lesion

    Article  in  The Journal of Association of Chest Physicians · January 2015


    DOI: 10.4103/2320-8775.146852

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    Kvs Hari Kumar Shijith Kp


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    L ett e r to E dito r

    Combined adrenal and and 24 h urine metanephrines was normal. Serology


    for the Echinococcal antigen (5.7  IU/ml, normal  <10)

    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.

      K. V. S. Hari Kumar, K. P. Shijith1, Vijay Dutta2


    Departments of Endocrinology, 1Radiology, 2Pulmonology, Command
    Hospital, Chandimandir, Panchkula, Haryana, India

    Address for correspondence:


    Dr. K. V. S. Hari Kumar,
    b Departments of Endocrinology,
    Command Hospital, Chandimandir, Panchkula ‑ 134 113,
    Haryana, India.
    E‑mail: [email protected]

    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,

    29 The Journal of Association of Chest Physicians | Jan-Jun 2015 | Vol 3 | Issue 1


    Letter to Editor
    Mafee MF, et al. Congenital malformations of the cervico‑thoracic
    Access this article online
    lymphatic system: Embryology and pathogenesis. Radiographics
    1992;12:1175‑89. Quick Response Code:
    Website:
    3. Zhao M, Li C, Zheng J, Yan M, Sun K, Wang Z. Cystic
    www.jacpjournal.org
    lymphangioma‑like adenomatoid tumor of the adrenal gland:
    Report of a rare case and review of the literature. Int J Clin Exp
    Pathol 2013;6:943‑50.
    4. Fauquenot‑Nollen AM, Plaisier ML, Tjon A Tham RT. Combined DOI:
    10.4103/2320-8775.146852
    thoracic and abdominal lymphangioma in an adult. JBR‑BTR
    2002;85:130‑1.

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