An adrenal cystic lymphangioma: a rare tumor
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Cystic lymphangioma is a rare benign tumor developing from lymphatic endothelial cells and is usually described in the neck or axilla. Published in the journal Urology Case Reports, the authors present a case of an adrenal cystic lymphangioma fortuitously found in a 37-year-old patient.

A 37-year-old women, with no past medical history was referred for left adrenal incidentaloma. The patient was asymptomatic, she has not experienced headache, palpitations or flank pain. Physical examination, including blood pressure, and routine laboratory examinations were normal.

Abdominal CT reveale a left adrenal tumor, measuring 47.7 x 21.3 mm in diameter which was well-circumscribed, had a low density, with very slight enhancement, containing multiple calcifications. Hormonal studies including urine metanephrine, normetanephrine and vanilmandelic acid were all normal. Also plasma cortisol concentration was normal.

Laparoscopic left adrenalectomy via lomboscopic approach was performed and the tumor was excised en-block with the left adrenal gland.

Microscopic examination revealed a multi-cystic lesion with flat and bland endothelial cells, containing eosinophilic material, adjacent to the normal-appearing adrenal cortex. Immunohistochemically, the tumor was positive for CD31 and CD 34 and the diagnosis of adrenal cystic lymphangioma was made.

Major takeaway:-
ACLs are rare, cystic, benign lesions. Its diagnosis can be difficult and challenging since imaging features are not specific and it is usually established after surgery by pathological report.