1Department of Internal Medicine, Matsunami General Hospital, 2Department of Surgery, Matsunami General Hospital, 3Department of Radiology, Matsunami General Hospital, 4Department of Pathology, Matsunami General Hospital
A 57-year-old man with an intraperitoneal cyst was referred to this institution upon discovery of a left adrenal incidentaloma.
The possibility of a functional adrenal tumor could not be ruled out endocrinologically. Ultrasonic examination showed a
homogenous, solid supra-left renal tumor echo that had echogenicity similar to that of the spleen. The tumor measured 4.7 cm
in diameter, and color flow imaging demonstrated no blood flow in it. Ultrasonic examination did not delineate a normal left
adrenal; however, CT imaging and 131I-iodocholesterol scintigraphy suggested that the tumor originated extra-adrenally.
Tumor intensity in MRI studies was lower than that of the liver in the T1-weighted image and slightly higher than that of the
liver in the T2-weighted image. Laparoscopic surgery showed a round extra-adrenal cyst containing a white lardlike substance,
and adhering tightly to the stomach and spleen. Formation of the cyst could conceivably be histopathologically attributable to
degeneration of lipoma or encapsulation of fatty necrosis. The imaging findings of this cyst were not characteristic of a cyst.
Extra care in obtaining images of tumors in the left adrenal region is necessary if the images are to shed light on tumor orign.