Large Adrenal Cyst Research Articles

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.

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.

Adrenal cysts: an emerging condition.

Adrenal cysts are rare lesions representing approximately 1-2% of adrenal incidentalomas. The majority of these rare lesions are benign. Rarely, phaeochromocytomas and adrenal malignant masses can present as cystic lesions and can occasionally be difficult to distinguish from benign cysts. Histologically, adrenal cysts are subdivided into pseudocysts, endothelial cysts, epithelial cysts and parasitic cysts. The radiological appearance of an adrenal cyst is generally similar to that of cysts in the kidney. They are thus well demarcated, usually rounded, with a thin wall and homogenous internal structure, low attenuating (<20 Hounsfield Units) on CT, low signalling on T1-weighted MRI sequences and high signalling on T2-weighted MRI sequences, and anechoic or hypoechoic on ultrasonography. Benign adrenal cysts have a slight female predominance and are usually diagnosed between the ages of 40 and 60. Most adrenal cysts are asymptomatic and are detected incidentally, although very large adrenal cysts can lead to mass effect symptoms, with surgery required to alleviate the symptoms. Thus, conservative management is usually recommended for asymptomatic cysts. However, when uncertainty exists regarding the benign nature of the cyst, additional work-up or follow-up is needed. The management of an adrenal cyst should preferably be discussed at an adrenal multidisciplinary team meeting.

Clinical case: large cystic mass of the left adrenal gland

Aim. A clinical case of a non-functioning tumor of the adrenal gland, its diagnosis and treatment.Materials and Methods. Histological preparations were stained with hematoxylin and eosin, photographed at 200 magnification.Results. Adrenal cysts are benign neoplasms that are hormonally inactive and can be asymptomatic for a long time. They are often discovered incidentally during an ultrasound or CT scan. Prior to the improvement of diagnostic methods, formations such as adrenal cysts were extremely rare. To date, there is a trend towards a steady increase in the frequency of adrenal tumors detected incidentally and is about 6–10%. Hormonally inactive adrenal tumors usually do not require surgery, but there are clinical situations in which surgery is necessary. As an example of a disease, a clinical case is given below.Patient P., 39 years old, was hospitalized in the urology department from 12/13/2021 to 12/24/2021 with a diagnosis: D35.0 Benign neoplasm of the adrenal gland (cyst of the left adrenal gland). Upon admission, there were complaints of aching pain in the left lumbar region.He considers himself ill for several years, was treated for another disease, an ultrasound in 2018 accidentally revealed a neoplasm of the adrenal gland on the left. At the last ultrasound control, an active growth of the neoplasm was detected, for this reason he was sent for surgical treatment to the urological department of RCH 1.Surgery was performed in the hospital by laparoscopic excision of a cyst of the left adrenal gland under endotracheal anesthesia. The adrenal gland was sent for post-mortem examination, the results are presented below.The wall of the cystic formation is represented by cells of the cortical layer of the adrenal gland, corresponding to the cells of the glomerular zone. The cells are large with abundant light cytoplasm and a monomorphic nucleus. In the wall of cyst there are foci of hemorrhages and accumulations of hemosiderin pigment. Outside, the cystic formation is surrounded by a fibrous capsule.Conclusion. This paper presents an analysis of a large adrenal cyst. It is important to pay attention to the fact that this incidentaloma was asymptomatic, without any clinical signs and hormonal activity. Incidentalomas are often «silent», so it is extremely difficult to identify them, but the likelihood of degeneration into a malignant tumor is high.

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.

Hepatic hydatid cyst: a masquerader

Liver is the most common organ involved in echinococcosis. Organs affected by E granulosus are the liver (63%), lungs (25%) and muscles (5%). Rest of the organs are rarely affected. Adrenal cysts are uncommon. Their size may range widely and the origin of large adrenal cysts is often difficult to distinguish from other organs, including the kidney, pancreas, spleen, and liver. A large right-sided adrenal cystic mass can rarely be mistaken for a hepatic cyst by imaging. In this report, authors have described an adrenal cyst in a 28 year old lady, who was diagnosed preoperatively to have a hepatic hydatid cyst but intraoperatively it was found to be of adrenal origin. The size of the adrenal cyst can vary from a few millimetres up to 50 cm in diameter. Majority of the adrenal cysts are unilateral, while 8-10% of those cysts have been noted to be present bilaterally. The majority of cases are diagnosed between the 3rd and 6th decades. Although uncommon, Adrenal cyst should be considered as one of the differential diagnosis of upper abdominal cysts. Surgical excision is advisable when the cysts are symptomatic, greater than 5 cm in diameter and in the case of suspecting malignancy.

An uncommon case of a large adrenal cyst

An uncommon case of a large adrenal cyst

Fauxing Epithelial Adrenal Cyst: A Case Report

Adrenal cysts are rare and varied in histology. Currently they are diagnosed more commonly due to improved imaging modalities. Large adrenal cysts can compress the adjacent viscera to produce symptoms and it is not possible in all cases to accurately diagnose these cysts preoperatively. Here in, we report a case of right adrenal cyst diagnosed preoperatively as Hydatid cyst of right lobe of liver and the correct diagnosis was made at laparotomy.

Adrenal pseudocyst: Diagnosis and laparoscopic management – A case report

Cysts of the adrenal gland are rare and are usually discovered incidentally. Large adrenal cysts can however present with severe abdominal pain and can be complicated by haemorrhage, rupture or infection. Adrenal pseudocysts appear to result from haemorrhage within a normal adrenal gland and can expand to accommodate massive amounts of fluid.We report the case of a 39-year-old woman who presented with worsening right upper quadrant pain. An ultrasound scan of the abdomen confirmed a large 29cm×20cm×17cm cyst that appeared to originate in the upper pole of the right kidney causing displacement of the liver and right kidney.Following complete aspiration the cyst re-accumulated and an MRI scan demonstrated a thickened and irregular cyst wall with haemorrhagic fluid. Laparoscopic right adrenalectomy was performed and the histopathological diagnosis was confirmed as an adrenal pseudocyst.

Laparoscopic Transperitoneal Surgery for Adrenal Cysts

Introduction: Adrenal cysts are uncommon lesions with an incidence ranging from 0.064% to 0.18 %. Adrenal cysts are detected more commonly in the present times due to widespread use of imaging modalities. We present our technique of laparoscopic adrenal cyst excision. Methods & Materials: Two patients with large adrenal cysts underwent laparoscopic transperitoneal excision. The size of the cysts was 6cm x 8cm and 15cm x 16cm, respectively. The cysts were first aspirated through 5mm suction to provide more space for dissection. Results: The cysts were completely removed. Operative time was 190 and 170 minutes. Blood loss was 100 and 70 ml. Hospital stay was 2 days for both patients. Pathological examination showed that they were epithelial adrenal cysts a histopathological rarity. Conclusion: Adrenal epithelial cysts are rarely encountered pathological entities. Laparoscopic dissection is a good treatment option for large adrenal cysts. Intracystic laparoscopic fluid aspiration helps in decreasing the size of cyst thus facilitating easy port placement, dissection and organ retrieval. This technique of meticulous aspiration of fluid is thus of immense help in laparoscopic surgery.

Adenomatoid tumor of the adrenal gland: a clinicopathologic study of 3 cases

Adenomatoid tumors are relatively uncommon benign neoplasms of mesothelial origin, usually occurring in the male and female genital tracts. Rare extragenital adenomatoid tumors have been identified in the adrenal glands, heart, mesentery, pleura, and lymph nodes. In the adrenal gland, adenomatoid tumors may pose a diagnostic challenge. The differential diagnosis includes adrenocortical carcinoma and metastatic carcinoma, especially signet ring cell carcinoma. Because of its glandular pattern, an adenomatoid tumor may be confused with an adenocarcinoma. We present 3 cases of adrenal adenomatoid tumors, including one with a concurrent large hemorrhagic vascular adrenal cyst. The adenomatoid tumors were unilateral, appeared solid and white, and varied from 1.7 to 4.2 cm in diameter. They occurred in 3 male patients aged 33, 33, and 46 years. One patient presented with abdominal pain due to the presence of a concurrent large adrenal cyst. The tumor was an incidental radiological finding in another case and was discovered during the course of a workup for hypertension in the third case. The light microscopic appearances were consistent with those of typical adenomatoid tumors. Immunohistochemical stains for calretinin and cytokeratin 5/6 were positive, confirming the tumors' mesothelial origin. Ultrastructural studies performed in 2 cases revealed microvilli and desmosomes. Follow-up showed no evidence of recurrence or metastasis. In our experience, the key to the diagnosis of this rare benign tumor is to consider adenomatoid tumor in the differential diagnosis of any glandular tumor occurring in the adrenal gland.

Large adrenal cysts in teenage girls: diagnosis and management.

Large adrenal cysts usually occur in the fifth and sixth decades of a patient's life but are rare in the first two decades. This paper presents the clinical, cross-sectional imaging, surgical, pathological and follow-up data of three teenage girls with large adrenal cysts. Two had vague upper abdominal pain and, in the other, the cyst was found incidentally. The cysts were surgically removed in two patients, while in the third, follow-up imaging has shown no change in the cyst over a 4-year period, suggesting that conservative management is a reasonable option.