Primary alveolar echinococcosis (Echinococcus multilocularis) of the adrenal gland: report of two cases.

We retrospectively analyzed two rare cases of primary alveolar echinococcosis of the adrenal gland that were misdiagnosed. One male patient was asymptomatic and the lesion was found incidentally, and the other female patient had an obscure abdominal pain. No masses were found in the epigastric region of either patient. Computed tomography (CT) scans revealed oval masses with indistinct margins adjacent to organs. The lesions were slightly enhanced by contrast medium, showing cystic and solid components with a cobbled road appearance. Both cases were diagnosed as adrenal malignant tumors, and adrenalectomies were performed. Postoperative pathology reports confirmed adrenal alveolar echinococcosis. Neither patient had recurrence at 2 years of follow-up. The cobbled road appearance of this disease on CT images may represent the early-stage image of alveolar echinococcosis.