Giant Adrenal Tumor Research Articles

Hyper-realistic rendering-assisted laparoscopic adrenalectomy for giant adrenal tumors: a pilot study.

This study aimed to explore the application value of hyperrealistic rendering (HRR) in laparoscopic giant adrenal tumor resection. We retrospectively analyzed 25 patients with giant adrenal tumors from January 2021 to January 2024, with a median age of 56 (40.5, 58.5) years and a tumor median diameter of 7.20 (6.80, 8.50) cm. All patients underwent preoperative medical HRR based on enhanced computed tomography, followed by laparoscopic adrenal tumor resection. HRR was used to initially determine the nature of the tumor and develop a detailed surgical plan, which was completed in 25 patients preoperatively. All 24 cases of tumors were located in the adrenal gland, 1 case was located in the retroperitoneum, and 13 and 12 cases were on the left and right side, respectively. Preoperative HRR 3D imaging was consistent with the intraoperative situation, and 25 cases had successful surgeries. The median operation time was 165 (120.0, 250.0) min, and median bleeding and blood transfusion volume were 200 (150.0, 450.0) and 200.0 (150.0, 450.0) mL, respectively. There were no collateral injuries to important organs and major vessels and no cases of conversion to open surgery. For large retroperitoneal adrenal tumors, HRR for three-dimensional (3D) reconstruction imaging enables the operator to fully understand the relationship between the tumor and surrounding organs and blood vessels preoperatively, which can reduce intraoperative bleeding and collateral injuries, improve the success rate of laparoscopic resection, and safety of the operation.

Clinical Efficacy Analysis of Different Surgical Methods for Giant Adrenal Tumors (≥10 cm): A Single-Center Study of 44 Cases.

Objective: The objective of this study was to compare the efficacy and safety of open adrenalectomy (OA) and laparoscopic adrenalectomy (LA) by summarizing the clinical features and treatment experience of giant adrenal tumors. Methods: The clinical data of 44 patients with adrenal tumors ≥10 cm admitted to the Second Hospital of Lanzhou University from January 2006 to August 2022 were retrospectively analyzed. The mean tumor diameter was 11.6 ± 1.8 cm. Regular follow-up was performed to observe the outcome of symptoms and the recurrence after operation. Results: All the 44 patients successfully completed the operation and were divided into the OA group (21 cases) and the LA group (11 cases of transabdominal laparoscopic adrenalectomy [TLA] and 12 cases of retroperitoneal laparoscopic adrenalectomy [RLA]) according to different operation methods. The analysis results showed that the proportion of estimated blood loss (EBL) >100 mL and the postoperative length of stay (PLOS) in the LA group were superior to those in the OA group, and there were no significant differences in other surgical indicators (P > .05); subgroup analysis was conducted for patients in the LA group according to different surgical pathways, and the results showed that there were no significant differences in each surgical indicator between TLA and RLA (P > .05). Among the 44 patients, 15 (34.1%) had intraoperative complications, 19 (43.2%) had postoperative complications, and 5 (21.7%) were converted from LA to OA. The median follow-up time was 68 (5-162) months. Conclusions: For adrenal tumors with diameter ≥10 cm, both LA and OA have relatively large damage to the patients, and the incidence of conversion to open surgery is also high. However, LA is superior to OA in EBL and PLOS. Given the fact that giant adrenal tumors are mainly pheochromocytoma and paraganglioma and have an increased possibility of malignancy, we suggest that the relationship between tumors and peripheral important blood vessels and organs should be carefully evaluated before operation, and the operative methods should be selected according to the experience of the surgeon.

Giant adrenal tumor in a patient admitted for fever

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

AB198. Influencing factors related to retroperitoneoscopic adrenalectomy for giant adrenal tumors

ObjectiveTo analyze what factors affect the key results of the retroperitoneoscopic adrenalectomy (RA) for giant adrenal tumors.MethodsFrom January 2007 to March 2015, 32 RA for giant adrenal tumors (2 cm) has been performed by one major surgeon. The influencing factors of operative time, estimated blood loss, postoperative days, and conversion were retrospectively analyzed.ResultsTotally, 27 subjects underwent RA successfully with five patients conversed to open. And maximum diameter (MD) was the risk factor predicting prolonged operative time, massive estimated blood loss and conversion. Age and pheochromocytoma played a role in longer postoperative days. MD and age were associated with estimated blood loss independently, with 55.9% of the variation can be explained by the model. And the equation is: EBL = 372.242MD + 25.229Age − 3127.797.ConclusionsRA is challenging to the surgeons for giant adrenal tumors. MD, age, pheochromocytoma were the key significant factors statistically predicting worse operative results, including operative time, estimated blood loss, postoperative days, and conversion.

Anterior Approach without hanging manoeuvre for liver transection for giant adrenal tumors involving inferior vena cava and right lobe of liver – a safe technique

Anterior Approach without hanging manoeuvre for liver transection for giant adrenal tumors involving inferior vena cava and right lobe of liver – a safe technique

Diagnosis of Bilateral Giant Adrenal Myelolipoma

A 33-year-old obese woman presented with a retroperitonealmassasanincidentalfindingduringherniasurgery.Aphysicalexam-inationrevealednopathologicfinding.Obesitypreventedpalpationofany abdominal mass. At the time of presentation to our hospital atEberhard-Karls-University(Tu¨bingen,Germany),laboratoryparam-eters were at normal levels. A computed tomography scan showedbilateral giant adrenal tumors with predominantly fatty regions (Fig1A;straightwhitearrows)interspersedwithsolid,septa-liketissue(Fig1A; curved white arrow) demonstrating mild enhancement after in-travenouscontrastadministration.Themasseswereencapsulatedandmeasured19.1 10.5 22.6cmattheleftand12.3 8.7 19.3cmat the right side, compressing retroperitoneal vessels. The tumor waswell circumscribed and extended to the surrounding tissue withoutinvasion. The suspected diagnosis of bilateral adrenal myelolipomaswas histologically confirmed after a computed tomography–guidedbiopsy. The microscopic analysis of biopsy samples revealed adipo-cytes with clear cytoplasm, interspersed with cells of hematopoiesis.One half of the cells were erythroid nests with dense blue nuclei (Fig1B,whitestar).Theothercellswereprimarilyofmyeloidlineagewithmaturation to segmented granulocytes (Fig 1B; white arrow). Onemultilobulatedmegakaryocytewasalsopresentinthebonemarrow–likespecimen.Giventheabsenceofclinicalsymptoms,thetreatmentstrategychosenwasawatchandwaitregimen.First described in 1905, adrenal myelolipomas are rare, hor-monally inactive, benign tumors that are composed of mature fattissue and hematopoietic elements.

巨大両側副腎腫瘤で見出された鼻型NK/T細胞リンパ腫の1例

A 76-year-old woman presented to a clinic with fever and loss of body weight. Abdominal echogram showed bilateral adrenal swelling (left adrenal 90x80 mm, right adrenal 50x20 mm) and she was admitted to the hospital for further examination. A tumor was also found inside nasal cavity by enhanced computed tomography (CT), and abnormal uptake in the nasal cavity and adrenal gland was shown in gallium scintigraphy. Laboratory tests revealed the elevation of lactate dehydrogenase (LDH) and sIL-2R. Biopsy of the nasal tumor revealed nasal natural killer or thymus-derived (NK/T) cell lymphoma. No Epstein-Barr virus (EBV) -encoded RNA was detected in tissue. After THP-COP chemotherapy regimen, both the nasal and adrenal tumors decreased in size. However, a CT scan taken on admission revealed a pulmonary embolism. After treatment with heparin and warfarin, emboli disappeared. Chemotherapy was continued, but perforation of the small intestine occurred. Since the prognosis was poor, no operation was performed. Her condition slowly, and she died 60 days after admission. Since she had a high level of plasma ACTH (158.0 pg/ml) and normal serum cortisol (14.6 microg/dl), partial adrenal insufficiency was suspected. In addition, since her cortisol circadian rhythm was lost and cortisol levels were not completely suppressed by the 1 mg and 8 mg dexamethasone test, she met the criteria of the diagnosis of preclinical Cushing syndrome. NK/T cell lymphoma with giant adrenal tumor is extremely rare, but should be considered as one of the differential diagnoses of bilateral adrenal tumor.