A Woman With Persistent Abdominal Pain in the Setting of a Solitary Fibrous Adrenal Tumor

Abstract

Background/Objective

We present a case of a woman with persistent abdominal pain, leading to the discovery of a rare solitary fibrous tumor (SFT) in the adrenal gland. The rarity of adrenal SFTs and their diagnostic challenges make this case noteworthy. The objective of this report is to describe a patient with an adrenal SFT, highlighting the unique diagnostic approach and management considerations for this rare condition.

Case Report

A 35-year-old woman presented with chronic abdominal pain and was referred to the endocrinology clinic for evaluation of an adrenal incidentaloma. Computed tomography imaging revealed a 4 cm homogeneous right adrenal mass, with precontrast Hounsfield units of 1 and an absolute contrast washout of 60%. A prior computed tomography scan from 6 years earlier showed a 1.5 cm adenoma with similar characteristics. Despite normal hormonal levels, the tumor's growth and the patient's symptoms prompted surgical referral. The patient underwent robotic-assisted laparoscopic right adrenalectomy. Pathological examination identified a well-circumscribed SFT, measuring 3.7 × 3.6 × 2.9 cm.

Discussion

Adrenal SFTs are rare, typically hormonally inactive, well-circumscribed masses that often present with abdominal pain. While more common in the pleura, adrenal SFTs can mimic other benign adrenal lesions on imaging, complicating diagnosis. Histopathology is essential for accurate diagnosis, and surgical resection remains the main treatment.

Conclusion

This case highlights the diagnostic challenges of adrenal SFTs, which can mimic other benign lesions. Despite significant growth, the tumor was histologically benign with low malignancy risk. Clinicians should consider adrenal SFTs in the differential diagnosis of incidental adrenal masses with atypical imaging features.