Xanthogranulomatous adrenalitis: A rare cause of adrenal mass and literature review

Xanthogranulomatous adrenalitis is a rare, benign, chronic inflammatory clinical entity that can present as an adrenal mass and may resemble malignancy on imaging. In this paper, we showcase our diagnostic approach, including clinical, radiological, and pathological findings, and review the existing literature to highlight the importance of accurate diagnosis and provide clinical data that may aid in the diagnosis and management of xanthogranulomatous adrenalitis. Case A 42-year-old woman presented with prolonged left-sided abdominal pain and recurrent vomiting. Initial evaluation was unremarkable except for a urinary tract infection, which was treated without resolution of symptoms. Computed tomography (CT) revealed a well-circumscribed, multilocular, thick-walled left suprarenal hypoattenuating lesion measuring about 8.5 × 4.5 cm. Hormonal evaluations were normal. Surgical excision with partial nephrectomy was performed due to suspected malignancy. Histopathology showed chronic inflammation, granulomatous changes, and a central abscess, with no evidence of malignancy, consistent with xanthogranulomatous adrenalitis. The patient had an uneventful recovery. Xanthogranulomatous adrenalitis can mimic malignancy and should be considered in the differential diagnosis of adrenal masses. Definitive diagnosis is based on histopathologic examination, and surgical resection is often required when malignancy cannot be excluded.