Adrenal Cyst Research Articles

A Decade of Insights into Bilateral Adrenal Masses: Epidemiology, Clinical Profiles, and Therapeutic Approaches

Bilateral adrenal masses (BAMs) are rare, accounting for 10-15% of adrenal masses. Their diagnostic and therapeutic approaches differ from those of unilateral masses. This study aimed to analyze the epidemiological, clinical, paraclinical, and therapeutic profiles of BAMs. It is based on a retrospective analysis of 30 patient records from the Endocrinology, Diabetology, and Nutrition Department at CHU Hassan II in Fez, over a 12-year period. The average age of the patients was 53 years, with a male predominance (53.3%). BAMs were symptomatically revealed in 46.7% of cases, incidentally discovered in 23.3%, identified during tumor staging in 20%, and associated with a genetic syndrome in 10% of cases. Clinical examination revealed hypertension in 23.3% of patients, an abdominal mass in 10%, signs of adrenal insufficiency in 10%, hypercortisolism in 6.67%, and hyperandrogenism in 16% of cases. Biological assessment showed elevated urinary or plasma metanephrine derivatives in 9 patients, hypercortisolism in 3 patients, adrenal insufficiency in 3 patients, 11-β-hydroxylase enzyme block in 3 patients, and primary hyperaldosteronism in 1 patient. Adrenal computed tomography (CT) was performed in 29 patients. A staging workup, including PET scan, was requested in 20% of cases. MIBG scintigraphy was performed in 23.3% of patients. The investigations revealed 53% of BAMs were secreting and 47% non-secreting. There were 9 cases of pheochromocytomas, including 5 associated with a syndrome (3 MEN2a, 1 MEN2b, 1 VHL), 8 cases of non-secreting adenomas, 3 cases of congenital adrenal hyperplasia due to 11-β-hydroxylase enzyme block, 2 cases of adrenal metastases, 2 cases of adrenocortical carcinoma, 2 cases of adrenal cysts, 1 case of Conn’s adenoma, 1 case of cortisol-secreting adenoma, 1 case of primary adrenal lymphoma, and 1 case of adrenal hematoma. Treatment included the management of emergencies and preoperative preparation for patients eligible for surgery. Bilateral adrenalectomy was performed in 33.3% of patients, and unilateral adenectomy in 1 case of cortisol-secreting adenoma. Medical treatment was initiated in 16.6% of cases, and palliative treatment in 13.33% of cases. Surveillance alone was implemented in the remaining 33.3%. Prognosis depends on the type of adrenal mass, with outcomes marked by the death of one case of malignant adrenocortical carcinoma and one case of primary adrenal lymphoma. Our study, involving 30 cases of BAMs, highlights their clinical, biological, radiological, therapeutic, and prognostic characteristics. Data in the literature are limited compared to unilateral adrenal masses. Future larger studies are desirable for optimal management.

Pseudocysts of the Adrenal Gland: A Systematic Review of Existing Scientific Literature From 2000 to 2023.

Adrenal masses are abnormal growths in the adrenal gland, comprising entities such as pheochromocytomas, adrenal adenomas, adrenocortical carcinomas, and adrenal cysts. Pseudocysts are predominant among adrenal cysts. Due to its infrequent presentation, there are no specific guidelines present in the current literature to steer its management. In such circumstances, a systematic review of the existing literature is imperative to develop comprehensive insights and evidence-based protocols. We aimed to comprehensively analyze the clinico-radiological characteristics and management outcomesof adrenal gland pseudocysts. Human adrenal gland pseudocysts identified through imaging and histopathology, as retrieved from the PubMed search engine, were included in the study. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Joanna Briggs Institute (JBI) CriticalAppraisal Checklist were used to stratify searched studies published between 2000 and 2023. A total of 39 studies were finally included, of which 36 were case reports and three case series, containing 45 patients in total. Data for clinical, radiological, histopathological, and outcome variables were collected, and descriptive analysis was carried out. All cases presented were adults with a clear female predominance of 66.67%. About 26.67% presented with no palpable mass or clinical symptoms, while 28.89% presented with vague abdominal pain. The most prevalent computed tomography (CT) finding was a cystic lesion with calcification and/or hemorrhage and/or necrosis, occurring in 17.78% of cases. Following this, a cystic lesion with only calcification was observed in 13.33% of cases, and a well-defined cystic mass/lesion was found in 11.11% of cases. The most important indication for surgery was compression effect in 44.44%, increasing size in 20.00%, and suspicion of malignancyin another 20.00% of cases. About 64.44% underwent open surgery, while 35.55% underwent minimally invasive surgery. Most patients, 95.55% of the total, had an uneventful postoperative course without any complications. Adrenal gland pseudocyst, though rare and incidental, warrants consideration in differential diagnosis as it presents with vague symptomsand sometimes no symptoms at all. Our review of existing literature highlights the importance of surgical intervention for symptomatic or potentially malignant cysts, with en bloc adrenalectomy being the preferred approach.

A Case of a Primary Giant Adrenal Gland Hydatid Cyst—An Exceptional Location: A Case Report

Background and clinical presentation: The adrenal hydatidosis is an exceptional site location for the occurrence of hydatid cyst with an incidence of being 0.073%. We hereby report this rare case of adrenal hydatid cyst in a 38-year-old male who presented with a history of right flank pain and no other associated complaints. On non-contrast computed tomography/high-resolution computed tomography, the whole abdomen revealed the finding of an adrenal hydatid cyst. He underwent laparoscopic right adrenalectomy, which was further confirmed with the pathological examination. In an adjunct to this, he was put on anti-helminthic drug Albendazole. On one year of follow-up, there was no recurrence. Conclusion: The hydatid cyst rarely occurs in the adrenal glands and is an uncommon pathology. It should always be suspected in the case of any cystic tumour of the adrenal gland, especially in endemic countries. The clinical features are variable and non-specific in the majority of the cases. Ultrasonography and CT abdomen hold a significant sensitivity in the diagnosis of the hydatid cyst. Surgical excision is the main choice of treatment. Adjunctive medical treatment improves the outcome and decreases the recurrence rate.

Adrenal cysts less than 10cm can be safely observed.

Adrenal cysts are rare and appropriate management is unclear due to a lack of data on their natural history. Understanding adrenal cyst growth patterns would assist in clinical management. This single-institution study included all adult patients diagnosed with simple adrenal cysts between 2004 and 2021. Baseline characteristics and outcomes of those who underwent resection (ADX) or observation (OBS) were compared using the chi-squared test, student's t-test, and Wilcoxon rank-sum test. Growth curves and sensitivity analysis were plotted for all patients who had follow-up imaging. We identified 77 patients with imaging-confirmed adrenal cysts. The majority were female (75.3%) and more than half were white (55.8%). One-third of patients underwent ADX, and the remaining were observed. ADX patients were younger (median age [IQR]: 55.5y [45.0-68.2y] vs. 44.2y [38.7-55.0y], p=0.01) and more likely to be Hispanic (12% vs. 0%, p=0.05). ADX patients presented with larger cysts (5.6 vs. 2.6cm, p=0.002). The median time from diagnosis to last follow-up was 1.1y for ADX and 4.1y for OBS. Average growth for OBS was 0.3cm/y, while average growth for ADX was 3.9cm/y. In ADX patients, cysts >10cm grew significantly faster than cysts <10cm (median growth rate 13.2cm/y vs. 0.3cm/y, p<0.05). There was no adrenal malignancy diagnosis, hyperfunctionality, or observation-related complications (e.g., rupture). While size >4-6cm has guided surgical referral for solid adrenal masses, this study demonstrates a size threshold of 10cm, below which asymptomatic, simple adrenal cysts can safely be observed.

Improving adrenalectomies: Safe outcomes of partial adrenalectomies and suitable characteristics

BackgroundPartial adrenalectomy (PA) is increasingly used to treat benign tumors to lower the probability of adrenal insufficiency and reduce need for lifetime hormone replacement therapy. Currently, two major concerns are increased bleeding and non-functioning adrenal remnants. This paper examines these concerns and compares surgical approaches with novel findings. MethodsBetween 1993 and 2023, 72 patients underwent PA for primary adrenal disorders. Demographic, clinicopathologic and outcome data were analyzed for summary statistics, confidence intervals, and heteroscedastic t-test statistics. ResultsThe patients were 17–76 years-old and were 59.7 % female. The PA was on the left 54.2 % and bilaterally 4.2 %. The indications were adrenal adenoma, pheochromocytoma, cyst, hyperplasia, and other. The mean tumor diameter was 2.7 cm (range 0.7-10 cm). 23 were performed open, 43 laparoscopically, and 6 with an intended robotic approach. Median follow-up was 9.3 years.Robotic had the shortest length of stay (LOS) (p-value 0.01), then laparoscopic (p-value 0.00004), then open. The estimated blood loss (EBL) ranged from 5 to 500 mL (median 50 mL). The median LOS was two days.Intra-operative complication rate was 1.4 % and readmission within 30 days occurred in 2.8 %. Out of 72 patients, 6.8 % needed hormone replacement; of the 14 patients with contralateral adrenalectomy, 28.6 % needed replacement. ConclusionPA appears to be safe with both laparoscopic and robotic-assisted techniques with superior perioperative outcomes. The functional results of PA prevent most patients from requiring ongoing steroid replacement treatment and recurrence rates were low. PA should be advised for more frequent use as the preferred treatment method of choice. Key messagePartial adrenalectomies' perioperative and long-term outcomes over a median 9.3 year follow-up emphasized its safety and efficacy with 95 % CI of (2.7 cm, 3.6 cm) for masses with adrenal sufficiency post-resection. Additionally, as healthcare institutions decide whether to invest in surgical robots, robotic approach's outperformance of laparoscopic and open on LOS may be counterbalanced by laparoscopic's strong performance in low EBL.

Simple Adrenal Endothelial Cyst in a Woman: A Case Report

Background and Objective: Adrenal cysts are very rare, and their prevalence has been reported at 5-6% in the clinic. Adrenal cysts comprise 1% to 22% of incidentally discovered adrenal masses. Given the rarity of adrenal cysts and their asymptomatic occurrence in some patients, in this study, a patient with an adrenal cyst referred by weight gain is introduced. Patient introduction: A 49-year-old female patient referred with a complaint of abdominal swelling and gradual weight gain since a year ago. In ultrasound examinations, she was found to have an abdominal mass of unknown origin. In the computed tomography (CT) scan with and without contrast of the patient, the image of a 32 × 28 × 40 cm cyst with a thin wall and transparent contents in the pelvic area showed the appearance of an adrenal pseudocyst, which has caused a pressure effect on the right kidney and its displacement to the left retroperitoneum. According to laboratory tests and repeated visits, the patient underwent surgery with a possible diagnosis of adrenal mass. The patient's complaints were resolved after the surgery. Conclusion: In general, the present study was related to adrenal cysts with uncommon manifestations. The diagnosis was made with the help of a CT scan before the surgery, and the patient's surgery was performed without any major or minor complications. However, if the centers are equipped with the appropriate skills and facilities, laparoscopic management of these patients is suggested.

Adrenal Pseudocyst, Case Report

Pseudocyst type of adrenal cysts is most common; however, this type of ectopic cyst is quite rare in excessively large adrenal cysts. A35-year-old woman was admitted to our institution with distension of her right flank and the upper quadrant of her abdomen. Abdominal ultrasonography revealed a cystic lesion with a homogenous anechoic texture, and measuring 28 cm in diameter. Computed tomography imaging displayed a giant cystic lesion adjacent to the liver, pancreas, kidney. The origin of the cyst was not identified. We were not able to make a preoperative diagnosis; therefore, the patient underwent resection of the mass by open laparotomy for therapeutic diagnosis. Intraoperatively, the mass was identified to be cystic and adhered to the right adrenal gland. It was filled with more than 2500 mL of serous brown fluid. The content of the cyst contained no atypical cells on cytological examination, and the cyst was pathologically classified as a pseudocyst cyst. We describe a case of a patient with a giant pseudocyst of the adrenal gland. The present data suggest that surgeons should decide treatment strategy for large adrenal cysts in consideration of hormonal function, degree of size, and possibility of malignancy.

Clinical features and treatment options for pediatric adrenal incidentalomas: a retrospective single center study

BackgroundThe aim of this study was to investigate the clinical features and treatment options for pediatric adrenal incidentalomas(AIs) to guide the diagnosis and treatment of these tumors.MethodsThe clinical data of AI patients admitted to our hospital between December 2016 and December 2022 were collected and retrospectively analyzed. All patients were divided into neonatal and nonneonatal groups according to their age at the time of the initial consultation.ResultsIn the neonatal group, 13 patients were observed and followed up, and the masses completely disappeared in 8 patients and were significantly reduced in size in 5 patients compared with the previous findings. Four patients ultimately underwent surgery, and the postoperative pathological diagnosis was neuroblastoma in three patients and teratoma in one patient. In the nonneonatal group, there were 18 cases of benign tumors, including 9 cases of ganglioneuroma, 2 cases of adrenocortical adenoma, 2 cases of adrenal cyst, 2 cases of teratoma, 1 case of pheochromocytoma, 1 case of nerve sheath tumor, and 1 case of adrenal hemorrhage; and 20 cases of malignant tumors, including 10 cases of neuroblastoma, 9 cases of ganglioneuroblastoma, and 1 case of adrenocortical carcinoma.ConclusionsNeuroblastoma is the most common type of nonneonatal AI, and detailed laboratory investigations and imaging studies are recommended for aggressive evaluation and treatment in this population. The rate of spontaneous regression of AI is high in neonates, and close observation is feasible if the tumor is small, confined to the adrenal gland and has no distant metastasis.

Adrenal Cysts: To Operate or Not to Operate?

Adrenal cysts are uncommon and usually asymptomatic, and therefore are usually incidentally discovered adrenal lesions. They have a broad pathohistological spectrum that includes pseudocysts and endothelial (vascular), parasitic, and epithelial (mesothelial) cysts. Although most adrenal cysts are benign and hormonally non-functional lesions, some can have ambiguous imaging appearances and mimic malignant adrenal neoplasms. On the other hand, the actual malignant neoplasms could undergo cystic transformation. Additionally, immune cell infiltrations, thrombosis, or haemorrhage seen in sepsis can frequently cause adrenal cyst development, raising a question about the possible connection between severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and adrenal cystic lesions. Due to the disease’s rarity, the likelihood of malignancy, and the lack of specific guidelines, the management of adrenal cysts is always challenging especially in a young person. This review discusses the important diagnostic and the current treatment possibilities for adrenal cystic lesions. Aiming to emphasize clinical dilemmas and help clinicians navigate the challenges when encountering a patient with an adrenal cyst in everyday practice, we based our review on a practical question–answer framework centred around the case of a young woman with an incidentally discovered large adrenal cyst.

A case of primary adrenal hydatid cyst

A case of primary adrenal hydatid cyst

Adrenal Cystic Lymphangioma with Radiological, Clinical and Histopathological Findings, Case report.

Cystic lymphangiomas are benign lesions originating from lymphatic endothelial cells. It occurs due to developmental anomalies of lymphatic vessels. They are usually localized in the head and neck region. Cystic lymphangiomas of adrenal origin are very rare. This presentation aims to report a case of left-sided adrenal cystic lymphangioma detected incidentally on radiological examination due to abdominal pain, with clinical, radiological, and pathological findings. A 65-year-old female patient was admitted to our clinic with abdominal pain. In the abdominal examination, the pain was detected in the epigastric region and left the upper quadrant with palpation. No pathology was observed in the complete blood count and biochemical parameters, except for a CRP elevation of 10.2 mg/dL. In examination with ultrasonography (US), in the left upper quadrant of the abdomen, in the localization of the adrenal gland, a multilocular cystic lesion with partially dense contents, which is not vascularised by Doppler US, containing thin echogenic septa was detected. Enhanced contrast multidetector computed tomography was performed to determine the nature and characterization of the mass. A 60x57 mm cystic lesion with multi-lobulated contour and fluid density was defined in the left adrenal gland. The patient was diagnosed with cystic lymphangioma radiologically and was operated upon due to symptoms and size. Pathological diagnosis was reported as cystic lymphangioma. Preoperative clinical and radiological correct diagnosis is critical because the treatment approach and prognosis may differ from other adrenal tumors or cysts.

FRI230 Cystic Pheochromocytoma

Abstract Disclosure: S. Saberi: None. A 67-year-old woman presented with right abdominal tenderness, abdominal distention, gas and belching. Her blood pressure was 134/70, pulse 84 with no palpable abdominal mass. Her medical history includes depression and anxiety which developed 17 years prior and later resolved. She was diagnosed with hypertension approximately 20 years earlier initially well-controlled with candesartan-hydrochlorothiazide 16-12.5 mg daily and metoprolol succinate ER 50 mg daily. Two years prior to presentation her blood pressure rose to the 180s/90s requiring doubling of her candesartan-hydrocholorothiazide. An abdominal ultrasound was obtained which showed an abdominal mass. Subsequently, a CT of the abdomen and MRI of the abdomen with and without contrast were obtained revealing a 10 cm predominantly cystic adrenal mass with partial irregular wall thickening and nodularity causing mass effect on the inferior vena cava, liver and right kidney. Results of lab testing revealed an elevated plasma free metanephrines 1187 pg/ml (normal &amp;lt; 57 pg/ml), plasma free normetanephrines 1911 pg/ml (normal &amp;lt; 148 pg/ml), total free metanephrines and normetanephrines 3098 pg/ml (normal &amp;lt; 205 pg/ml). Her other adrenal biochemical evaluation was normal. She underwent open right adrenalectomy after adequate pre-operative blockade. Post-operatively her plasma free normetanephrines decreased to 0.47 nmol/L (normal &amp;lt; 0.90 nmol/L) and plasma free metanephrines were less than 0.20 nmol/L (normal &amp;lt; 0.50 nmol/L). Cystic Pheochromoctyoma: Spontaneous rupture of cystic pheochromocytoma can cause an adrenergic crisis. Cystic pheochromocytoma may develop due to hemorrhage within the lesion, necrosis and subsequent cyst formation (1). Patients may present with abdominal pain, GI symptoms or palpable masses rather than classic symptoms of pheochromocytoma (2).The differential diagnosis of cystic adrenal lesions includes lymphangiomas, pseudocysts of other surrounding structures (such as liver, pancreas, kidney, spleen, retroperitoneal and urachal and mesenteric cysts), dermoids, adrenal carcinoma, hydatid cysts of the adrenal glands (3).Small case series report the incidence of adrenal cysts in adrenal disease as 5.1% (4). A female predominance has been reported in prior studies (4). More commonly cystic adrenal lesions are unilateral and present in persons aged 30s-50s (2). Adrenal cysts are classified based on their origin as endothelial cysts derived from malformation of the lymphatic or arteriovenous systems, pseudocysts derived from prior hemorrhage, epithelial cysts with thin wall and serous fluid, or parasitic cysts. Necrosis and liquefaction in the adrenal lesion may lead to fluid accumulation and a cystic appearance. Large cysts are at risk for hemorrhage and rupture. All adrenal cysts require biochemical evaluation. Particular attention should be paid to predominantly cystic masses with any solid component as up to 7% of these may be malignant (5). Uniform guidelines for surgical management of these lesions have not been well established. Patients with symptoms such as abdominal pain, biochemical abnormalities, complications such as pressure on adjacent organs or rupture with cyst content leakage, suspicion of malignancy, cysts larger than 5 cm or increasing size of the cyst should be considered for surgical intervention (5, 6). In patients presenting with abdominal pain and hypertension who are found to have a cystic adrenal lesion pheochromocytoma should be considered. Presentation: Friday, June 16, 2023

SAT345 Disappearing Adrenal Masses: A Tale Of Two Lesions

Abstract Disclosure: A. arooj: None. A. Lansdown: None. Introduction: Adrenal lesions are being increasingly detected on CT scans performed for other reasons. Adrenal lesions that “disappear” on subsequent imaging are rare, most commonly due to adrenal hematomas, cysts or infection. Case: 1 73-year-old man was admitted with a collapse and fall. CT head &amp; angiogram demonstrated cerebral sinus thrombosis, subarachnoid hemorrhage and right parietal hematoma. Furthermore, high density4cm left adrenal lesion on CT abdomen(Fig 1) Consideration was given to COVID vaccine induced thrombotic thrombocytopenia. ACTH, aldosterone, renin, aldosterone renin ratio normal. Slightly low cortisol (386) after short synacthen test. Later, CT showed the left adrenal lesion had disappeared in Fig 2. Case 2: 36-year-old man following a road traffic collision, fell from his electric scooter at a speed of 30mph, also noted to have high blood pressure on admission. He had small laceration of the liver which was managed conservatively. CT abdomen and pelvis, showed a low density 28mm right adrenal nodule, measuring 37 Hounsfield Units,(fig 3) that was completely resolved in subsequent imaging (Fig4). His biochemistry reports of dexamethasone suppression test, renin, aldosterone, 24hr metadrenaline urinary profile and urinary cortisol remained normal. Learning points: "Disappearing", adrenal mass lesions are rare, though reported, and most commonly due to adrenal hematomas, cysts or infection.

FRI174 Spectrum Of Presentation Of Adrenal Incidentalomas : Is The Distribution Changing? Experience From A Tertiary Care Centre Of Eastern India

Abstract Disclosure: I. Mishra: None. M.V. Vivek: None. A.K. Baliarsinha: None. Spectrum of presentation of adrenal incidentalomas : Is the distribution changing? Experience from a tertiary care centre of Eastern India Abstract: Incidentally discovered adrenal masses have become a common clinical problem. An adrenal mass is uncovered in up to 4% -10% of patients imaged for non-adrenal disease. Incidentalomas are uncommon in patients younger than 30 years of age but increase in frequency with age; more frequently in females, especially in the sixth and seventh decades. Functioning tumors with a clear clinical phenotype (pheochromocytomas and those secreting cortisol, aldosterone, or sex steroids) and carcinomas account for around 28%- 32% of all adrenal incidentalomas. We reviewed last three year records of all the patients with the diagnosis of adrenal incidentaloma presenting to our institute and data regarding the clinical profile and outcomes of all the patients were analysed. The data obtained was entered into Microsoft Excel Worksheet and analysed using Statistical Package for Social Sciences (SPSS, IBM Corp. Released 2020.IBM SPSS Statistics for Windows, Version 20.0.Armonk,NY: IBM Corp.).Total 44 patients of adrenal incidentalomas were reviewed. In our case series, incidentalomas frequency were found to be increasing with age, most common in the 5th and 6th decades with equal frequency between male and females. Functioning tumours accounted for 54.5%(n=24), non functioning in 38.6%(n=17) and adrenal deficiciency in 6.8%(n=3)respectively. Most commonly encountered tumour was Pheochromocytoma(n=14,31.8%)followed by benign adenoma(n=10, 22.7%), adrenalcarcinoma (n=7,15.9%), myelolipoma(n=5,11.3%), aldosterone producing adenoma (n=3,6.8%), adrenal haemorrhage (n=1,2.2%), angiomyolipoma (n=1,2.2%), adrenal cyst (n=1,2.2%), and adrenal granuloma (n=2,4.5%) respectively. Amongst benign adenomas 40%(n=4) were functional( cortisol excess) and 60%(n=6) were non functional.Amongst adrenal carcinomas 42.8% (n=3) were functional and 57.2%(n=4) were non functional. Adrenal haemorrhage and adrenal granulomas had features of adrenal deficiency. The present work demonstrates that the distribution of adrenal incidentalomas is equal in both males and females, with functioning tumour Pheochromocytoma being more common than other variants. Hence the importance of complete biochemical investigation of adrenal incidentalomas is warranted. The probable changing pattern in the distribution of etiologies of adrenal incidentolomas can be further elucidated by analyzing data of a large cohort of patients with adrenal incidentolomas. Reference: Mansmann G, Lau J, Balk E, Rothberg M, Miyachi Y, Bornstein SR. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev. 2004 Apr;25(2):309-40. doi: 10.1210/er.2002-0031. PMID: 15082524. Presentation: Friday, June 16, 2023

Laparoscopic management of giant adrenal cyst: a case report

Laparoscopic management of giant adrenal cyst: a case report

Adrenal pseudo cyst presenting as retroperitoneal lesion: a rare presentation

Adrenal pseudocyst are cystic lesions arising from the adrenal gland and do not contain any definitive epithelial lining. These are extremely rare and very few cases are reported, representing 1-2% of adrenal incidentalomas. Patients generally have a non-specific presentation with most patients being asymptomatic and detected incidentally, while others may present with the ensuing mass symptoms in cases of large cysts. Multiple differential diagnosis may be considered for the same. Here we reported the case of a 43 year old female who presented to us with worsening pain abdomen in the left upper quadrant. An ultrasonography revealed an 8×9×9 cm cystic lesion in the region of the tail of pancreas. Subsequent CT was suggestive of a retroperitoneal cyst with multiple diagnostic possibilities owing to the many intra-abdominal structures it was found to be associated with. A definitive pre-operative diagnosis regarding the origin of the cystic swelling could not be made. A decision to remove the lesion operatively via an open approach through an upper midline laparotomy was made and eventual histopathological diagnosis confirmed it to be an adrenal pseudocyst.

Adrenal Hemangiomatous Endothelial Cyst That was Difficult to Differentiate from Adrenal Malignant Tumor: A Case Report

A 65-year-old woman was referred to our hospital for fever and diagnosed with pyelonephritis. Abdominal computed tomography showed a right adrenal tumor incidentally, that was 6.5 cm in diameter. We could not rule out malignant disease by magnetic resonance imaging examination and performed resection of the right adrenal tumor. The histopathological examination revealed an adrenal hemangiomatous endothelial cyst, and there was no evidence of malignancy. It was difficult to differentiate between adrenal cyst and adrenal cancer in preoperative diagnostic imaging because the tumor contained hemorrhage and necrotic tissue.

A case of Adrenal Endothelial Cyst in a young female

Adrenal cysts are rare, often asymptomatic and non-functional. Here, we discuss the case of a 24-year-old young female who had been experiencing unexplained abdominal heaviness and pain for 6 months’ duration. An almost 5 cm anechoic lesion without a septum was detected by abdominal sonography across the left abdominal region. A 4.8x4.2x4.8cm suprarenal cyst was discovered on abdominal computed tomography (CT) scan displacing the left kidney inferiorly and anteriorly. There was no evidence of hormonal hypersecretion clinically or biochemically. She underwent successful laparoscopic left adrenalectomy, revealing a histopathological diagnosis of an endothelial cyst without any features of malignancy. The postoperative course was uneventful without recurrence during the period of follow-up. Current literature on the management of adrenal cysts is sparse although, personalized management with multidisciplinary team involvement is paramount importan

Adrenal Neoplasms: Lessons from Adrenal Multidisciplinary Tumor Boards.

The radiologic diagnosis of adrenal disease can be challenging in settings of atypical presentations, mimics of benign and malignant adrenal masses, and rare adrenal anomalies. Misdiagnosis may lead to suboptimal management and adverse outcomes. Adrenal adenoma is the most common benign adrenal tumor that arises from the cortex, whereas adrenocortical carcinoma (ACC) is a rare malignant tumor of the cortex. Adrenal cyst and myelolipoma are other benign adrenal lesions and are characterized by their fluid and fat content, respectively. Pheochromocytoma is a rare neuroendocrine tumor of the adrenal medulla. Metastases to the adrenal glands are the most common malignant adrenal tumors. While many of these masses have classic imaging appearances, considerable overlap exists between benign and malignant lesions and can pose a diagnostic challenge. Atypical adrenal adenomas include those that are lipid poor; contain macroscopic fat, hemorrhage, and/or iron; are heterogeneous and/or large; and demonstrate growth. Heterogeneous adrenal adenomas may mimic ACC, metastasis, or pheochromocytoma, particularly when they are 4 cm or larger, whereas smaller versions of ACC, metastasis, and pheochromocytoma and those with washout greater than 60% may mimic adenoma. Because of its nonenhanced CT attenuation of less than or equal to 10 HU, a lipid-rich adrenal adenoma may be mimicked by a benign adrenal cyst, or it may be mimicked by a tumor with central cystic and/or necrotic change such as ACC, pheochromocytoma, or metastasis. Rare adrenal tumors such as hemangioma, ganglioneuroma, and oncocytoma also may mimic adrenal adenoma, ACC, metastasis, and pheochromocytoma. The authors describe cases of adrenal neoplasms that they have encountered in clinical practice and presented to adrenal multidisciplinary tumor boards. Key lessons to aid in diagnosis and further guide appropriate management are provided. © RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.

Adrenal cyst: our experience in its laparoscopic management

Adrenal cyst: our experience in its laparoscopic management