Adrenal cavernous hemangiomas are rare, benign and predominantly nonfunctioning tumors. Coexistence of myelolipomatous lesion within, was reported only once. Ectopic adrenal tissue is infrequent and located mostly in pelvis, scrotum and groin. Peritoneal adrenal rests count for 5% and are frequently mistaken with pheocromocytoma or cortical carcinoma.

Case report

A 70-year-old male, background of hypertension and toxic goiter, presented with a several month-long left abdominal pain, as single symptom. CT revealed a paravertebral left lumbodorsal mass, 3.6x3.76x2.53cm, with 26HU on non-contrast acquisition, macrocalcifications, cystic areas and heterogeneous enhancement. On MRI was heterogeneously mildly hyperintense on T2-weighted sequences, T1-weighted hypointense and hypervascular, concordant with paraganglion. 68Ga-DOTANOC-PET-TC confirmed MRI and excluded other expressing somatostatin receptors's lesions. Basic blood and hormonal work-up were normal. Transabdominal laparoscopic resection, converted due to haemorrhage of left kidney's upper pole, was performed. A yellowish lesion, partially enclosed behind lumbar spine, left border of aorta and renal vein, in front of duplicated renal artery with no relation with the left adrenal gland, was excised. Pathology showed an irregular mass, 4.3x2.7x1cm, of adrenal cortex and medulla (confirmed with IHQ for Synaptophysin, S100 and MelanA), surrounding a vaguely nodular and hemorrhagic nodule with 2.5x1.5x1.5cm, composed of wide and ectatic vascular spaces (positive for Actine and CD34) and a foci of myelolipoma.

Cavernous hemangioma associated with myelolipoma is a rare benign incidentaloma with nonspecific symptoms. Peritonial heterotopic adrenal masses are even rarer. Imaging plays crucial role in differential diagnosis of hypervascular neoplasms. Surgical resection is sometimes necessary to exclude malignancy and alleviate symptoms secondary to mass effect. This case report is a unique combination.