Case: 235

Inflammatory Pseudotumor Of The Adrenal Gland

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History: 26 yo male with Fever of Unknown Origin
Solution: Inflammatory pseudotumor is a quasineoplastic condition that consists of inflammatory cells and myofibroblastic spindle cells and most frequently involves the lung and the orbit, but has been reported in nearly every site in the body. They may and often do mimic malignant disease and are frequently diagnosed at surgery, but biopsy may be elucidatory. The cause is unknown, but many people believe that it is a low-grade fibrosarcoma with inflammatory elements. The inflammatory cells are usually both T and B cells and their heterogeneity distinguishes this process from lymphoma. They are thought to arise related to a variety of processes, including infection, trauma, and autoimmune diseases. Patients tend to present with fever and growth restriction/failure to thrive. The imaging findings are variable, but on CT, abdominal inflammatory pseudotumors are frequently associated with calcification, be similar in attenuation to muscle on non-contrast images, show enhancement (usually relatively mild), and may have central necrosis. On MRI, they tend to be hypointense to muscle on T1 weighted images, hyperintense on T2 weighted images, and show heterogeneous enhancement. The behavior on DWI images has not been well described. Treatment is complete surgical resection if possible.

Questions

This is most likely to be:
  • Vascular
  • Neoplastic
  • Post-traumatic
  • Congenital
  • Iatrogenic
The most appropriate management would be surgical resection.
True
What is the diagnosis? You can give a differential of up to 3 entities.
Inflammatory pseudotumor (no good way to differentiate from adrenocorticocarcinoma on the imaging).