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+A 41-year-old smoker diagnosed with lipoma on the right thigh underwent an abdominal ultrasound scan following an elevation of catecholamines in the blood (noradrenaline and dopamine) without accompanying hypertension. A hypoanechoic nodular lesion of approximately 3 cm in maximum dimension compatible with a solid lesion with cystic degeneration, multitabic, was observed at the adrenal level. The lesion was confirmed by CT scan and scintigraphy. The patient underwent surgery with the clinical findings of pheochromocytoma versus adrenal gland adenoma. A 9 cm irregular adipose tissue fragment was received with serial sections showing a 1.2 cm yellowish-orange tissue together with a thin-walled, whitish multilocular cystic formation with no papillary formations or outgrowths inside. Histological examination showed a large cystic formation without haematic content lined by flat cells with central spindle-shaped nuclei sometimes protruding intraluminally, with immunohistochemical positivity for CD 31 and CD 34 and negativity for calrretinin (endothelium). Cystic formations with similar characteristics to the one described, although smaller in size, were observed both adjacent to the main formation and randomly distributed within the adrenal parenchyma. Based on these findings, the diagnosis of cystic lymphangioma was made.
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