A Large Splenic Hemangioma Masquerading as An “Adrenal Incidentaloma”

ABSTRACT Objective: A case is presented of a large splenic hemangioma masquerading as an adrenal tumor. Methods: Case report and literature review. Results: A 65-year-old woman with a history of lower-extremity edema and refractory hypertension was incidentally found to have an apparent 8.5-cm left-adrenal mass on magnetic resonance imaging, suspicious for adrenal cortical carcinoma. An adrenal functional evaluation was unrevealing. The patient underwent laparoscopic resection of the mass with splenectomy, as the tumor was inseparable from the spleen. Final pathology revealed a 9 × 8 × 7 cm splenic hemangioma. Splenic hemangioma is a rare tumor, associated with thrombocytopenia and anemia, which can rupture and bleed. Management varies from observation to partial or total splenectomy. Several factors, including the patient's history, presentation, and imaging, contributed to the incorrect pre-operative diagnosis of an adrenal tumor. Conclusion: Adrenal incidentalomas are common. However, it is important to be aware of other visceral tumors that can masquerade as an adrenal incidentaloma. Abbreviations: CD cluster of differentiation; CT computed tomography; FNA fine-needle aspiration