Unilateral Mass Research Articles

Laparoscopic Postchemotherapy Retroperitoneal Lymph-Node Dissection Can Be a Standard Option in Defined Nonseminomatous Germ Cell Tumor Patients.

Residual retroperitoneal masses in NSGCT need postchemotherapy retroperitoneal lymph-node dissection (PC-RPLND). Open (O) PC-RPLND is a standardized procedure, but morbidity is not negligible and mostly attributable to laparotomy. Laparoscopic (L) PC-RPLND may improve tolerability profile. We evaluated viability, toxicity, and short to medium-term oncologic outcome of L-PC-RPLND following well-defined selection criteria. Since February 2011, consecutive patients with a unilateral residual mass (≥1 cm or growing), normalized markers, and limited encasement of inferior vena cava and/or aorta were candidate to unilateral L-PC-RPLND. Surgical performances, histology, hospital stay, complications within 30 days, and survival were recorded. Patients were regularly followed up. Adjuvant chemotherapy was not provided. Sixty-seven patients (stage IIA = 14; IIB = 41; IIC = 7; III = 5), representing 29% of all those candidate to PC-RPLND in this time frame, underwent L-PC-RPLND up to August 2015. Median size of the mass was 27 mm (interquartile range [IQR] 15-31). Median operative time was 234 minutes (IQR 184-250). Three procedures were converted to open surgery. Mean hospital stay was 3 days (IQR 2-4). Out of three (4.5%), one grade III (lymphocele requiring drainage) complication occurred. Sixty-six (98.5%) patients maintained antegrade ejaculation. Histology revealed teratoma in 76%, fibronecrotic tissue in 21%, and viable cancer in 3% patients. All patients are alive and event free after a median follow-up of 21 months (IQR 10-30). In a referral center, L-PC-RPLND is a transferable option for a proportion of patients with a residual mass. Tolerability is acceptable, and current oncologic outcome is consistent with a safe oncologic profile.

Floating Lateral Mass Fractures of the Cervical Spine.

Level I trauma center case series. The purpose of this study was (i) to characterize the floating lateral mass (FLM) fracture with the mechanism of injury, anatomical injury pattern, associated vascular injuries, neurological deficits, and key radiographic features; and (ii) to better understand the most effective method of treatment. An uncommon and poorly described subset of unilateral lateral mass fractures is FLM with fractures of the adjacent pedicle and lamina. Prospectively collected trauma registries were assessed to identify all patients with FLM fractures involving C3 to C7 between January 1, 2007 and December 31, 2012. After institutional review board approval, 60 consecutive cases were identified from the trauma registries. The mean follow-up was 9 months (range 0-42 months). The most common level was C6. The most common mechanism of injury was a high speed motor vehicle accident (45%). Radiographic rotational displacement manifested as an anterolisthesis. CT showed facet joint widening at the level above and below in 63%. Vertebral artery injuries occurred in 22%. Neurological deficits occurred as radiculopathy in 38% and spinal cord injury in 18%. All eight patients, who were treated nonoperatively, developed subluxation despite external immobilization and six patients required surgery. Of the 58 patients treated operatively, 31 (53%) patients underwent a 2 level Anterior Cervical Discectomy and Fusion (ACDF) alone. Nine (15%) patients had one level ACDF, with 83% demonstrating radiographic failure. Posterior fusion alone or combined with ACDF/corpectomy was performed in 6 patients (10%) and 7 patients (12%), respectively. A FLM fracture results from a high energy injury and involves two motion segments. Vertebral artery injuries and neurological deficits frequently occur. Magnetic Resonance demonstrates a significant disc injury in 81% of patients, usually at the lower level. Two level ACDF or Posterior Spinal Instrumented Fusion are effective means of treatment. 3.

Retrospective Evaluation of Hemithyroidectomy in 14 Horses.

To describe the presentation, presurgical diagnostic findings, treatment, and outcome of horses with histologically confirmed, unilateral thyroid neoplasia. The complications, particularly laryngeal hemiplegia, were investigated. Retrospective case series. Client-owned horses (n=14). Medical records of horses presenting with a unilateral thyroid mass due to neoplasia from 2003-2015 were reviewed. Horses must have undergone preoperative clinical evaluations that included ultrasound examination of the mass and upper airway endoscopy. Short-term follow-up at 2 weeks after surgery and owner questionnaire for long-term follow-up at >6 months were completed. Fourteen horses aged 6-21 years were included. The majority of tumors were adenocarcinomas (11/14), mainly diagnosed in mares (9/14). Intraoperative complications included hemorrhage (1/14) and postoperative complications included seroma formation (4/14). No horse developed postoperative laryngeal hemiplegia. No horses developed clinical signs of metastases or a thyroid disorder long term (mean follow-up 4.9 years). All owners reported a successful long-term outcome. The clinical findings of thyroid neoplasia in horses are not associated with the diagnosis of malignancy. Complete surgical resection of the abnormal lobe prevents local recurrence of neoplastic thyroid tissue. The modified hemithyroidectomy technique preserves the function of the recurrent laryngeal nerve.

Idiopathic Orbital Inflammation Syndrome

Idiopathic orbital inflammation syndrome is a rare inflammatory disease, with unknown etiology. We present a 72-year-old man with unilateral medial rectus mass lesion. Histologically, the mass composed of dense fibrotic tissue with infiltration of lymphocytes, plasma cells, and few eosinophils. Management was done by surgical debulking with good result and no complications.

Diagnosis and management of spermatic cord tumors.

Spermatic cord tumors (SCT) are very rare. The present review discusses the most recent literature regarding clinical presentation, pathological characteristics, diagnosis, and management of SCT. Although the majority of SCT are benign, when malignant almost all SCT are sarcomas. Liposarcomas are the most common; whereas rhabdomyosarcomas recorded the highest tendency of develop distant metastases. The clinical presentation is usually a unilateral solid slow-growing mass at the level of the inguinal canal and of the scrotum. Surgical excision represents the most common used treatment, and considering the risk in developing local recurrence, radical inguinal orchiectomy and resection of the tumor with negative microscopic surgical margins is mandatory. Adjuvant therapies such as radiotherapy and chemotherapy have been suggested in selected patients, but clear data to demonstrate any improvement in survival are not available. SCT are rare tumors with high risk of misdiagnosis or mistreatment. The majority are benign, but when malignant almost all are sarcomas. A surgical excision is the treatment of choice; however, no clear data exists documenting the efficacy of a multimodal treatment in reducing high local recurrence rates after surgery.

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors.

: By definition, an adrenal incidentaloma is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g. adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma or metastasis). The purpose of this guideline is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with adrenal incidentalomas based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions crucial for the management of adrenal incidentaloma patients, addressing these four with systematic literature searches: (A) How to assess risk of malignancy?; (B) How to define and manage low-level autonomous cortisol secretion, formerly called 'subclinical' Cushing's syndrome?; (C) Who should have surgical treatment and how should it be performed?; (D) What follow-up is indicated if the adrenal incidentaloma is not surgically removed? SELECTED RECOMMENDATIONS: (i) At the time of initial detection of an adrenal mass establishing whether the mass is benign or malignant is an important aim to avoid cumbersome and expensive follow-up imaging in those with benign disease. (ii) To exclude cortisol excess, a 1mg overnight dexamethasone suppression test should be performed (applying a cut-off value of serum cortisol ≤50nmol/L (1.8µg/dL)). (iii) For patients without clinical signs of overt Cushing's syndrome but serum cortisol levels post 1mg dexamethasone >138nmol/L (>5µg/dL), we propose the term 'autonomous cortisol secretion'. (iv) All patients with '(possible) autonomous cortisol' secretion should be screened for hypertension and type 2 diabetes mellitus, to ensure these are appropriately treated. (v) Surgical treatment should be considered in an individualized approach in patients with 'autonomous cortisol secretion' who also have comorbidities that are potentially related to cortisol excess. (vi) In principle, the appropriateness of surgical intervention should be guided by the likelihood of malignancy, the presence and degree of hormone excess, age, general health and patient preference. (vii) Surgery is not usually indicated in patients with an asymptomatic, nonfunctioning unilateral adrenal mass and obvious benign features on imaging studies. We provide guidance on which surgical approach should be considered for adrenal masses with radiological findings suspicious of malignancy. Furthermore, we offer recommendations for the follow-up of patients with adrenal incidentaloma who do not undergo adrenal surgery, for those with bilateral incidentalomas, for patients with extra-adrenal malignancy and adrenal masses and for young and elderly patients with adrenal incidentalomas.

Clear Cell Myoepithelioma - A Rare Presentation in Nasal Cavity

Myoepitheliomas are predominantly tumors of salivary glands constituting less than 1% of all salivary gland tumors. A 65 year old women presented with bleeding unilateral mass for 03 months. Contrast Enhanced Computed Tomography (CECT) revealed a heterogeneously enhancing mass lesion arising from right anterior ethmoid air cells and filling the right nasal cavity entirely. Endoscope guided endoscopic biopsy was performed. Histopathological examination showed a well circumscribed tumour arranged in small glands and sheets. Tumor cell were immunopositive for S100 (Ib), Cytokeratin (CK) and Vimetin (focally ) while negative for chromogranin, synaptophysin, CD 10 and Smooth Muscle Actin (SMA). MIB-Labelling Index was <5%. With these features a diagnosis of clear cell myoepithelioma was made. Nasal myoepithelioma is an extremely rare low-grade neoplasm. Nasal myoepitheliomas are composed of myoepithelial cells with solid, myxoid or reticular patterns of growth. The cells themselves may be clear-cell type, spindle-shaped, plasmacytoid and epithetlioid. In all reported cases of myoepithelioma, surgery was the mainstay treatment. Partial maxillectomy via a lateral rhinotomy approach, Caldwell-Luc procedure has been recommended for patients who were suspected to have a low-grade sarcomatous neoplasm. Only five cases have been reported in sinonasal region. We report the second case to be managed endoscopically. We report an extremely rare benign tumor of nasal cavity (clear cell myoepithelioma) which was managed endoscopically with recurrence within 6 months. The recurrence was also managed endoscopically. This case highlights the varied malignancies which may be encountered in sinonasal region.

Atypical Presentation of Nasopharyngeal Carcinoma

Nasopharyngeal Carcinoma (NPC) is a rare neoplasm which is associated with Epstein Barr Virus (EBV). We report a case of an 18 year-old African American male patient with no significant past medical history, presenting with a unilateral neck mass. Imaging and biopsy confirmed a neoplasm, diagnosed as nasopharyngeal carcinoma. Our case is remarkable as NPC is perhaps most common in China where annual incidence is 25 cases per 100,000 compared to the US, with an annual incidence of 0.5 cases per 100,000. Our patient is African American and had never been outside the country. Furthermore, he is young, while most cases of NPC happen in the elderly. While age and race were atypical, our patient was both a smoker and EBV positive. Finally, as a stage 2 NPC he received chemo radiotherapy and has thus far responded well.

Tumor carcinoide atípico nasal. Descripción de un caso

Introduction: Carcinoid tumors are neuroendocrine tumors that are usually located on the gastrointestinal system, but infrequent in the sinus area. Description: The case of a 55-year-old woman with a unilateral nasal mass is described. The pathological analysis shows histological and immunohistochemical characteristics compatible with atypical carcinoid tumor. Discussion: carcinoid tumors may be typical or atypical according to their degree of differentiation. Although rare, they should be considered in differential diagnosis of unilateral polyposis. Treatment is essentially surgical. Conclusions: This case highlights the importance of histopathological analysis of all unilateral nasal lesions.

CT findings and analysis for misdiagnosis of female pelvic tuberculosis

PurposeTo analyze the computed tomography (CT) findings and the reasons for misdiagnosis of female pelvic tuberculosis. MethodsThe clinical and CT features of 32 cases of female pelvic tuberculosis identified over a five-year period (2010–2015) were retrospectively analyzed. The CT features were analyzed for nature, range and extent of the various pathological patterns. ResultsBecause of the non-specific clinical and CT features, 20 of 32 cases were misdiagnosed either as ovarian tumor, or chocolate cyst, or PID preoperatively and received surgery. The mean age of the patients was 29.97 years (age range 15–67 years). Elevated levels of serum CA125 were found in 29 patients (90.62%, 29/32). The CT findings were as follows: 1. Pelvic mass (87.5%, 28/32): unilateral adnexal mass was in 15 cases, bilateral in 13 cases, 8 masses were cystic, 10 were solid, 23 were mixed, 24 masses showed multilocular caseous necrotic enhancement; 2. Ascites (40.62%, 13/32): 8 of 13 cases showed high density ascites (CT value > 18 HU); 3. Thickening and enhancement of peritoneum (37.5%, 12/32): nodulously thickened in 7 cases, smoothly in 5 cases; 4. Adhesion in the abdominopelvic cavity (28.12%, 9/32); 5. Lymphadenopathy (21.87%, 7/32): calcified in 4 cases, low attenuation necrotic lymph nodes with ring enhancement in 2 cases; 6. Thickening and enhancement of bowel wall (15.62%, 5/32). ConclusionsIntegrated with clinical history and laboratory tests, pelvic tuberculosis should be considered in young female patients with elevated CA125 and CT findings of adnexal mixed (solid and cystic) mass with multilocular caseous necrotic enhancement, high density ascites, thickened and enhanced peritoneum. Early diagnosis of the disease is a key consideration for early institution of anti-TB therapy to avoid misdiagnosis and surgical explorations.

The Surgical Management of Low Grade Single Level Adult Degenerative Spondylolisthesis: Posterolateral Fusion versus Posterior Lumbar Interbody

Introduction Posterolateral Fusion (PLF) and Posterior Lumbar Interbody Fusion (PLIF) are procedures that can be undertaken for the surgical management of degenerative low grade spondylolisthesis. Although there is tentative evidence in the literature that PLIF provides an increased fusion rate and therefore an improvement in symptomology, PLIF surgery does carry an increased peri- and post-operative complication rate. The aim of this study was to establish which surgical intervention has the better outcomes. Materials and Method A prospective cohort study was undertaken of patients who underwent a single level instrumented fusion for low grade degenerative lumbosacral spondylolisthesis between 2008 and 2010. There were 56 patients in total, with 36 patients in the PLF group (group1), and 20 patients in the PLIF group (group 2). Follow-up was at 3 month, 1 year and 3 year post operatively. Visual analogue leg pain score (VAS), Oswestry Disability Index (ODI) for back pain, and SF 12 Health Survey were measured pre and 3 year post operatively. All patients were assessed by MRI scans preoperatively. Standardized lumbosacral radiographs were taken preoperatively, and at 3 month, 1 year and 3 year postoperatively, to assess radiological union. Results In the PLF group, the VAS score improved from 8 to 2, the SF 12 score from 25 to 76, and the ODI score from 36 to 8. In the PLIF group, the VAS score improved from 8 to 4, the SF 12 score from 27 to 72, and the ODI score from 38 to 12. All improvements were statistically significant. There was a statistically larger improvement margin in all scores in the PLF group than in the PLIF group. Radiological union was demonstrated in 91% of all patients, with 95% of patients in each group demonstrating at least, unilateral lateral mass bone graft incorporation. Conclusion We conclude that PLF surgery is superior to PLIF surgery for the surgical management of low grade single level degenerative spondylolisthesis

Primary Breast Diffuse Large B Cell Lymphoma: Summarization of 12 Cases

To investigate the clinicopathological manifestation, immunophenotypic features and prognostic factors of patients with primary breast DLBCL (PB-DLBCL). Twelve cases of PB-DLBCL, diagnosed according to the 2008 World Health Organization classification of tumors of hematopoietic and lymphoid tissues, were retrospectively studied. Most patients were admitted to hospital because of painless unilateral breast mass. Out of 12 cases, 5 were in Ann Arbor stage I (41.7%), 7 case were in stage II (58.3%). Most (89.9%) were assigned to non-GCB subtypes, 11.1% were classified as GCB subtype. The patients who recepted treatment were sensitive to chemotherapy and they were all alive following 12 to 92 months. Primary breast DLBCL is extremely rare without specific clinical features. They all respond well to chemotherapy and show good prognosis.

CT findings of adrenal schwannoma

To analyse the computed tomography (CT) imaging features of patients with adrenal schwannoma. Eight cases of adrenal schwannoma confirmed by histopathology were included in this study. All eight patients had undergone multiphase CT examinations. The features of the adrenal schwannoma in the CT images were analysed retrospectively in detail, including size, shape, margin, radiodensity, calcification, and enhancement pattern. There were six male and two female patients, with a median age of 44.5 years (range, 25-52 years). Two patients complained of right flank pain, and two with left upper abdominal discomfort, while the remaining patients were diagnosed by routine ultrasound examinations. On unenhanced CT images, all cases of adrenal schwannoma were well circumscribed, rounded or oval, heterogeneous masses with cystic components, with two cases exhibiting calcification, and three cases with septa. On enhanced CT images, all cases displayed mild heterogeneous enhancement of the tumour during the arterial phase, and progressive enhancement during the portal venous phase and equilibrium phase. Adrenal schwannoma commonly presents as a well-defined unilateral mass with cystic degeneration, septa, and a characteristic progressive contrast-enhancement pattern on multiphase enhanced scans.

Role of adrenal vein sampling in primary aldosteronism: Impact of imaging, localization, and age

The role of adrenal vein sampling (AVS) has been debated, with some authorities advocating selective use in younger patients (≤40 years), and those localized by preoperative imaging. We examined our experience to determine the impact of AVS in patients who routinely underwent AVS with a high success rate. A retrospective cohort study was performed using a prospectively maintained database of patients referred for evaluation of PA (1997-2013). Patients were classified as localized (L) if a unilateral mass was identified on imaging, and non-localized (NL) otherwise. Of 367 patients, 94% (n = 345) underwent successful AVS. Seventy-two percent (n = 265) were L; AVS was lateralizing 58% (n = 214). AVS changed management in 43% of patients (n = 158). In patients ≤40 years, AVS changed management in 30% (n = 15). In patients ≤40 years with a ≥1 cm adrenal mass, 12% (n = 3) would have undergone unnecessary surgery based on imaging results alone; in patients >40 years with a ≥1 cm adrenal mass, 3% (n = 5) would have undergone wrong-side surgery, and 30% (n = 50) would have undergone unnecessary surgery based on imaging. AVS changed management in a significant minority of patients regardless of age and imaging findings. AVS should be routinely recommended in all patients with PA, to direct operative therapy. J. Surg. Oncol. 2016;113:532-537. © 2016 Wiley Periodicals, Inc.

Differential Diagnosis of Chronic Rhinosinusitis with Nasal Polyps.

Nasal polyps are semi-translucent mucosal outgrowths of the paranasal sinuses which typically arise in the setting of chronic rhinosinusitis (CRS). Nasal polyps are also associated with asthma, aspirin sensitivity, cystic fibrosis and allergic fungal rhinosinusitis (AFS). The majority of nasal polyps are bilateral and characterized by tissue edema and eosinophil infiltration. Patients with nasal polyps often present with complaints including nasal obstruction, congestion, rhinorrhea or altered sense of smell. The differential diagnosis ranges from benign masses such as schneiderian papilloma, antrochoanal polyp, angiofibroma and encephalocele to malignant neoplasms such as squamous cell carcinoma (SCC), esthesioneuroblastoma, nasal lymphoma and rhabdomyosarcoma. These lesions may have a similar appearance as nasal polyps and particular attention to an alternative diagnosis for nasal polyps should be entertained if the mass is unilateral or congenital in nature. Workup for patients with a unilateral mass should include radiographic imaging, possible biopsy and careful follow-up when appropriate. Here, we review the disease etiology of nasal polyps and describe the approach to the patient with nasal polyps with emphasis on differential diagnosis and workup.

Our Experience in Laparoscopic Adrenalectomy and Literature Review

Objective: To present our experience in laparoscopic adrenalectomy. Material and Methods: We have reviewed the records of our 64 adrenalectomy cases between August 2007 and October 2014 retrospectively. Of these cases, 63 had unilateral masses (25 right-sided, 38 left-sided) while only one patient had bilateral masses. The mean age of the patients was 46.72 years (26-81) and 44 (68.75%) patients were women and 20 (31.25%) were men. The average mass size was calculated as 35x29 mm and 48x34 mm in functional and non-functional adenomas, respectively. Results: Of the 64 patients, 48 were referred by endocrinology clinics while 16 patients were diagnosed incidentally. Fourteen patients had history of previous intra-abdominal surgery and five of them were continued as open surgery due to intraperitoneal adhesions. Mean duration of operation was 94±42 minutes and mean hospitalization time was 3.1±1,6 days. We did not encounter any major complications and recurrent or residual masses. Conclusion: Laparoscopic adrenalectomy is a safe method that can provide comfort to patients and surgeons in appropriate cases.

Angiofibroma Originating outside the Nasopharynx: A Management Dilemma.

Background. Angiofibroma is a benign tumor, consisting of fibrous tissue with varying degrees of vascularity, characterized by proliferation of stellate and spindle cells around the blood vessels. It most commonly arises from the nasopharynx, although it may rarely arise in extranasopharyngeal sites. Case Report. A 46-year-old male presented with left side nasal obstruction and epistaxis for one month. Clinical nasal examination revealed left sided polypoidal mass arising from the vestibular region of the lateral nasal wall. Results. CT scan and MRI showed highly vascular soft tissue mass occupying the anterior part of the left nostril. Preoperative selective embolization followed by transnasal excision was performed. Histopathological examination confirmed the diagnoses of nasal vestibular angiofibroma. Conclusion. Extranasopharyngeal angiofibroma is a very rare pathology. It should be kept in mind as a differential diagnosis with any unilateral nasal vestibular mass causing nasal obstruction and epistaxis. A biopsy without further investigation can cause life threatening bleeding in the patient.

Isolated unilateral adrenal metastasis as a presenting feature of occult hepatocellular carcinoma

Unilateral isolated adrenal metastasis from occult hepatocellular carcinoma (HCC) is extremely rare and seldom reported. We report a case where radiological and biochemical evidence of HCC was absent in a patient with metastatic adrenal mass. A 69-year-old male patient was investigated for abdominal pain which revealed a left adrenal mass. Contrast-enhanced computed tomography was suggestive of adrenocortical carcinoma (ACC). Resection was performed and the histopathology revealed metastasis from HCC. However, the primary in the liver could be radiologically and biochemically demonstrated only 6 months later. Even though rare in occurrence, radiologically undetectable HCC can present as unilateral adrenal mass, which can be mistaken as ACC.

Lymphoepithelial Cyst in the Palatine Tonsil.

Lymphoepithelial cyst (LEC) is the most commonly encountered congenital neck pathology in the lateral part of the neck. A 66-year-old woman presented to the ENT clinic due to difficulty in swallowing persisting for approximately 1 year. Magnetic resonance imaging revealed a cystic mass at right tonsil. Surgery was performed due to this unilateral tonsillar mass, which was excised together with the right tonsil. LEC was diagnosed at histopathological examination. LEC in the palatine tonsil is rare, and only a few cases have been reported in the literature. We report a rare case of LEC in the palatine tonsil.

Adrenal Histoplasmosis in Immunocompetent Patients Presenting as Adrenal Insufficiency.

Histoplasmosis is an infectious disease caused by the dimorphic fungus Histoplasma capsulatum, endemic in central and eastern states of United States, South America and Africa. India is considered to be non-endemic area for histoplasmosis. Disseminated histoplasmosis may affect almost all systems. Disseminated histoplasmosis with asymptomatic adrenal involvement has been described in immunocompromised patients; whereas isolated adrenal involvement with adrenal insufficiency as the presenting manifestation of the disease is rare. Twelve patients from a non-endemic area with adrenal histoplasmosis, who were immunocompetent and diagnosed as adrenal histoplasmosis by cytology/histopathology between January 2012 to December 2014 were studied. 18F-FDG PET/CT (fluorodeoxyglucose positron emission tomography/computed tomography) was used to assess the extent of involvement. There were a total of 12 immunocompetent males (mean age: 56.9 years). Ten patients had bilateral adrenal involvement and two had a unilateral left adrenal mass. All the patients had histopathologically/cytologically proven adrenal histoplasmosis. Two patients had simultaneous histoplasmosis of other sites, one in the epiglottis and the other in the alveolus. 18F-FDG PET/CT was performed in 10 patients showing high FDG uptake in the adrenals. All these patients received Amphotericin B and/or Itraconazole treatment that led to symptomatic improvement. A diagnosis of invasive fungal infection requires a high index of suspicion, especially in immunocompetent patients who present with nonspecific symptoms, clinical signs, laboratory and radiological features that can resemble adrenal neoplasms. Clinical specimens must be sent for cytopathology/histopathology together with fungal culture for a definite diagnosis and appropriate management.