Primary Leiomyosarcoma of the Adrenal Gland: A Case Report with Immunohistochemical Study and Literature Review

Primary adrenal leiomyosarcoma is extremely rare tumor. We report a case with adrenal leiomyosarcoma. Our case was a 48-year-old man who presented with lower urinary tract symptoms. Ultrasonography and magnetic resonance imaging revealed approximately 9？cm solid mass originating from right adrenal gland. He underwent right adrenalectomy. Pathology of the specimen showed histologic and immunohistochemical features of adrenal leiomyosarcoma. 1. Introduction Primary leiomyosarcoma of the adrenal gland is a malignant tumor very rarely encountered in the literature and is without any specific findings by laboratory tests and radiologic imaging modalities. Herein, we present a rare case of primary leiomyosarcoma of the right adrenal gland in a 48-year-old male patient who presented with lower urinary tract symptoms. We aim to present a case with a definitive diagnosis of adrenal leiomyosarcoma, which was histopathologically established based on the microscopic examination and immunohistochemical staining of the specimen from the time of diagnosis to its treatment. A review of the recent literature is also presented. 2. Case A 48-year-old male patient consulted an outpatient urology clinic with complaints of frequent urination and awaking during night hours due to the need to urinate. During his physical examination, a mass was palpated on the upper right abdominal quadrant. Upon ultrasonography, a right adrenal mass measuring ？mm was detected, and the patient was hospitalized for further investigation and treatment. The mass was evaluated by the endocrinology department for identification. Upon abdominal magnetic resonance imaging (MRI), a ？mm hypervascular solid mass originating from the right adrenal gland and extending to the right hepatic lobe was observed, with intense contrast uptake on postcontrast images (Figures 1(a) and 1(b)). Figure 1: Magnetic resonance images of a 9？cm right adrenal leiomyosarcoma. T1-weighted images in coronal section (a) and transverse section show a homogenous solid mass in the right suprarenal area. (c) Macroscopic appearance of roundish, fibrous neoplasia. (d) Six months after right adrenalectomy, postoperative abdominal computerized tomography demonstrated no signs of local recurrence. The rectal examination findings and PSA values of the patient, whose father had been diagnosed with prostatic carcinoma, were within the normal limits. A routine laboratory examination and chest X-ray findings were unremarkable. To evaluate the endocrine activity of the mass, the 24-hour vanyl-mandelic acid, metanephrine, and normetanephrine