A Retroperitoneal Leiomyosarcoma Presenting as an Adrenal Incidentaloma in a Subject on Warfarin
Adrenal incidentalomas (AIs) are mostly benign and nonsecretory. Management algorithms lack sensitivity when assessing malignant potential, although functional status is easier to assess. We present a subject whose AI was a retroperitoneal leiomyosarcoma (RL). Case Presentation. A woman on warfarin...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2015/830814 |
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| author | Ishrat N. Khan Mohamed A. Adlan Michael J. Stechman Lakdasa D. Premawardhana |
| author_facet | Ishrat N. Khan Mohamed A. Adlan Michael J. Stechman Lakdasa D. Premawardhana |
| author_sort | Ishrat N. Khan |
| collection | DOAJ |
| description | Adrenal incidentalomas (AIs) are mostly benign and nonsecretory. Management algorithms lack sensitivity when assessing malignant potential, although functional status is easier to assess. We present a subject whose AI was a retroperitoneal leiomyosarcoma (RL). Case Presentation. A woman on warfarin with SLE and the antiphospholipid syndrome, presented with left loin pain. She was normotensive and clinically normal. Ultrasound scans demonstrated left kidney scarring, but CT scans revealed an AI. MRI scans later confirmed the AI without significant fat and no interval growth. Cortisol after 1 mg dexamethasone, urinary free cortisol and catecholamines, plasma aldosterone renin ratio, and 17-hydroxyprogesterone were within the reference range. Initially, adrenal haemorrhage was diagnosed because of warfarin therapy and the acute presentation. However, she underwent adrenalectomy because of interval growth of the AI. Histology confirmed an RL. The patient received adjuvant radiotherapy. Discussion. Our subject presented with an NSAI. However, we highlight the following: (a) the diagnosis of adrenal haemorrhage in this anticoagulated woman was revised because of interval growth; (b) the tumour, an RL, was relatively small at diagnosis; (c) this subject has survived well over 60 months despite an RL perhaps because of her acute presentation and early diagnosis of a small localised tumour. |
| format | Article |
| id | doaj-art-e70f6d372b2b4479a13b820d151d8ee8 |
| institution | Kabale University |
| issn | 2090-6501 2090-651X |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-e70f6d372b2b4479a13b820d151d8ee82025-02-03T01:00:10ZengWileyCase Reports in Endocrinology2090-65012090-651X2015-01-01201510.1155/2015/830814830814A Retroperitoneal Leiomyosarcoma Presenting as an Adrenal Incidentaloma in a Subject on WarfarinIshrat N. Khan0Mohamed A. Adlan1Michael J. Stechman2Lakdasa D. Premawardhana3Section of Endocrinology, Ysbyty Ystrad Fawr, Ystrad Fawr Way, Hengoed, Caerphilly CF82 7EP, UKSection of Endocrinology, Ysbyty Ystrad Fawr, Ystrad Fawr Way, Hengoed, Caerphilly CF82 7EP, UKDepartment of Endocrine Surgery, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UKSection of Endocrinology, Ysbyty Ystrad Fawr, Ystrad Fawr Way, Hengoed, Caerphilly CF82 7EP, UKAdrenal incidentalomas (AIs) are mostly benign and nonsecretory. Management algorithms lack sensitivity when assessing malignant potential, although functional status is easier to assess. We present a subject whose AI was a retroperitoneal leiomyosarcoma (RL). Case Presentation. A woman on warfarin with SLE and the antiphospholipid syndrome, presented with left loin pain. She was normotensive and clinically normal. Ultrasound scans demonstrated left kidney scarring, but CT scans revealed an AI. MRI scans later confirmed the AI without significant fat and no interval growth. Cortisol after 1 mg dexamethasone, urinary free cortisol and catecholamines, plasma aldosterone renin ratio, and 17-hydroxyprogesterone were within the reference range. Initially, adrenal haemorrhage was diagnosed because of warfarin therapy and the acute presentation. However, she underwent adrenalectomy because of interval growth of the AI. Histology confirmed an RL. The patient received adjuvant radiotherapy. Discussion. Our subject presented with an NSAI. However, we highlight the following: (a) the diagnosis of adrenal haemorrhage in this anticoagulated woman was revised because of interval growth; (b) the tumour, an RL, was relatively small at diagnosis; (c) this subject has survived well over 60 months despite an RL perhaps because of her acute presentation and early diagnosis of a small localised tumour.http://dx.doi.org/10.1155/2015/830814 |
| spellingShingle | Ishrat N. Khan Mohamed A. Adlan Michael J. Stechman Lakdasa D. Premawardhana A Retroperitoneal Leiomyosarcoma Presenting as an Adrenal Incidentaloma in a Subject on Warfarin Case Reports in Endocrinology |
| title | A Retroperitoneal Leiomyosarcoma Presenting as an Adrenal Incidentaloma in a Subject on Warfarin |
| title_full | A Retroperitoneal Leiomyosarcoma Presenting as an Adrenal Incidentaloma in a Subject on Warfarin |
| title_fullStr | A Retroperitoneal Leiomyosarcoma Presenting as an Adrenal Incidentaloma in a Subject on Warfarin |
| title_full_unstemmed | A Retroperitoneal Leiomyosarcoma Presenting as an Adrenal Incidentaloma in a Subject on Warfarin |
| title_short | A Retroperitoneal Leiomyosarcoma Presenting as an Adrenal Incidentaloma in a Subject on Warfarin |
| title_sort | retroperitoneal leiomyosarcoma presenting as an adrenal incidentaloma in a subject on warfarin |
| url | http://dx.doi.org/10.1155/2015/830814 |
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