Adrenal Cyst Research Articles

The Clinical Value of Prenatal Ultrasonography in the Differential Diagnosis of Fetal Suprarenal Space-Occupying Lesions.

ObjectiveThis study aimed to investigate the value of prenatal ultrasonography in the differential diagnosis of fetal space-occupying lesions in the adrenal gland.MethodsThirty-six fetuses with adrenal gland space-occupying lesions diagnosed by prenatal ultrasonography between January 2019 and July 2021 were included in this retrospective study. The clinical data, ultrasonographic features, treatments, and prognoses of the fetuses were analyzed. Postnatal diagnoses were made using computed tomography (CT), magnetic resonance imaging, and surgical resection.ResultsOf the 36 fetuses, 10 were diagnosed with adrenal hematomas, eight with adrenal neuroblastomas, seven with adrenal cysts, seven with subphrenic pulmonary sequestration, and four with adrenal teratomas. The accuracy of prenatal diagnosis was highest in those with adrenal cysts and subphrenic pulmonary sequestration, with the accuracy being 85.7% for both conditions. The mean gestational age at first detection of subphrenic pulmonary sequestration was 22.5 ± 3.1 weeks, which was significantly lower than that of other diagnoses (P < 0.05), and the mean diameter of adrenal cysts was 15.1 ± 4.2 mm, which was significantly smaller than that of other lesions (P < 0.05). All newborns with adrenal teratomas and neuroblastomas were treated surgically. Five of the seven patients with subphrenic pulmonary sequestration and three of the seven patients with cysts were also treated surgically. Follow-ups of the remaining cases were carried out by enhanced CT examination, and the prognoses were good.ConclusionPrenatal ultrasonography can help differentiate between different types of fetal adrenal space-occupying lesions, and there is a high coincidence rate between the diagnosis of adrenal cysts and subphrenic pulmonary sequestration.

Clinical, imagingand biochemical presentationof cystic pheochromocytomas.

Cystic adrenal mass is a rare imaging presentation of pheochromocytoma. We aimed to describe the clinical, biochemicaland imaging characteristics of patients with cystic pheochromocytoma. Single-centre, retrospective study, 2000-2020. Consecutive patients with cystic pheochromocytoma were identified from our institutional pathology and adrenal tumour database. Of the 638 patients with pheochromocytomas, 21 (3.2%) had cystic pheochromocytomas (median age: 57 years, 57% women). Most pheochromocytomas were discovered incidentally (57%) or due to symptoms of catecholamine excess (24%). The median tumour size was 6.4 cm. On imaging, cystic pheochromocytomas were round or oval (90%), heterogeneous lesions (86%) with a thick solid rim (median rim thickness 13.9 mm, unenhanced computed tomography (CT) attenuation 40 Hounsfield units(HU), venous-phase CT attenuation 83 HU), and a median cystic component of 40% (unenhanced CT attenuation 17.6 HU, venous-phase CT attenuation 20.4 HU), and rarely with calcifications (15%). All 20 patients with biochemical testing had functioning tumours (adrenergic in 80%, noradrenergic in 20%). Total urinary metanephrine excretion correlated with the volume of the solid component (R2 = .75, p < .0001) but not the cystic component (R2 = .04, p = .4386). All patients underwent adrenalectomy (48% laparoscopic, 52% open), and the median duration of hospital stay was 4 days. Cystic pheochromocytomas are rare, large tumours with a phenotypic appearance that can masquerade as other adrenal cystic lesions. The degree of biochemical abnormality in cystic pheochromocytomas is associated with the volume of the solid component. All patients with adrenal cysts that have a solid component or an unenhanced attenuation >10 HU should undergo biochemical testing for pheochromocytoma.

Senhance robot-assisted adrenalectomy: a case series

We present a case series of 12 consecutive robot-assisted adrenalectomies performed from May 2019 to March 2020 by a single surgeon experienced in laparoscopy using the novel Senhance robotic system. Eleven patients had primary aldosteronism due to an adrenal adenoma, diagnosed by means of endocrinological and radiological evaluation, and 1 had a benign adrenal cyst. The robotic adrenalectomy technique is described in detail. The mean procedure time was 165.1 minutes, with robotic docking time of 11.6 minutes and console time of 98.6 minutes. The mean estimated blood loss was 47 mL, and hospital stay duration was 4.5 days. There was 1 Clavien Dindo IIIB complication and 1 patient underwent conversion to laparoscopy. All patients with adenoma had complete biochemical remission after surgery. In conclusion, the Senhance robotic system is a safe and feasible platform for benign adrenal surgery in high-volume centers.

Detection of near-infrared autofluorescence from adrenal neoplasms: An initial experience.

Fluorescence from adrenal tumors can be detected with near-infrared imaging after injection with indocyanine green. However, it is unknown if adrenal tumors exhibit autofluorescence. The aim of this study was to determine whether adrenal tumors emit near-infrared autofluorescence (NIRAF). This was a prospective study of patients who underwent minimally invasive adrenalectomy at a tertiary center. Intraoperative images were analyzed to detect NIRAF with a 750 nm camera. Descriptive and comparative statistical analyses were performed. Twenty-five adrenalectomies were examined. Only 11tumors (44%), that originated from the cortex exhibited autofluorescence. A contrast distinction between the tumor and retroperitoneum was observed in 23 patients, whereas a contrast distinction between the tumor and normal adrenocortical tissue was seen in 12 patients. The overall fluorescence intensity of adrenal tumors was found to be variable and ranging between 0.3 and 5.6 times that of the background tissue. Pheochromocytoma, malignancy and adrenal cyst did not demonstrate NIRAF. This is the first study to show that adrenocortical tissue can demonstrate NIRAF. The pattern of fluorescence was similar to that observed after indocyanine green injection in our historical experience. NIRAF has a potential to be used as an intraoperative optical adjunct during adrenalectomy.

A 15-Year Change of an Adrenal Endothelial Cyst

Patient: Male, 61-year-old Final Diagnosis: Adrenal endothelial cyst Symptoms: No obvious self-conscious symptoms Medication:— Clinical Procedure: Laparoscopic adenectomy Specialty: Urology Objective: Rare disease Background:Adrenal gland cysts are rare and often occur without any symptoms. Even with advanced imaging modalities, it is still difficult to differentiate a benign adrenal neoplasm from a malignant one. Therefore, it is difficult to arrive at a definitive diagnosis and provide treatment.Case Report:We describe a patient with asymptomatic adrenal incidentaloma. The patient was lost to follow-up until 7 years later. On resuming follow-up, an enlarged suprarenal tumor was noted on ultrasound imaging. Magnetic resonance imaging revealed a 6×4 cm tumor mass, and the peripheral part expressed progressive enhancement on dynamic contrast-enhanced images. Laboratory data showed slight hypokalemia, and a complete endocrine assessment was performed, which showed no abnormality. Because malignancy of the adrenal gland remained suspected, a laparoscopic adenectomy was performed. The pathological result showed an adrenal endothelial (vascular) cyst with the formation of thrombi and calcification, without any evidence of malignancy.Conclusions:Adrenal cystic lesions can change with time. Routine imaging studies during follow-up are recommended, and endocrine evaluations should be performed as an initial adrenal tumor work-up. Surgery is the treatment of choice when the cyst is >6 cm in size, malignancy is suspected, or abnormal endocrine activity is present.

Overview of the 2022 WHO Classification of Adrenal Cortical Tumors

The new WHO classification of adrenal cortical proliferations reflects translational advances in the fields of endocrine pathology, oncology and molecular biology. By adopting a question–answer framework, this review highlights advances in knowledge of histological features, ancillary studies, and associated genetic findings that increase the understanding of the adrenal cortex pathologies that are now reflected in the 2022 WHO classification. The pathological correlates of adrenal cortical proliferations include diffuse adrenal cortical hyperplasia, adrenal cortical nodular disease, adrenal cortical adenomas and adrenal cortical carcinomas. Understanding germline susceptibility and the clonal-neoplastic nature of individual adrenal cortical nodules in primary bilateral macronodular adrenal cortical disease, and recognition of the clonal-neoplastic nature of incidentally discovered non-functional subcentimeter benign adrenal cortical nodules has led to redefining the spectrum of adrenal cortical nodular disease. As a consequence, the most significant nomenclature change in the field of adrenal cortical pathology involves the refined classification of adrenal cortical nodular disease which now includes (a) sporadic nodular adrenocortical disease, (b) bilateral micronodular adrenal cortical disease, and (c) bilateral macronodular adrenal cortical disease (formerly known primary bilateral macronodular adrenal cortical hyperplasia). This group of clinicopathological entities are reflected in functional adrenal cortical pathologies. Aldosterone producing cortical lesions can be unifocal or multifocal, and may be bilateral with no imaging-detected nodule(s). Furthermore, not all grossly or radiologically identified adrenal cortical lesions may be the source of aldosterone excess. For this reason, the new WHO classification endorses the nomenclature of the HISTALDO classification which uses CYP11B2 immunohistochemistry to identify functional sites of aldosterone production to help predict the risk of bilateral disease in primary aldosteronism. Adrenal cortical carcinomas are subtyped based on their morphological features to include conventional, oncocytic, myxoid, and sarcomatoid subtypes. Although the classic histopathologic criteria for diagnosing adrenal cortical carcinomas have not changed, the 2022 WHO classification underscores the diagnostic and prognostic impact of angioinvasion (vascular invasion) in these tumors. Microscopic angioinvasion is defined as tumor cells invading through a vessel wall and forming a thrombus/fibrin-tumor complex or intravascular tumor cells admixed with platelet thrombus/fibrin. In addition to well-established Weiss and modified Weiss scoring systems, the new WHO classification also expands on the use of other multiparameter diagnostic algorithms (reticulin algorithm, Lin–Weiss–Bisceglia system, and Helsinki scoring system) to assist the workup of adrenal cortical neoplasms in adults. Accordingly, conventional carcinomas can be assessed using all multiparameter diagnostic schemes, whereas oncocytic neoplasms can be assessed using the Lin–Weiss–Bisceglia system, reticulin algorithm and Helsinki scoring system. Pediatric adrenal cortical neoplasms are assessed using the Wieneke system. Most adult adrenal cortical carcinomas show > 5 mitoses per 10 mm2 and > 5% Ki67. The 2022 WHO classification places an emphasis on an accurate assessment of tumor proliferation rate using both the mitotic count (mitoses per 10 mm2) and Ki67 labeling index which play an essential role in the dynamic risk stratification of affected patients. Low grade carcinomas have mitotic rate of ≤ 20 mitoses per 10 mm2, whereas high-grade carcinomas show > 20 mitoses per 10 mm2. Ki67-based tumor grading has not been endorsed in the new WHO classification, since the proliferation indices are continuous variables rather than being static thresholds in tumor biology. This new WHO classification emphasizes the role of diagnostic and predictive biomarkers in the workup of adrenal cortical neoplasms. Confirmation of the adrenal cortical origin of a tumor remains a critical requirement when dealing with non-functional lesions in the adrenal gland which may be mistaken for a primary adrenal cortical neoplasm. While SF1 is the most reliable biomarker in the confirmation of adrenal cortical origin, paranuclear IGF2 expression is a useful biomarker in the distinction of malignancy in adrenal cortical neoplasms. In addition to adrenal myelolipoma, the new classification of adrenal cortical tumors has introduced new sections including adrenal ectopia, based on the potential role of such ectopic tissue as a possible source of neoplastic proliferations as well as a potential mimicker of metastatic disease. Adrenal cysts are also discussed in the new classification as they may simulate primary cystic adrenal neoplasms or even adrenal cortical carcinomas in the setting of an adrenal pseudocyst.

Adrenal cysts of lymphatic origin: A clinical and pathological study of six cases and systematic literature review

Adrenal cysts are rare, benign, and usually asymptomatic, being detected as an incidental finding on imaging methods. Adrenal Cysts of Lymphatic Origin (ACLO) and Adrenal Lymphangiomas (AL) are types of endothelial cyst and are the most prevalent subtype in this series. This study aims to present a single institutional experience of these rare cysts and compare their features with those found in the review of existing literature on ACLO and AL. Overall, thirteen cases of adrenal cysts were diagnosed and surgically excised during the study period, onto which we performed immunohistochemistry using a panel of antibodies (CD31, CD34, Pan Cytokeratin AE-1/AE-3, Factor VII, D2–40, and ERG). Four cases of ACLO and two AL were found. The lesions predominantly affected right adrenal, and the majority of patients were middle-age females, of Caucasian ethnicity, and asymptomatic. In our literature review, we found 108 cases of ACLO/AL from 57 articles with similar sex and age distribution. The diagnosis and subclassification of adrenal cysts are challenging, and there is a significant overlapping between the definition of ACLO and AL.

Giant adrenal endothelial Cyst: A case report

Adrenal cyst initially described in 1670s, is being diagnosed more frequently with the advent of widespread use of diagnostic imaging. Most of these cysts are small and remain nonfunctional with requirement of only conservative approach. Functional, malignant or benign lesions more than 5cm in size needs surgical intervention. Giant adrenal cysts (&gt;10cm) do pose a clinical diagnostic dilemma and present with symptoms as was the scenario in the case being described. The management of this case along with a review of literature is being briefly described.

Haemorrhagic suprarenal pseudocysts: a systematic review of a rare condition from family physicians’ perspective during the COVID-19 global pandemic

Adrenal cysts are rare lesions that could be epithelial, endothelial, parasitic or haemorrhagic[1], as well as pseudocysts. Haemorrhagic adrenal cysts are extremely rare and are often asymptomatic, so diagnosis can be really challenging. This can prove really difficult for primary care physicians who are often the frontline clinicians these patients tend to present to. They are usually benign lesions and do not often cause mortality if detected early and prompt surgery is done, as was the case with the patient in our case report[4]. When they do become symptomatic, they can present with different systemic symptoms as documented in literature, including in our case report[2,4]. Diagnosis is usually through Ultrasound and CT Scan and management is largely laparoscopic or open excision depending on the size of the lesion, surgical expertise and local protocol. Most patients make full recovery and mortality is extremely low [3]. The aim of this review is to provide a broader overview of the subject, highlight salient points in several studies relating to haemorrhagic cysts, provide an up to date follow up information on the index patient in our case report and to explore possible areas for future study [4,6]. This review also includes a suggested management algorithm and intends to emphasize the fact that patients who present in primary, urgent or emergency care settings with persistent non-specific symptoms should be investigated for rare diseases.

New genetic and clinical evidence associated with fetal Beckwith-Wiedemann syndrome.

Early detection of Beckwith-Wiedemann syndrome (BWS) is very important since it is very useful regarding counseling of parents concerning the risk of developing embryonic tumors, selection of the mode of delivery due to potential adrenal cysts that might bleed during labor, prevention of neonatal hypoglycemia and even options of pregnancy termination in non-viable fetuses. This report describes the prenatal classic sonographic triad of fetal BWS (omphalocele, macrosomia, macroglossia) and other supporting findings (hepatomegaly, adrenal enlargement) as well as additional postnatal evidence. Also, it demonstrates new molecular genetic evidence potentially associated with the disease (the presence of a novel heterozygous c.358G>T variant of the CDKN1C gene). Importantly, we provide new evidence indicating that elevated levels of the four serum biomarkers (alpha-fetoprotein, beta-human gonadotropin, unconjugated estriol, and inhibin-A) in late first or early second trimester might be strongly suggestive of BWS which may facilitate early detection especially in cases of no obvious anomaly. In conclusion, this study emphasizes on early detection of BWS as early as at 14 weeks of gestation, based on the abnormal rise of the four serum biomarkers together with omphalocele. To the best of our knowledge, this is the earliest prenatal detection of BWS ever reported. Finally, we provide new molecular genetic evidence that is, potentially associated with BWS.

Coincidence of Large Adrenal Cyst and Prominent Hyporeninemic Hyperaldosteronism

A 67-year-old Japanese woman who had end-stage renal disease was referred to our hospital for kidney transplantation. Abdominal CT revealed a large adrenal mass with inhomogeneity. She had a history of hospitalization for stroke and heart failure and exhibited prominent hyporeninemic hyperaldosteronism. Histological examination of the resected tumor with anti-CYP11B2 antibody indicated that she had a vascular endothelial cyst with primary aldosteronism (PA) due to multiple adrenocortical micronodules. This report implicates the pathological interaction between adrenal vascular cysts and PA-mediated vascular damage of the adrenal vein.

Large adrenal tumours mimicking hepatic malignancy: the role of concurrent adrenalectomy and anterior approach hepatectomy.

Large right adrenal tumours may invade the liver and mimic primary hepatic malignancy, presenting diagnostic and management challenges. The 'anterior approach hepatectomy' (AAH) using hanging manoeuvre may be safe for resection of such tumours. Prospectively maintained database was analysed to identify the large tumours of adreno-hepatic region subjected to hepatectomy. Clinico-biochemical, radiological and surgical details were reviewed. AAH and hanging manoeuvre was adopted for the patients requiring right hepatectomy. Out of the eight patients with adreno-hepatic tumour, four had indeterminate origin of the mass, two had complex cysts, and two were diagnosed as hepatocellular carcinoma on the pre-operative imaging. The median age was 38 years (23-66); male:female ratio was 5:3. AAH was performed in four patients, while others underwent non-anatomical resection of involved segment(s). This accounted for 1.01% of 789 hepatectomies performed during the study period. The median intra-operative blood loss was 525 mL (150-2200 mL) and the median tumour size was 9 cm (6-17 cm). All patients underwent R0 resection. The final histopathological diagnoses were: three phaeochromocytomas (two malignant and one benign), two adrenocortical carcinomas, one malignant paraganglionomas and two adrenal cysts. Major complication (grade IVa) was experienced in one patient. On median follow-up of 67.5 months (7-84), all were alive and one patient had tumour recurrence. Adrenal tumours mimicking primary hepatic malignancy are rare but pose diagnostic challenges. The AAH is a safe approach with acceptable R0 resection, blood loss, surgical complications and overall outcome for the patients requiring right hepatectomy.

Novel Presentation of Retroperitoneal Cyst-A Clinical Case Report

Cystic lesions of the adrenal gland are usually rare, seen in 1/5750 to 1/250,000 of the population. They may be true cysts, infectious cysts, malignancies with cystic degeneration, or pseudocysts. Adrenal cysts are rare in the differential diagnosis of Retroperitoneal Cysts (RPC) and may be treated. They can be correctly identified through pathological testing. Here, the author presents a case of giant adrenal cyst in a young 38-year-old female.

A Case of an Adrenal Hemangiomatous Endothelial Cyst Presented with Anemia

A Case of an Adrenal Hemangiomatous Endothelial Cyst Presented with Anemia

Endothelial Cyst of the Left Adrenal Gland in Female Patient Presented as a Cystic Tumor of the Pancreas: A Case Report

Large adrenal gland cysts represent a rare clinical entity than can be misdiagnosed as pancreatic cystic tumor and eventually change the preoperative plan of the surgeon. Their sex predomination is with female to male ratio of 3:1, occurring mostly in middle aged women and are mostly always unilateral and left-sided in 55% of cases. The treatment for cysts larger than 5 cm in diameter is surgical regardless of the symptoms, due to their potential for malignancy. We present a case of left adrenal gland endothelial cyst primarily presented on CT scan as a cystic tumor of the pancreatic tale. Therefore, even when the proper preoperative imaging tools are used, the diagnosis is not certain and the preoperative plan is changed during the surgery. Keywords: adrenal gland, endothelial cyst. DOI: 10.7176/JHMN/85-06 Publication date: January 31 st 2021

A case of successful surgical treatment of patient with adrenal cyst using 3-d modeling

Aim. Demonstration of potentials of preoperative planning and implementation of surgical resection in patients with adrenal cysts.&#x0D; A clinical observation of a successful surgical treatment of a rare pathology cyst of the right adrenal is presented. The choice of surgical treatment tactics is determined by the size of tumor and clinical presentation of the disease. The surgical treatment was accomplished laparoscopically which permitted to reduce the time of recovery and rehabilitation of the patient. In this clinical observation, the benefit of using 3D-modeling of the surgical area was shown for visualization of topographic and anatomic peculiarities and facilitation of the intraoperative navigation with the help of Avtoplan program developed by Samara State Medical University.&#x0D; Conclusion. Preoperative 3D-modeling permits to prepare to surgical intervention taking into account individual anatomic peculiarities of a patient, and to determine the optimal volume of the operation.

Histopathologic spectrum of adrenal lesions

Introduction: The bipartite adrenal gland has tumors arising from cortex, medulla or as metastasis from extra-adrenal sites. Distinguishing benign from malignant types is a challenging task for pathologists, this study gives an insight into adrenal lesions with their histopathological and immunohistochemical findings and its role in categorizing these tumors to aid in their diagnosis and proper management. Aim: To study the Histopathological patterns of adrenal lesions with clinical correlation. Materials and Methods: In a five year period10 surgical specimens of adrenal tumors were resected and studied between July 2010 to June 2015 at Kamineni Institute of Medical Sciences, Narketpally and King Koti. Tissues were processed and stained sections were studied for histopathological patterns and IHC markers used were vimentin, synaptophysin, NSE, chromogranin immunohistochemistry was done wherever necessary and the markers used were vimentin, synaptophysin, NSE, chromogranin. Result: Out of ten adrenal lesions we have studied, two cases were adrenal cysts,1 three were cortical adenoma, one case is Adrenocortical carcinoma-positive for synaptophysin, vimentin, two cases were neuroblastoma-positive for NSE, chromogranin and synaptophysin and two cases are pheochromocytoma - positive for chromogranin. Conclusion: Pathological evaluation and immunohistochemical profiling has got important role in categorizing adrenal tumors along with clinical, radio logical and biochemical inputs and their subsequent management. Keywords: Adrenal cyst, Adrenal adenoma and Carcinoma (Weiss system), Neuroblastoma, Pheochromocytoma.

Клініко-морфологічний аналіз патології надниркових залоз у Харківському регіоні (за даними архівного матеріалу у період 2015-2019 рр.)

The adrenal glands play an important role in the functioning of the human body. There are more opportunities for early tumors detection of these endocrine glands thanks to modern diagnostic procedures, but the problem is very relevant. Morphological investigation is the basis for differentiating adrenocortical adenoma from carcinoma. Material and methods. The article presents the clinical and morphological features of the adrenal glands pathology in Kharkiv region in the period 2015-2019 by analyzing the archival histological material of 77 patients who were operated in hospitals of the State Institution "Institute of General and Emergency Surgery named after V. T. Zaitsev of National Academy of Medical Sciences of Ukraine" and "V. Danilevsky Institute for Endocrine Pathology Problems of the National Academy of Medical Sciences of Ukraine". Results and discussion. The study established that in 2015 there were 18 cases (including 8 malignant tumors), in 2016 – 16 cases (2 cases with bilateral damage, 1 malignant tumor), in 2017 – 12 cases, in 2018 – 20 cases, in 2019 – 11 cases. All tumors were benign in the last 3 years of the study. We calculated that 48.6 years was the average age of patients with this localization tumor processes (20-75 years). Women suffered more often than men (61.03% and 38.97%, respectively). Both adrenal glands had pathological changes in 2 people. The left gland is most often affected. The vast majority of the formations in 2015-2019 were benign (88.61%). Adrenocortical adenomas (45 cases, mostly clear cell variant, leftward, in women) and mature pheochromocytomas (13 cases, uncomplexed variant, leftward, in men), adrenal cysts (6 cases, more often on the right, in men, with a dense fibrous capsule), hyperplasia of the cortical, cerebral or both layers (4 cases), ganglioneuroma of the adrenal medulla (1 case) and a combination of pheochromocytoma with two adrenocorticosteromas (1 case) were among them. Conclusion. Malignant tumors were represented by malignant corticosteromas (5 cases out of 9, leftward, various sizes, with secondary changes in tumor tissue), malignant pheochromocytomas (3 cases out of 9, right, different size) and malignant paraganglioma (1 case). The larger size of the tumor did not always correlate with the nature of the process

Laparoscopic management of an adrenal cyst – A case report

Adrenal cysts are generally rare clinical entity, but due to advances in imaging diagnostic methods, detection incidental cases are increasing. Therefore, discussions about the therapeutic management of these cases are more numerous, due to the growing number of cases. We present a case of a 29-year-old woman who has had complaints of headaches and right low back pain in the last week. She had a history of high blood pressure in the past 6 months. Clinical examination was essentially normal. Routine blood investigations including a workup for pheochromocytoma was normal. CT abdomen and pelvis showed 8x8x8cm cyst in the right adrenal gland. We decided to perform a laparoscopic excision of the adrenal cyst and successfully excised the adrenal cyst, fully saving the adrenal gland. Laparoscopic excision of the adrenal cyst seems to be the best recommended treatment option for these pathologies. The probability of recurrence after surgical excision is low.

A Giant Adrenal Pseudocyst Presenting With Right Hypochondralgia and Cachexia: A Case Report

Adrenal cysts are rare clinical condition that can present as abdominal swelling and chronic abdominal pain with weight loss. A 26 year old girl presented to our hospital with a 3 years history of right sided abdominal swelling and cachexia. Ultrasound of the abdomen reaveled a cystic area measuring 20x18 cm below the liver. Computed tomography scan showed a large cystic homogenous mass measuring 20x18x18.5cm in the right hypochondrium with most likely origin from the right adrenal gland. IVU showed left sided kidney was absent and left sided crossed ectopia was present. Both kidney on right side was pushed downwards. limited work up for hormone done. Hypersecretion was negative.A laparotomy with right adrenalectomy was performed. Final pathology showed a benign adrenal endothelial cyst.post operative period was unevenful. Surgical resection appears a safe and reasonable management strategy in a patient with adrenal cyst. Bangladesh Journal of Urology, Vol. 18, No. 1, Jan 2015 p.43-46