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Adrenal Disorders

(17.11) A Nagging Case of a Solitary Fibrous Tumor

Saturday, May 11, 2024
7:30 AM – 7:45 AM CDT
Location: ePoster Showcase, Empire Ballroom Foyer, Level 2
Introduction : Adrenal incidentalomas are a common entity. However, we present a case of a young healthy woman who initially presented with persistent abdominal pain, ultimately leading to the discovery of a rare adrenal tumor. 

Case(s) Description : A 35-year-old woman with history of chronic abdominal pain presented to the endocrinology clinic for evaluation of an adrenal incidentaloma. CT scan of the abdomen and pelvis with and without IV contrast revealed a homogeneous 4 cm right adrenal mass. Precontrast Hounsfield Units were 1, and the absolute contrast washout was 60%.  A CT scan of the abdomen dated 6 years prior identified an adenoma, which had similar characteristics but measured 1.5 cm. A biochemical workup did not reveal any hormonal hypersecretion. The patient did not have any significant past medical history and denied family history of adrenal disorders. Due to debilitating abdominal pain and significant growth of the lesion, she was referred for surgical evaluation.  The patient underwent a robotic-assisted laparoscopic right adrenalectomy. Surgical pathology revealed a 3.7 x 3.6 x 2.9 cm well-circumscribed fleshy tumor. Microscopic evaluation showed spindle cells, arranged in a haphazard fashion. Hyalinized staghorn-like blood vessels were identified in the background. Immunohistochemical analysis showed positive stains for CD34 and STAT6. The findings were compatible with a solitary fibrous tumor (SFT) of the adrenal gland. There was no evidence of necrosis and the mitotic activity was 3/10 hpf. The tumor was categorized as low risk.  

Discussion : Solitary fibrous tumor of the adrenal gland is a rare adrenal pathology which generally presents as a well circumscribed hormonally inactive mass. No apparent gender predilection is observed. The mean age of presentation is 47 years.  Abdominal pain is the most common clinical presentation. Tumor dimensions range between 2.5 and 18 cm. Microscopic evaluation demonstrates classical features such as spindle cells with a pattern-less architecture. SFTs usually share immunoexpression for CD34 and STAT6. Tumor risk stratification is based on age, tumor size, presence of necrosis, and mitosis rate >4/10 hpf. The majority of SFTs are categorized as benign.  Treatment is surgical and adjuvant therapy is rarely needed. Long-term follow up is suggested due to reports of local recurrence of disease.