PMC7815587_01
On CT, a slightly low-density and ill-defined mass in the body of pancreas was detected on plain CT scan (A, red arrow), with a size of 4.1 cm x 2.8 cm, likewise, a left adrenal lesion measuring 2.8 cm x 2.8 cm can be observed, with relatively well-defined margin and mixed-density (A, white arrow). The left adrenal lesion showed continuously nonuniform enhancement in the portal venous phase (B, white arrow), the same enhancement pattern can be observed in the pancreatic tumor (B, red arrow). When compared with the previous CT scans 1 month ago (C, portal venous phase) and 3 months ago (D, portal venous phase) respectively, the size and density of pancreatic tumor (red arrow) and adrenal lesion (white arrow) presented no significant changes through the whole timeline.
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To evaluate the pancreatic tumor and the left adrenal mass, an abdominal CT scan was performed, which showed a slightly low-density (18-38 HU, plain scan) and ill-defined mass in the body of the pancreas ( Figure 1A ), with a size of 4.1 x 2.8 cm. Simultaneously, it revealed a left adrenal lesion with relatively well-defined margin and mixed density (-18 to 46 HU, plain scan) ( Figure 1A ), with a size of 2.8 x 2.8 cm. Both the pancreatic and the adrenal masses showed a continuously nonuniform enhancement in the portal venous phase ( Figure 1B ). The size and density of pancreatic and adrenal lesions showed no significant changes during different phases of chemotherapy compared with the previous CT scans in our hospital ( Figures 1C, D ).
On MRI, T2-weighted sequences showed a mixed hyperintense lesion located in the left adrenal (A), and partly restricted diffusion in DWI (B), in contrast-enhanced T1 weighted sequences, this lesion manifested a thin capsular-rim arterial phase hyperenhancement with slow heterogeneous centripetal enhancement (C).
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The patient then underwent MRI to more precisely evaluate these lesions; on T2-weighted sequences, it showed a mixed hyperintense lesion in the left adrenal gland with a size of 2.8 x 2.8 cm ( Figure 2A ) and partly restricted diffusion in diffusion-weighted imaging (DWI) ( Figure 2B ). After intravenous administration of extracellular contrast agent, this lesion manifested a thin capsular-rim arterial phase hyperenhancement with slow heterogeneous centripetal enhancement ( Figure 2C ).
Histological view at low magnification (A) and high magnification (B) showing a multi-cystic lesion of the left adrenal (hematoxylin and eosin staining, x100 and x200), the entire picture is consistent with benign lymphangioma.
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The specimen from the adrenal gland showed a solid mass with an irregular appearance, measuring 3 x 2 x 0.4 cm, and the definitive diagnosis confirmed a lymphangioma originating from the left adrenal gland ( Figure 3 ), which indicated its benign nature and excluded the possibility of a metastatic tumor.