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Adrenal Mass in a 70-Year-Old Woman. Case Rep Endocrinol 2022; 2022:2736199. [PMID: 35865995 PMCID: PMC9296303 DOI: 10.1155/2022/2736199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Adrenocortical carcinoma is a rare endocrine malignancy with a bimodal age distribution pattern that affects women more than men. More than half of the patients present with hormone excess manifestations such as Cushing's syndrome and virilization. Non-functional tumors usually are diagnosed incidentally following imaging studies due to a mass effect or metastatic disease. Surgical resection is considered the best curative treatment for these tumors. Case Presentation. A 70-year-old woman presented with a 3-month history of diffuse intermittent abdominal discomfort, weight loss, and additional hair growth. Imaging investigations revealed a large 187 × 85 × 140 mm mass between the liver and upper pole of the right kidney which has displaced the adjacent structures. Hormonal evaluations detected high levels of cortisol and adrenal androgens. She underwent open adrenalectomy and right nephrectomy due to severe adhesion of the mass. Histopathological evaluations revealed adrenocortical carcinoma and the patient received adjuvant radiotherapy. Conclusion Precise physical examination, hormonal evaluation, and imaging studies play a key role in differentiating malignant adrenal masses in all patients, especially in those with vague symptoms. Radical excision of the mass and appropriate adjuvant chemotherapy or radiotherapy improve the outcome for patients.
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Naffouje SA, Sabesan A, Hallanger-Johnson J, Kirtane K, Gonzalez RJ, Mullinax J. Adrenal biopsy, as a diagnostic method, is associated with decreased overall survival in patients with T1/T2 adrenocortical carcinoma: A propensity score-matched analysis. J Surg Oncol 2021; 124:1261-1271. [PMID: 34424540 DOI: 10.1002/jso.26639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/01/2021] [Accepted: 07/25/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The standard diagnosis for adrenocortical carcinoma (ACC) is clinical diagnosis (CD) based on radiographic and biochemical studies. Biopsy diagnosis (BD) is seldom required for the suspicion of secondary malignancy. We aim to study the impact of BD in the context of underlying T1/T2 ACC on overall survival (OS) compared with CD. METHODS National Cancer Database (NCDB) for endocrine malignancies was utilized. Only patients with non-metastatic ACC, whose method of diagnosis and local disease extension were reported, and received a surgical adrenalectomy with curative intent were included. Patients were divided by disease stage into T1/T2, T3, and T4 groups. A propensity score match was applied to those with T1/T2 disease who received CD versus BD and the Kaplan-Meier method was used to compare OS. RESULTS In total, 4000 patients with ACC were reported in the database, 1410 met selection criteria. Eight hundred and thirty patients had T1/T2, 365 had T3, and 162 had T4 ACC. Of patients with T1/T2 ACC, 742 (89.4%) received CD versus 88 (11.6%) with BD. A propensity score was calculated per a multivariable regression model with 79 patients matched from each group. Exact matching was applied for margin status and adjuvant therapies. Kaplan-Meier analysis showed a significant difference in median OS between CD versus BD patients in the matched data set (103.89 ± 15.65 vs. 54.93 ± 8.22 months; p = 0.001). In all comers, patients with T1/T2 ACC and BD had comparable median OS to that of patients with T3 ACC (52.21 ± 9.69 vs. 36.01 ± 3.33 months; p = 0.446). CONCLUSION BD in T1/T2 ACC could be associated with disease upstaging and worse OS outcomes.
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Affiliation(s)
- Samer A Naffouje
- Department of Surgical Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Arvind Sabesan
- Department of Surgical Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Kedar Kirtane
- Head and Neck Oncology Program, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Ricardo J Gonzalez
- Sarcoma Oncology Program, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - John Mullinax
- Sarcoma Oncology Program, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
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Point du Jour KS, Alwelaie Y, Coleman A, Tadros T, Aneja R, Reid MD. Adrenal gland fine needle aspiration: a multi-institutional analysis of 139 cases. J Am Soc Cytopathol 2020; 10:168-174. [PMID: 32988789 DOI: 10.1016/j.jasc.2020.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Adrenal gland lesions span a range of entities from benign and malignant primary neoplasms to metastatic tumors. Fine-needle aspiration (FNA) provides a minimally invasive diagnostic tool to stage patients with known malignancy and procure material for molecular testing. This study characterizes the clinicopathologic associations of patients with adrenal gland FNA from 2 large hospitals. MATERIALS AND METHODS FNAs were identified by query of electronic medical record from 2002-2019. Clinical and pathological information was collated and correlated with corresponding surgical diagnosis when available. RESULTS Of 139 cases, the majority (n = 127, 91%) were adequate computed tomography-guided FNAs and included the following diagnoses: positive for malignancy (n = 77, 55%), negative for malignancy (n = 32, 23%), neoplastic cells present (n = 16, 12%), nondiagnostic (n = 12, 9%), atypical (n = 1, 1%), and suspicious for carcinoma (n = 1, 1%). The majority (94%, n = 72 of 77) of malignancies were metastatic tumors, most frequently carcinoma (n = 53 of 72, 74%), followed by melanoma (n = 11 of 72, 15%), lymphoma (n = 4 of 72, 6%), and sarcoma (n = 4 of 72, 6%). Metastatic carcinomas included lung (n = 21 of 72, 29%), genitourinary (n = 12 of 72, 17%), and hepatobiliary or gastrointestinal tract (n = 11 of 72, 15%) primaries. Primary adrenal neoplasms (n = 23) included adenomas (n = 11 of 23, 48%), pheochromocytomas (n = 4 of 23, 17%), and myelolipomas (n = 3 of 23, 13%). Thirty-two patients with metastases died of disease after median follow-up of 8 months. CONCLUSIONS High specimen adequacy (n = 127, 91%) and low indeterminate rates (n = 2, 2%) are achieved with adrenal FNA. Most aspirated lesions represent metastases from primary lung carcinomas, but other primary sites including those below the diaphragm are part of the diagnostic differential. Adrenal metastasis was associated with a poor prognosis, with median survival of 8 months.
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Affiliation(s)
| | - Yazeed Alwelaie
- Department of Pathology, Emory University Hospital, Atlanta, Georgia
| | - Arlixer Coleman
- Department of Pathology, Grady Memorial Hospital, Atlanta, Georgia
| | - Talaat Tadros
- Department of Pathology, Grady Memorial Hospital, Atlanta, Georgia
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, Georgia
| | - Michelle D Reid
- Department of Pathology, Emory University Hospital, Atlanta, Georgia.
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Dietrich CF, Correas JM, Dong Y, Nolsoe C, Westerway SC, Jenssen C. WFUMB position paper on the management incidental findings: adrenal incidentaloma. Ultrasonography 2020; 39:11-21. [PMID: 31786909 PMCID: PMC6920619 DOI: 10.14366/usg.19029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 12/26/2022] Open
Abstract
Focal lesions of the adrenal glands are incidentally detected in approximately 5% of cases by modern imaging techniques. Fewer than 5% of these adrenal incidentalomas are malignant and approximately 10% have endocrine activity. Reliable differentiation of malignant versus benign and hormonally active versus nonfunctional adrenal incidentalomas significantly influences therapeutic management and the outcome of affected individuals. Therefore, each adrenal incidentaloma should undergo a standardized diagnostic work-up to exclude malignancy and endocrine activity. This position statement of the World Federation of Ultrasound in Medicine and Biology (WFUMB) summarizes the available evidence on the management of adrenal incidentaloma and describes efficient management strategies with particular reference to the role of ultrasound techniques.
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Affiliation(s)
- Christoph F. Dietrich
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany
- Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Germany
| | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Yi Dong
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Christian Nolsoe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Copenhagen, Denmark
| | | | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen and Brandenburg Institute for Clinical Ultrasound, Neuruppin, Germany
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Ma H, Wang P, Shang D, Liu Y. Spatial-domain low-coherence quantitative phase microscopy to improve the cytological diagnosis of pancreatic cancer. J Investig Med 2019; 68:60-67. [DOI: 10.1136/jim-2019-000997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2019] [Indexed: 12/15/2022]
Abstract
Use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) cytology to detect pancreatic cancer is limited, with a high false negative rate mainly due to the relatively fewer number of completely cancerous cells. To improve the accuracy of EUS-FNA cytological diagnosis, we evaluated a novel optical system—spatial-domain low-coherence quantitative phase microscopy (SL-QPM)—to analyze nanoscale nuclear architecture on original cytology samples, especially those diagnosed as indeterminate for malignancy, with the goal of maintaining high specificity and reducing false positive rate. We performed SL-QPM on original cytology samples obtained by EUS-FNA from 40 patients with suspicious pancreatic solid lesions (27 adenocarcinomas, 5 neuroendocrine tumor, 8 chronic pancreatitis), including 13 cases that were cytologically indeterminate. Each diagnosis had been confirmed by follow-up surgical pathology. The SL-QPM-derived nanoscale nuclear architectural parameters distinguished pancreatic cancer from cytologically indeterminate cells. A logistic regression model using nuclear entropy and SD increased the sensitivity of cytology in identifying pancreatic cancer from 72% to 94% while maintaining 100% specificity. The SL-QPM-derived nanoscale nuclear architecture properties show great promise in improving the cytological diagnosis of EUS-FNA for pancreatic cancer and could be used when traditional cytopathology does not get an accurate diagnosis, and can be easily translated into a traditional clinical device.
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Zhang CD, Delivanis DA, Eiken PW, Atwell TD, Bancos I. Adrenal biopsy: performance and use. MINERVA ENDOCRINOL 2019; 44:288-300. [DOI: 10.23736/s0391-1977.19.02969-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Novotny AG, Reynolds JP, Shah AA, Bhatt A, Chahal P, Remer EM, Stevens T, Gmitro S, Sturgis CD. Fine‐needle aspiration of adrenal lesions: A 20‐year single institution experience with comparison of percutaneous and endoscopic ultrasound guided approaches. Diagn Cytopathol 2019; 47:986-992. [DOI: 10.1002/dc.24261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Aaron G. Novotny
- Pathology and Laboratory Medicine InstituteCleveland Clinic Cleveland Ohio
| | - Jordan P. Reynolds
- Pathology and Laboratory Medicine InstituteCleveland Clinic Cleveland Ohio
| | - Akeesha A. Shah
- Pathology and Laboratory Medicine InstituteCleveland Clinic Cleveland Ohio
| | - Amit Bhatt
- Department of GastroenterologyCleveland Clinic Cleveland Ohio
| | | | | | - Tyler Stevens
- Department of GastroenterologyCleveland Clinic Cleveland Ohio
| | - Stephen Gmitro
- Pathology and Laboratory Medicine InstituteCleveland Clinic Cleveland Ohio
| | - Charles D. Sturgis
- Pathology and Laboratory Medicine InstituteCleveland Clinic Cleveland Ohio
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Arambewela M, Ross R, Pirzada O, Balasubramanian SP. Tuberculosis as a differential for bilateral adrenal masses in the UK. BMJ Case Rep 2019; 12:12/5/e228532. [PMID: 31142485 DOI: 10.1136/bcr-2018-228532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Primary adrenal insufficiency (PAI) is a potentially fatal disease. Adrenal tuberculosis(TB) causing PAI is rare in the developed world. We present a seemingly well, 78-year-old Caucasianwoman in the UK who developed adrenal crisis following elective hip surgery. Biochemical tests confirmed PAI and steroid replacement was initiated. Imaging of the abdomen demonstrated bilateral adrenal masses and a fluorodeoxyglucose positron emission tomography (FDG-PET) scan showed increased uptake in both adrenals suggestive of malignancy. Following a retroperitoneoscopic left adrenalectomy, histology showed caseating necrosis with xanthogranulomatous inflammation favouring a diagnosis of TB. She was commenced on anti-TB treatment. Diagnosing adrenal TB in the west can be challenging especially in the absence of extra-adrenal TB. FDG-PET scans can be falsely positive in presence of chronic active inflammatory conditions, such as TB, and a tissue diagnosis is required. It is important that clinicians remain vigilant of this important disease, which can masquerade as malignancy.
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Affiliation(s)
- Maulee Arambewela
- Endocrinology Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Physiology, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Richard Ross
- Endocrinology Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Omar Pirzada
- Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sabapathy P Balasubramanian
- Department of Surgical Oncology, University of Sheffield, Sheffield, UK.,Endocrine Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Khoury T, Kadah A, Farraj M, Barhoum M, Livoff A, Mari A, Mahamid M, Sbeit W. The role of rapid on‐site evaluation on diagnostic accuracy of endoscopic ultrasound fine needle aspiration for pancreatic, submucosal upper gastrointestinal tract and adjacent lesions. Cytopathology 2019; 30:499-503. [DOI: 10.1111/cyt.12712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Tawfik Khoury
- Department of Gastroenterology Galilee Medical Center Nahariya Israel
- Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
| | - Anas Kadah
- Department of Gastroenterology Galilee Medical Center Nahariya Israel
- Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
| | - Moaad Farraj
- Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
- Department of Surgery Galilee Medical Center Nahariya Israel
| | - Masaad Barhoum
- Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
- Administration Department Galilee Medical Center Nahariya Israel
| | - Alejandro Livoff
- Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
- Department of Pathology Galilee Medical Center Nahariya Israel
| | - Amir Mari
- Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
- Gastroenterology and Endoscopy United The Nazareth Hospital EMMS Nazareth Israel
| | - Mahmud Mahamid
- Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
- Gastroenterology and Endoscopy United The Nazareth Hospital EMMS Nazareth Israel
| | - Wisam Sbeit
- Department of Gastroenterology Galilee Medical Center Nahariya Israel
- Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
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Abstract
Given the frequent use of cross-sectional imaging in medicine, adrenal masses are discovered at an increasing rate. Once detected, it is critical to ensure the patient undergoes the appropriate biochemical/hormonal workup to rule out any aberrant activity and ensure imaging features do not raise suspicion for a malignant neoplasm. Patients with hormonal overactivity, concerning size, and/or imaging characteristics must be referred for surgical consideration. For those not requiring adrenalectomy, it is important to determine which patients mandate follow-up to ensure no further growth or development of hormonal production. It is also critical to understand what is the appropriate follow-up.
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11
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Nuñez Bragayrac LA, Schwaab T. Adrenal Tumors. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Patel S, Jinjuvadia R, Devara A, Naylor PH, Anees M, Jinjuvadia K, Al-Haddad M. Performance characteristics of EUS-FNA biopsy for adrenal lesions: A meta-analysis. Endosc Ultrasound 2019; 8:180-187. [PMID: 30880721 PMCID: PMC6589998 DOI: 10.4103/eus.eus_42_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and Objective: The role of EUS-FNA biopsy (EUS-FNAB) for detection of metastatic lesions (mets) to adrenals has not been evaluated systematically. Our aim is to systematically evaluate the performance characteristics of EUS-FNAB in detecting metastasis to the adrenal glands. Materials and Methods: We performed a systematic search on PubMed and OvidSP from January 1990 to July 2016 using various search terms for EUS and adrenal lesion. Only articles published in English literature were included in the study. Studies with fewer than 10 patients were excluded from the study. Publication bias was assessed using Begg-Mazumdar test and visual inspection of funnel plots. Results: Eight studies including 360 adrenal lesions that underwent EUS-FNAB were identified. Of these, 137 FNABs were conclusive for malignancy. Sensitivity of EUS-FNAB in detecting metastasis to the adrenals was 95% (95% confidence interval [CI]: 90%–98%) and specificity was 99% (95% CI: 96%–100%). Pooled positivity of EUS-FNAB in detecting lung cancer metastasis to the adrenals was 44% (95% CI: 31.5%–57.3%). No evidence of publication bias was noted. Conclusion: Our study demonstrates that EUS-FNAB is highly sensitive and specific in detecting metastasis to adrenals. It also shows that up to about half of the patients with lung cancer and adrenal lesions on imaging have metastasis, a finding with profound implications on lung cancer staging and treatment.
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Affiliation(s)
- Suhag Patel
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Anupama Devara
- Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Paul H Naylor
- Division of Gastroenterology, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Mohammad Anees
- Division of Gastroenterology, Mayo Clinic, Rochester MN, USA
| | - Kartikkumar Jinjuvadia
- Division of Gastroenterology, Detroit Medical Center, Wayne State University, Detroit, MI, USA
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Béguin JS, Chevallier L, Rannou B, Fontaine JJ, Benchekroun G. Primary hypoaldosteronism in a dog with pituitary and adrenal T-cell lymphoma. J Small Anim Pract 2018; 61:588-592. [PMID: 30390298 DOI: 10.1111/jsap.12955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 07/19/2018] [Accepted: 09/28/2018] [Indexed: 11/24/2022]
Abstract
A 7-year-old mixed breed dog was presented with a 2-week history of vomiting, diarrhoea, weakness and loss of appetite. Initial laboratory tests revealed hyponatraemia and hyperkalaemia consistent with hypoadrenocorticism. Basal plasma cortisol and adrenocorticotropic hormone concentrations were not suggestive of primary hypoadrenocorticism but the aldosterone concentration was undetectable. Abdominal ultrasound scan showed a mass within the left kidney and a nodular enlargement of the left adrenal gland. Cytological analysis revealed a large granular lymphoma. The dog died 17 days later. Post mortem histological and immunohistochemical examinations revealed a diffuse large granular T-cell lymphoma involving the mediastinal lymph node, kidneys, pancreas, adrenal and pituitary glands.
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Affiliation(s)
- J S Béguin
- Department of Internal Medicine, Ecole nationale vétérinaire d'Alfort, Paris, F-94700, France
| | - L Chevallier
- Department of Pathology, Ecole nationale vétérinaire d'Alfort, Paris, F-94700, France
| | - B Rannou
- Department of Biochemistry, VetAgro Sup Campus Vétérinaire de Lyon, Université de Lyon, 69280, Lyon, France
| | - J J Fontaine
- Department of Pathology, Ecole nationale vétérinaire d'Alfort, Paris, F-94700, France
| | - G Benchekroun
- Department of Internal Medicine, Ecole nationale vétérinaire d'Alfort, Paris, F-94700, France
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Morelli V, Palmieri S. Adrenal incidentaloma: differential diagnosis and management strategies. MINERVA ENDOCRINOL 2018; 44:4-18. [PMID: 29808642 DOI: 10.23736/s0391-1977.18.02868-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Adrenal incidentaloma is a frequent clinical finding. Once an adrenal mass is detected, is mandatory to determine whether the lesion is malignant or benign and whether it is hormonally active or non-functioning, to estabilish an adequate treatement or follow-up. The European Society of Endocrinology and ENSAT Guideline recently provided the best recommendation based on the available literature. However, due to the retrospective design of the majority of the studies, the small number of patients included and the inadequate follow-up, some issues are still unresolved. In particular, there is a general consensus about the need of adrenalectomy in the presence of unilateral adrenal mass and clinically relevant hormone excess or radiological findings suspected for malignancy. On the other side, how to manage adrenal masses with indeterminate characteristics or subtle cortisol secretion, and how long the radiological and functional follow-up of benign adrenal mass should last in non-operated patients, are still open questions. Therefore, high-quality research for establish the adequate management of these patients and randomized clinical trials are needed to avoid unnecessary investigations and invasive procedures and ensure a clinically effective work-up.
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Affiliation(s)
- Valentina Morelli
- Unit of Endocrinology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy -
| | - Serena Palmieri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Lumachi F, Borsato S, Tregnaghi A, Marino F, Fassina A, Zucchetta P, Marzola MC, Cecchin D, Bui F, Iacobone M, Favia G. High Risk of Malignancy in Patients with Incidentally Discovered Adrenal Masses: Accuracy of Adrenal Imaging and Image-Guided Fine-Needle Aspiration Cytology. TUMORI JOURNAL 2018; 93:269-74. [PMID: 17679462 DOI: 10.1177/030089160709300307] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Aims and background The incidental finding of nonfunctioning adrenal masses (incidentalomas) is common, but no reliable criteria in differentiating between benign and malignant adrenal masses have been defined. The aim of this preliminary study was to assess the usefulness of adrenal imaging and image-guided fine-needle aspiration cytology in patients with nonfunctioning adrenal incidentalomas with the aim of excluding or confirming malignancy before surgery. Methods Forty-two consecutive patients (18 men and 24 women; median age, 54 years; range, 25-75 years) with incidentally discovered adrenal masses of 3 cm or more in the greatest diameter were prospectively enrolled in the study. All patients underwent helical computerized tomography scan and image-guided fine-needle aspiration cytology, 33 (78.6%) underwent magnetic resonance imaging, and 26 (61.9%) underwent norcholesterol scintigraphy before adrenalectomy. Results The revised final pathology showed 30 (71.4%) benign (26 adrenocortical adenomas, of which 3 were atypical, 2 ganglioneuromas, and 2 nonfunctioning benign pheochromocytomas) and 12 (28.6%, 95% CI = 15-42) adrenal malignancies (8 adrenocortical carcinomas and 4 unsuspected adrenal metastases). The definitive diagnosis of adrenocortical carcinoma was made according to Weiss criteria and confirmed on the basis of local invasion at surgery or metastases. The sensitivity, specificity and accuracy were 75%, 67% and 83% for computerized tomography scan, 92%, 95% and 94% for magnetic resonance imaging, 89%, 94% and 92% for norcholesterol scintigraphy, and 92%, 100% and 98% for fine-needle aspiration cytology. The sensitivity and accuracy of image-guided fine-needle aspiration cytology and magnetic resonance imaging together reached 100%. Immediate periprocedural complications of fine-needle aspiration cytology occurred in 2 (4.7%) patients: self-limited pneumothorax (n = 1), and severe pain (n = 1) requiring analgesic therapy. No postprocedural or late complications were observed. Conclusions With the aim of selecting for surgery patients with a non-functioning adrenal incidentaloma of 3 cm or more in diameter, the combination of magnetic resonance imaging and fine-needle aspiration cytology should be considered the strategy of choice.
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Affiliation(s)
- Franco Lumachi
- Endocrine Surgery Unit, Department of Surgical & Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy.
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Gupta RK, Majumdar K, Saran RK, Srivastava S, Sakhuja P, Batra VV. Role of Endoscopic Ultrasound-guided Fine-needle Aspiration in Adrenal Lesions: Analysis of 32 Patients. J Cytol 2018; 35:83-89. [PMID: 29643654 PMCID: PMC5885609 DOI: 10.4103/joc.joc_241_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: Endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) is a precise and safe technique that provides both radiological and pathological diagnosis with a better diagnostic yield and minimal adverse events. EUS-FNAC led to the remarkable increase in the detection rate of incidentaloma found during radiologic staging or follow-up in various malignancy or unrelated conditions. Aims: We did this preliminary study with an aim to evaluate the role of EUS-FNA in diagnosing and classifying adrenal lesions, clinical impact, and compare the outcome with the previously published literature. Materials and Methods: We included 32 consecutive cases (both retrospective and prospective) of EUS-guided adrenal aspirate performed over a period of 3.3 years. The indications for the aspirate in decreasing order were metastasis (most common carcinoma gall bladder) > primary adrenal mass > disseminated tuberculosis > pyrexia of unknown origin. On EUS, 28 cases revealed space occupying lesion or mass (two cases bilateral) and four cases revealed diffuse enlargement (two cases bilateral) with a mean size of 21 mm. Results: The cytology reports were benign adrenal aspirate (43.8%), metastatic adenocarcinoma (15.6%), histoplasmosis (9.4%), tuberculosis (9.4%), round cell tumor (6.2%), adrenocortical carcinoma (3.1%), and descriptive (3.1%). Three cases (9.4%) yielded inadequate sample. The TNM staging was altered in 22.23% of the cases by result of adrenal aspirate. Conclusions: EUS-FNA of the adrenal gland is a safe, quick, and sensitive and real-time diagnostic technique, which requires an integrated approach of clinician, endoscopist, and cytopathologist for high precision in diagnosis. Although the role of EUS-FNA for right adrenal is not much described, we found adequate sample yield in all the four patients that underwent the procedure.
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Affiliation(s)
- Rakesh K Gupta
- Department of Pathology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Kaushik Majumdar
- Department of Pathology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Ravindra K Saran
- Department of Pathology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Siddharth Srivastava
- Department of Gastroenterology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Puja Sakhuja
- Department of Pathology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Vineeta V Batra
- Department of Pathology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
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Patil R, Ona MA, Papafragkakis C, Duddempudi S, Anand S, Jamil LH. Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of adrenal lesions. Ann Gastroenterol 2016; 29:307-11. [PMID: 27366030 PMCID: PMC4923815 DOI: 10.20524/aog.2016.0047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 04/26/2016] [Indexed: 12/13/2022] Open
Abstract
The use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) appears to be a safe and feasible means of confirming or excluding malignancy in the adrenal glands. EUS-FNA with biopsy of suspicious masses in either adrenal gland allows for assessment of these lesions while keeping complications relatively rare. The main advantages of EUS-FNA are that it can be done as an outpatient procedure, with good results, minimal morbidity, and a short hospital stay. Nevertheless, EUS-FNA of adrenal masses should be indicated only in selected cases, in which there is potential to either decrease unnecessary treatment or guide therapy in cancer patients by aiding in either staging of malignancy or treatment of recurrence.v.
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Affiliation(s)
- Rashmee Patil
- Department of Internal Medicine, Mount Sinai Health Systems, New York (Rashmee Patil)
| | - Mel A Ona
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York (Mel A. Ona, Sushil Duddempudi, Sury Anand)
| | - Charilaos Papafragkakis
- Department of Advanced Therapeutic Endoscopy, MD Anderson Cancer Center, Academic and Clinical Affiliate of the University of Texas, Houston, Texas (Charilaos Papafragkakis)
| | - Sushil Duddempudi
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York (Mel A. Ona, Sushil Duddempudi, Sury Anand)
| | - Sury Anand
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York (Mel A. Ona, Sushil Duddempudi, Sury Anand)
| | - Laith H Jamil
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA (Laith H. Jamil), USA
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Tanimoto A, Takeuchi S, Yaegashi H, Kotani H, Kitai H, Nanjo S, Ebi H, Yamashita K, Mouri H, Ohtsubo K, Ikeda H, Yano S. Recurrence of renal cell carcinoma diagnosed using contralateral adrenal biopsy with endoscopic ultrasound-guided fine-needle aspiration. Mol Clin Oncol 2016; 4:537-540. [PMID: 27073657 DOI: 10.3892/mco.2016.739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/21/2016] [Indexed: 11/05/2022] Open
Abstract
A 76-year-old female in whom a renal cell carcinoma (RCC) lesion was resected 19 years previously presented to our hospital with cognitive dysfunction. Magnetic resonance imaging and computed tomography revealed nodules in the brain, lung, adrenal gland and a pelvic osteolytic lesion. To identify the primary cancer site, the present study performed endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the left adrenal lesion. Consequently, the pathological findings of the tissue obtained by EUS-FNA were similar to those of the previous nephrectomy specimen, revealing that the adrenal lesion was the recurrence of RCC. The majority of the metastatic lesions in the patient were reduced in size by the multiple kinase inhibitor, pazopanib. Contralateral adrenal metastasis of RCC is rare and the use of EUS-FNA in the diagnosis of adrenal lesions remains to be elucidated. This is a rare case of adrenal lesion, diagnosed by EUS-FNA. Therefore, EUS-FNA is considered to be a useful diagnostic modality of adrenal metastases from unidentified primary tumor types.
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Affiliation(s)
- Azusa Tanimoto
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Shinji Takeuchi
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa 920-8641, Japan
| | - Hiroshi Kotani
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hidenori Kitai
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Shigeki Nanjo
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hiromichi Ebi
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Kaname Yamashita
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hisatsugu Mouri
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Koushiro Ohtsubo
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hiroko Ikeda
- Division of Pathology, Kanazawa University Hospital, Kanazawa, Ishikawa 920-8641, Japan
| | - Seiji Yano
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
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Jenssen C, Annema JT, Clementsen P, Cui XW, Borst MM, Dietrich CF. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography. J Thorac Dis 2015; 7:E439-58. [PMID: 26623120 DOI: 10.3978/j.issn.2072-1439.2015.10.08] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [endoscopic ultrasound fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all MLNs can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review in two integrative parts is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part 1 deals with an introduction into ultrasound techniques, MLN anatomy and diagnostic reach of ultrasound techniques and part 2 with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.
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Affiliation(s)
- Christian Jenssen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Jouke Tabe Annema
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Paul Clementsen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Xin-Wu Cui
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Mathias Maximilian Borst
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Christoph Frank Dietrich
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
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Ieni A, Barresi V, Todaro P, Caruso RA, Tuccari G. Cell-block procedure in endoscopic ultrasound-guided-fine-needle-aspiration of gastrointestinal solid neoplastic lesions. World J Gastrointest Endosc 2015; 7:1014-1022. [PMID: 26322154 PMCID: PMC4549658 DOI: 10.4253/wjge.v7.i11.1014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 07/01/2015] [Accepted: 08/03/2015] [Indexed: 02/05/2023] Open
Abstract
In the present review we have analyzed the clinical applications of endoscopic ultrasound-guided-fine-needle-aspiration (EUS-FNA) and the methodological aspects obtained by cell-block procedure (CBP) in the diagnostic approach to the gastrointestinal neoplastic pathology. CBP showed numerous advantages in comparison to the cytologic routine smears; in particular, better preservation of cell architecture, achievement of routine haematoxylin-eosin staining equivalent to histological slides and possibility to perform immunohistochemistry or molecular analyses represented the most evident reasons to choose this method. Moreover, by this approach, the differential diagnosis of solid gastrointestinal neoplasias may be more easily achieved and the background of contaminant non-neoplastic gastrointestinal avoided. Finally, biological samples collected by EUS-FNA CBP-assisted should be investigated in order to identify and quantify further potential molecular markers.
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Abstract
Adrenocortical carcinoma (ACC) is rare but one of the most malignant endocrine tumors. This article reviews and summarizes the current knowledge about the treatment of ACC. The epidemiology and molecular events involved in the pathogenesis of ACC are briefly outlined. The different diagnostic tools to distinguish benign from malignant adrenocortical tumors, including biochemical analysis and imaging, are discussed. The surgical treatment of ACC has evolved in the last 2 decades. The different surgical alternatives for the treatment of ACC in the context of primary, recurrent, or metastatic disease are reviewed, and the remaining challenges and controversies are discussed.
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Affiliation(s)
- Gustavo G Fernandez Ranvier
- Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1259, New York, NY 10029, USA
| | - William B Inabnet
- Department of Surgery, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, First Ave at 16th St, Baird Hall, 16th Floor, Suite 20, New York, NY 10003, USA.
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Puri R, Thandassery RB, Choudhary NS, Kotecha H, Misra SR, Bhagat S, Paliwal M, Madan K, Saraf N, Sarin H, Guleria M, Sud R. Endoscopic ultrasound-guided fine-needle aspiration of the adrenal glands: analysis of 21 patients. Clin Endosc 2015; 48:165-70. [PMID: 25844346 PMCID: PMC4381145 DOI: 10.5946/ce.2015.48.2.165] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/22/2014] [Accepted: 10/17/2014] [Indexed: 01/23/2023] Open
Abstract
Background/Aims Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology of adrenal masses helps in etiological diagnosis. The aim of this study was to evaluate the diagnostic yield of EUS-FNA of adrenal masses in cases where other imaging methods failed and/or were not feasible. Methods Twenty-one consecutive patients with adrenal masses, in whom adrenal FNA was performed because conventional imaging modalities failed and/or were not feasible, were prospectively evaluated over a period of 3 years. Results Of the 21 patients (mean age, 56±12.2 years; male:female ratio, 2:1), 12 had pyrexia of unknown origin and the other nine underwent evaluation for metastasis. The median lesion size was 2.4×1.6 cm. Ten patients were diagnosed with tuberculosis (shown by the presence of caseating granulomas [n=10] and acid-fast bacilli [n=4]). Two patients had EUS-FNA results suggestive of histoplasmosis. The other patients had metastatic lung carcinoma (n=6), hepatocellular carcinoma (n=1), and adrenal lipoma (n=1) and adrenal myelolipoma (n=1). EUS results were not suggestive of any particular etiology. No procedure-related adverse events occurred. Conclusions EUS-FNA is a safe and effective method for evaluating adrenal masses, and it yields diagnosis in cases where tissue diagnosis is impossible or has failed using conventional imaging modalities.
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Affiliation(s)
- Rajesh Puri
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Ragesh Babu Thandassery
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Narendra S Choudhary
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Hardik Kotecha
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Smruti Ranjan Misra
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Suraj Bhagat
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Manish Paliwal
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Kaushal Madan
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Neeraj Saraf
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
| | - Haimanti Sarin
- Department of Cytopathology, Medanta The Medicity, Gurgaon, India
| | - Mridula Guleria
- Department of Cytopathology, Medanta The Medicity, Gurgaon, India
| | - Randhir Sud
- Department of Gastroenterology, Medanta Institute of Digestive & Hepatobiliary Sciences, Medanta, India
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EUS-guided tissue acquisition: an evidence-based approach (with videos). Gastrointest Endosc 2014; 80:939-59.e7. [PMID: 25434654 DOI: 10.1016/j.gie.2014.07.066] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/17/2014] [Indexed: 02/08/2023]
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Chakrabarti I, Bhowmik S, Sinha MGM, Bera P. Ultrasound-guided aspiration cytology of retroperitoneal masses with histopathological corroboration: A study of 71 cases. J Cytol 2014; 31:15-9. [PMID: 25190978 PMCID: PMC4150336 DOI: 10.4103/0970-9371.130629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Diagnosis of retroperitoneal lesions is one of the most difficult areas in surgical pathology. Both primary and metastatic tumors can grow silently in retroperitoneum before the appearance of clinical signs and symptoms. Guided aspiration cytology has shown a promising role in diagnosis of lesions in this region. Aims: This study was undertaken to evaluate the reliability of guided fine-needle aspiration cytology (FNAC) in the diagnosis of retroperitoneal masses and to study the spectrum of retroperitoneal lesions in a rural tertiary care hospital. Materials and Methods: This study was done on 71 patients presenting with retroperitoneal masses over a period of 20 months in a tertiary care hospital. Ultrasound-guided FNAC was done and the smears were stained by MGG and H and E stains. Histopathological corroboration could be done on all neoplastic lesions along with some non-neoplastic lesions. Results: Out of 71 cases, 48 cases (67.6%) were found to be neoplastic. Malignant tumors (35 cases) were more common than benign ones (13 cases). Malignant lesions were predominantly composed of lesions of lymph node (17 cases i.e. 48.57%) followed by sarcomas (5 cases) and germ cell tumors. Some uncommon retroperitoneal lesions like adrenal myelolipoma, renal angiomyolipoma, Burkitt's lymphoma and adrenocortical carcinoma were found in our study. Guided FNAC could diagnose all the malignant lesions with 100% accuracy except in 2 cases of poorly differentiated carcinoma which came out to be non-Hodgkin lymphoma on subsequent biopsies. Conclusion: Guided FNAC is an inexpensive, rapid and reliable method for diagnosis of retroperitoneal masses.
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Affiliation(s)
- Indranil Chakrabarti
- Department of Pathology, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India
| | - Sourav Bhowmik
- Department of Pathology, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India
| | - Mamata Guha Mallick Sinha
- Department of Pathology, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India
| | - Pranati Bera
- Department of Pathology, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India
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Bertazzolo W, Didier M, Gelain ME, Rossi S, Crippa L, Avallone G, Roccabianca P, Bonfanti U, Giori L, Fracassi F. Accuracy of cytology in distinguishing adrenocortical tumors from pheochromocytoma in companion animals. Vet Clin Pathol 2014; 43:453-9. [DOI: 10.1111/vcp.12161] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Martine Didier
- Veterinary Animal Hospital “Città di Pavia”; Pavia Italy
| | - Maria Elena Gelain
- Department of Comparative Biomedicine and Nutrition; University of Padua; Padua Italy
| | | | | | - Giancarlo Avallone
- Department of Veterinary Science and Public Health; University of Milan; Milan Italy
| | - Paola Roccabianca
- Department of Veterinary Science and Public Health; University of Milan; Milan Italy
| | | | - Luca Giori
- Department of Veterinary Science and Public Health; University of Milan; Milan Italy
| | - Federico Fracassi
- Department of Veterinary Medical Science; University of Bologna; Bologna Italy
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Diagnostic yield and safety of endoscopic ultrasound guided fine needle aspiration of central mediastinal lung masses. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2013; 2013:150492. [PMID: 23818747 PMCID: PMC3683425 DOI: 10.1155/2013/150492] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 05/11/2013] [Indexed: 11/18/2022]
Abstract
UNLABELLED Background and Aims. EUS-FNA is an accurate and safe technique to biopsy mediastinal lymph nodes. However, there are few data pertaining to the role of EUS-FNA to biopsy central lung masses. The aim of the study was to assess the diagnostic yield and safety of EUS-FNA of indeterminate central mediastinal lung masses. Methods. DESIGN Retrospective review of a prospectively maintained database; noncomparative. SETTING Tertiary referral center. From 10/2004 to 12/2010, all patients with a lung mass located within proximity to the esophagus were referred for EUS-FNA. MAIN OUTCOME MEASUREMENT EUS-FNA diagnostic accuracy and safety. Results. 73 consecutive patients were included. EUS allowed detection in 62 (85%) patients with lack of visualization prohibiting FNA in 11 patients. Among sampled lesions, one patient (1/62 = 1.6%) had a benign lung mass (hamartoma), while the remaining 61 patients (61/62 = 98.4%) had a malignant mass (primary lung cancer: 55/61 = 90%; lung metastasis: 6/61 = 10%). The sensitivity, specificity, and accuracy of EUS-FNA were 96.7%, 100%, and 96.7%, respectively. The sensitivity was 80.8% when considering nonvisualized masses. One patient developed a pneumothorax (1/62 = 1.6%). Conclusions. EUS-FNA appears to be an accurate and safe technique for tissue diagnosis of central mediastinal lung masses.
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Eloubeidi MA, Khan AS, Luz LP, Linder A, Moreira DM, Crowe DR, Eltoum IA. Combined use of EUS-guided FNA and immunocytochemical stains discloses metastatic and unusual diseases in the evaluation of mediastinal lymphadenopathy of unknown etiology. Ann Thorac Med 2012; 7:84-91. [PMID: 22558013 PMCID: PMC3339209 DOI: 10.4103/1817-1737.94527] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 12/22/2011] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Mediastinal lymphadenopathy (ML) is a cause for concern, especially in patients with previous malignancy. We report our experience with the use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with immunocytochemical stains in patients being evaluated for ML. METHODS Retrospective analysis of patients with ML of unknown origin who underwent EUS-FNA. On-site evaluation was performed by experienced cytologist, and special immunocytochemical stains were requested as indicated. RESULTS A total of 116 patients were included, and a total of 136 mediastinal LN were sampled. Prior malignancy was present in 45%. The most common site of examined lymph node (LN) were subcarinal (76%, 103 LN). The median long and short axis diameters were 28 mm and 13 mm, respectively. FNA was read on-site as malignant, 21 (16%); benign, 100 (76.9%); suspicious, six (4%); atypical, 3 (2%); and inadequate sample, six (4%). Sixty-four LN were deferred for additional studies; 22 for immunocytochemical and 26 for Gimesa (GMS) stain and 21 for flow cytometry. Final FNA read was malignant in 28 (21%), benign in 103 (76%), suspicious in three (2%), and atypical in two (1%). Metastatic malignancies disclosed included Hodgkin's and Non-Hodgkin's lymphoma, melanoma, hepatoma, breast, lung, colon, renal, endometrial, Fallopian tube, and unknown carcinoma. The sensitivity, specificity, and accuracy of the final FNA read to predict malignancy were 100%. CONCLUSION EUS-guided FNA with additional ancillary studies is useful in disclosing metastatic ML from a variety of neoplasms. Due to its safety and accuracy profile, it should be considered the test of choice in evaluating abnormal ML in appropriately selected patients.
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Affiliation(s)
- Mohamad A Eloubeidi
- Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham, Birmingham, Alabama, Lebanon
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Role of EUS for the evaluation of mediastinal adenopathy. Gastrointest Endosc 2011; 74:239-45. [PMID: 21802583 DOI: 10.1016/j.gie.2011.03.1255] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 03/30/2011] [Indexed: 12/11/2022]
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Immunohistochemical distinction of primary adrenal cortical lesions from metastatic clear cell renal cell carcinoma: a study of 248 cases. Am J Surg Pathol 2011; 35:678-86. [PMID: 21490444 DOI: 10.1097/pas.0b013e3182152629] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The diagnosis of metastatic clear cell renal cell carcinoma (CC-RCC) can be difficult because of its morphologic heterogeneity and the increasing use of small image-guided biopsies that yield scant diagnostic material. This is further complicated by the degree of morphologic and immunophenotypic overlap with nonrenal neoplasms and tissues, such as adrenal cortex. In this study, a detailed immunoprofile of 63 adrenal cortical lesions, which included 54 cortical neoplasms, was compared with 185 metastatic CC-RCCs using traditional [anticalretinin, CD10, antichromogranin, antiepithelial membrane antigen, anti-inhibin, antimelanA, anticytokeratins (AE1/AE3 and AE1/CAM5.2), antirenal cell carcinoma marker, and antisynaptophysin)] and novel [anticarbonic anhydrase-IX, antihepatocyte nuclear factor-1b, antihuman kidney injury molecule-1 (hKIM-1), anti-PAX-2, anti-PAX-8, antisteroidogenic factor-1 (SF-1), and anti-T-cell immunoglobulin mucin-1] antibodies. Tissue microarray methodology was used to simulate small image-guided biopsies. Staining extent and intensity were scored semiquantitatively for each antibody. In comparing different intensity thresholds required for a "positive" result, a value of ≥2+ was identified as optimal for diagnostic sensitivity/specificity. For the distinction of adrenal cortical lesions from metastatic CC-RCCs, immunoreactivity for the adrenal cortical antigens SF-1 (86% adrenal; 0% CC-RCC), calretinin (89% adrenal; 10% CC-RCC), inhibin (86% adrenal; 9% CC-RCC), and melanA (86% adrenal; 10% CC-RCC) and for the renal epithelial antigens hKIM-1 (0% adrenal; 83% CC-RCC), PAX-8 (0% adrenal; 83% CC-RCC), hepatocyte nuclear factor-1b (0% adrenal; 76% CC-RCC), epithelial membrane antigen (0% adrenal; 78% CC-RCC), and carbonic anhydrase-IX (3% adrenal; 87% CC-RCC) had the most potential use. Use of novel renal epithelial markers hKIM-1 (clone AKG7) and/or PAX-8 and the adrenocortical marker SF-1 in an immunohistochemical panel for distinguishing adrenal cortical lesions from metastatic CC-RCC offers improved diagnostic sensitivity and specificity.
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Colasacco C, Mount S, Leiman G. Documentation of immunocytochemistry controls in the cytopathologic literature: A meta-analysis of 100 journal articles. Diagn Cytopathol 2011; 39:245-50. [DOI: 10.1002/dc.21370] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Wang KX, Ben QW, Jin ZD, Du YQ, Zou DW, Liao Z, Li ZS. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc 2011; 73:283-90. [PMID: 21295642 DOI: 10.1016/j.gie.2010.10.045] [Citation(s) in RCA: 269] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 10/21/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND EUS-guided FNA (EUS-FNA) permits both morphologic and cytologic analysis of lesions within or adjacent to the GI tract. Although previous studies have evaluated the accuracy of EUS-FNA, little is known about the complications of EUS-FNA. Moreover, the frequency and severity of complications may vary from center to center and may be related to differences in individual experience. OBJECTIVE To systematically review the morbidity and mortality associated with EUS-FNA. DESIGN MEDLINE and EMBASE were searched to identify relevant English-language articles. MAIN OUTCOME MEASUREMENTS EUS-FNA-specific morbidity and mortality rates. RESULTS We identified 51 articles with a total of 10,941 patients who met our inclusion and exclusion criteria; the overall rate of EUS-FNA-specific morbidity was 0.98% (107/10,941). In the small proportion of patients with complications of any kind, the rates of pancreatitis (36/8246; 0.44%) and postprocedure pain (37/10,941; 0.34%) were 33.64% (36/107) and 34.58% (37/107), respectively. The mortality rate attributable to EUS-FNA-specific morbidity was 0.02% (2/10,941). Subgroup analysis showed that the morbidity rate was 2.44% in prospective studies compared with 0.35% in retrospective studies for pancreatic mass lesions (P=.000), whereas it was 2.33% versus 5.07% for pancreatic cysts (P=.036). LIMITATIONS Few articles reported well-designed, prospective studies and few focused on overall complications after EUS-FNA. CONCLUSIONS EUS-FNA-related morbidity and mortality rates are relatively low, and most associated events are mild to moderate in severity.
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Affiliation(s)
- Kai-Xuan Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Schuurbiers OCJ, Tournoy KG, Schoppers HJ, Dijkman BG, Timmers HJLM, de Geus-Oei LF, Grefte JMM, Rabe KF, Dekhuijzen PNR, van der Heijden HFM, Annema JT. EUS-FNA for the detection of left adrenal metastasis in patients with lung cancer. Lung Cancer 2011; 73:310-5. [PMID: 21277038 DOI: 10.1016/j.lungcan.2010.12.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 12/03/2010] [Accepted: 12/18/2010] [Indexed: 12/25/2022]
Abstract
In patients with lung cancer, enlarged or (18)Fluoro-deoxyglucose positron emission tomography ((18)FDG-PET) positive left adrenal glands are suspected for distant metastases and require tissue confirmation for a definitive assessment. The aim of this study was to assess the sensitivity of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for left adrenal metastases in lung cancer patients with a suspect adrenal gland based on imaging. EUS-FNA findings of patients with (suspected) lung cancer and CT enlarged or (18)FDG-PET positive left adrenal glands were retrospectively evaluated. In the absence of metastases at EUS, clinical and radiological follow-up was obtained. In 85 patients, EUS-FNA demonstrated left adrenal metastases of lung cancer in 53 (62%), benign adrenal tissue in 25 (29%), a metastasis from colon carcinoma in 1 (1%) and a primary adrenocortical carcinoma in 1 (1%) patient. In five patients (5.9%), the aspirates contained non-representative material. EUS outcomes were false negative in two patients. Sensitivity and negative predictive value (NPV) for EUS-FNA of the left adrenal gland were at least 86% (95% CI 74-93%) and 70% (95% CI 50-85%). No complications occurred. EUS-FNA is a sensitive, safe and minimally invasive technique to provide tissue proof of left adrenal metastases in patients with (suspected) lung cancer and enlarged or (18)FDG-PET positive adrenal glands. Therefore, EUS-FNA qualifies as the staging test of choice for patients with lung cancer with suspected left adrenal metastases.
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Affiliation(s)
- Olga C J Schuurbiers
- Department of Pulmonology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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The use of immunohistochemistry in the diagnosis of metastatic clear cell renal cell carcinoma: a review of PAX-8, PAX-2, hKIM-1, RCCma, and CD10. Adv Anat Pathol 2010; 17:377-93. [PMID: 20966644 DOI: 10.1097/pap.0b013e3181f89400] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The diagnosis of metastatic clear cell renal cell carcinoma may be difficult in some cases, particularly in the small image-guided biopsies that are becoming more common. As targeted therapies for renal cell carcinoma are now standard treatment, the recognition and diagnosis of renal cell carcinoma has become even more critical. Many adjunctive immunohistochemical markers of renal epithelial lineage such as CD10 and RCCma have been proposed as aids in the diagnosis of metastatic renal cell carcinoma, but low specificities often limit their utility. More recently described markers (PAX-2, PAX-8, human kidney injury molecule-1, hepatocyte nuclear factor-1-β, and carbonic anhydrase-IX) offer the potential for greater sensitivity and specificity in this diagnostic setting; however, knowledge of their expected staining in other neoplasms and tissues is critical for appropriate use. In this review, we discuss the most widely used immunohistochemical markers of renal lineage with an emphasis on their sensitivity and specificity for metastatic clear cell renal cell carcinoma. Subsequently, we present a variety of organ-specific differential diagnostic scenarios in which metastatic clear cell renal cell carcinoma might be considered and we propose immunopanels for use in each situation.
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Hevia Suárez M, Abascal Junquera J, Boix P, Dieguez M, Delgado E, Abascal García J, Abascal García R. Manejo de la masa suprarrenal: lo que el urólogo debe saber. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2009.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Qing Y, Bin X, Jian W, Li G, Linhui W, Bing L, Huiqing W, Yinghao S. Adrenal ganglioneuromas: a 10-year experience in a Chinese population. Surgery 2010; 147:854-60. [PMID: 20060552 DOI: 10.1016/j.surg.2009.11.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Accepted: 11/20/2009] [Indexed: 12/17/2022]
Abstract
BACKGROUND Adrenal ganglioneuroma (GN) is extremely rare. The present study is to describe the largest series of this adrenal tumor treated in a single medical center to our knowledge. METHODS Clinical details, radiologic, laboratory, and pathologic findings as well as follow-up data were analyzed retrospectively in 17 patients with incidentally discovered adrenal GN who received operative resection at a tertiary referral hospital in eastern China between June 1999 and June 2009. RESULTS The mean age of the 17 GN patients was 39.2 years (range, 7-72; male:female ratio, 1:2.4), of whom 13 patients had unilateral GN on the right side, and the remaining 4 on the left side. None of the 17 tumors was hormonally active. Only 6 of the 17 GN cases were diagnosed as benign nerve cell tumors by computed tomography or magnetic resonance imaging before operation. Treatment consisted of open unilateral adrenalectomy in 9 patients and laparoscopy in 8 patients. The mean pathologic size of the adrenal GNs was 6.3 +/- 3.1 cm (range, 1.0-13.0). Ultrastructural examination provided additional support for confirming the diagnosis. CONCLUSION Although there have been some clues for radiologic diagnosis of adrenal GN, pre-operative mis- and maldiagnosis are not infrequent. We recommend that complete operative resection should be considered once malignancy cannot be excluded by pre-operative evaluation. Laparoscopic adrenalectomy is a reasonable option at least for tumors < or =7 cm.
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Affiliation(s)
- Yang Qing
- Department of Urology, Changhai Hospital, The Second Military Medical University, Shanghai, China
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García E, Sánchez R, Martínez G, Bernal C, Calatayud M, Partida M, Hawkins F. [Lumbar pain and bilateral adrenal masses]. ACTA ACUST UNITED AC 2009; 56:262-4. [PMID: 19627747 DOI: 10.1016/s1575-0922(09)71409-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 04/07/2009] [Indexed: 11/17/2022]
Abstract
Many problems may arise when defining whether adrenal lesions are primary to the adrenal glands or represent other tissue, whether they are benign or malignant and whether they are functioning or nonfunctioning. Adrenal imaging complements the clinical and hormonal evaluation of these patients. We present a patient with lumbar pain and bilateral adrenal masses.
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Affiliation(s)
- Elena García
- Servicio de Endocrinología y Nutrición, Hospital 12 de Octubre, Madrid, Spain.
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Bin X, Qing Y, Linhui W, Li G, Yinghao S. Adrenal incidentalomas: experience from a retrospective study in a Chinese population. Urol Oncol 2009; 29:270-4. [PMID: 19481963 DOI: 10.1016/j.urolonc.2009.03.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 03/27/2009] [Accepted: 03/31/2009] [Indexed: 01/15/2023]
Abstract
BACKGROUND With no generally accepted criteria for preoperative differential diagnosis between benign and malignant adrenal lesions, management of adrenal incidentalomas, especially those between 4 and 6 cm, remains controversial. PATIENTS AND METHODS Clinical details, radiological diagnosis, laboratory examination, intervention measures, and follow-up data were noted in 152 patients with adrenal incidentaloma hospitalized at a tertiary referral hospital in eastern China between July 1999 and February 2008. Pathologic diagnoses were analyzed in surgical cases. RESULTS Of 143 surgical patients, the mean pathologic size of the tumors was 5.6 ± 3.2 cm (range 0.5 to 22.0 cm). The final benign pathologic diagnosis mainly included adrenocortical adenoma (31.3%), pheochromocytoma (18.8%), myelolipoma (16.7%), and ganglioneuromas (9.0%). The incidence of malignancy was 6.9%. Based on the size criterion of 6 cm, there was a significant difference between malignant and benign tumor groups (P=0.007), but based on the size criterion of 4 or 5 cm, there was no significant difference between the two groups. CONCLUSIONS In our experience, the incidence of malignancy in adrenal incidentalomas was generally low, but relatively high in adrenal incidentalomas >6 cm. Nerve cell tumors constitute a significant number of cases of adrenal incidentaloma. Overtreatment of nonfunctional incidentalomas <4 cm remains frequent in China, and close follow-up for this group is recommended. Factors such as radiologic characteristics and patient concern should be taken into account for nonfunctional incidentalomas between 4 and 6 cm (not including 6 cm), for which laparoscopic adrenalectomy is a reasonable option.
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Affiliation(s)
- Xu Bin
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Haseganu LE, Diehl DL. Left adrenal gland hemorrhage as a complication of EUS-FNA. Gastrointest Endosc 2009; 69:e51-2. [PMID: 19152908 DOI: 10.1016/j.gie.2008.09.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 09/17/2008] [Indexed: 02/08/2023]
Affiliation(s)
- Laura E Haseganu
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania 17822, USA
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41
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Rossi ED, Fadda G. Thin-layer liquid-based preparation of non-gynaecological exfoliative and fine-needle aspiration biopsy cytology. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.mpdhp.2008.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Bakdounes K, Jhala N, Jhala D. Diagnostic usefulness and challenges in the diagnosis of mesothelioma by endoscopic ultrasound guided fine needle aspiration. Diagn Cytopathol 2008; 36:503-7. [PMID: 18528879 DOI: 10.1002/dc.20811] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Malignant mesothelioma is a rare neoplasm. It has been noted in the literature that fine needle aspiration (FNA) is a useful tool for the diagnosis of mesothelioma. However, the differential diagnosis may require use of a battery of immunohistochemical stains. Clinico-radiologic correlation is also crucial. Real time endoscopic ultrasound (EUS) combined with FNA has been shown to be a very sensitive technique to obtain samples from different organ sites, including mediastinal lesions. The use of EUS-FNA for the diagnosis of mesothelioma, reinforces the role of a cytopathologist as a cohesive team player along with a radiologist and a clinician during on-site assessment for the proper triage of additional specimens for ancillary studies leading to a better patient management.
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Affiliation(s)
- Khldoun Bakdounes
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama 3524-7331, USA
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Gao B, Kong F, Xu Z. Development of differential diagnosis for benign and malignant pheochromocytomas. Int J Urol 2008; 15:771-7. [PMID: 18651863 DOI: 10.1111/j.1442-2042.2008.02111.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Unlike common malignant tumors, malignant pheochromocytomas cannot be definitely diagnosed using histological features. This unique nature of pheochromocytomas provides a valuable model that may promote the investigation of the mechanism of other common malignant tumors where similar frameworks are not available. Studies on malignant pheochromocytomas should benefit not only the individuals with pheochromocytomas but those with other tumors. A review on the development of differentiating diagnosis between malignant and benign pheochromocytomas in imaging studies, biological fluid examinations, pathological examinations, molecular markers and genome studies, was updated in the hopes of guiding the next studies of pheochromcytomas.
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Affiliation(s)
- Baohua Gao
- The Fourth Hospital of Jinan City, Shandong University School of Medicine, Jinan, China
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Eloubeidi MA, Morgan DE, Cerfolio RJ, Eltoum IA. Transduodenal EUS-guided FNA of the right adrenal gland. Gastrointest Endosc 2008; 67:522-7. [PMID: 18234198 DOI: 10.1016/j.gie.2007.10.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Accepted: 10/08/2007] [Indexed: 12/10/2022]
Abstract
BACKGROUND EUS-guided FNA is commonly performed to sample peri-intestinal targets such as the pancreas, lymph nodes, and the left adrenal gland. To our knowledge, EUS-guided FNA of the right adrenal gland has not been reported. OBJECTIVE Our purpose was to determine the feasibility and success in sampling an enlarged right adrenal gland. STUDY DESIGN Observational study. SETTING Tertiary referral center. PATIENTS Consecutive patients that underwent EUS-guided FNA of the right adrenal gland. RESULTS Over a span of 3.5 years, 4 patients underwent transduodenal EUS-guided FNA of the right adrenal gland with a curvilinear echoendoscope. Four passes were performed in all cases, and the diagnosis was rendered on the first pass. The posterior wall of the descending duodenum was the port of entry of the needle. Three of the patients had metastatic lung cancer to the right adrenal gland; one was proven by surgical histopathologic examination. One patient had a benign aspirate consistent with angiomyolipoma. None of the patients had any minor or major complications. LIMITATIONS Observational study, small sample size. CONCLUSIONS Transduodenal EUS-guided FNA of the right adrenal gland is feasible and safe. Future large-scale studies are needed to replicate our findings and to determine the rate of successful identification and sampling of the right adrenal gland with the curvilinear echoendoscope.
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Affiliation(s)
- Mohamad A Eloubeidi
- Department of Gastroenterology and Hepatology, University of Alabama in Birmingham, Birmingham, Alabama 35294-0007, USA
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Shami VM, Jones DR, Hernandez A, Stelow EB. Endoscopic ultrasound-guided fine needle aspiration of a malignant pleural effusion to diagnose and stage lung cancer: when should this approach be considered? Dig Dis Sci 2008; 53:757-9. [PMID: 17717747 DOI: 10.1007/s10620-007-9920-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Accepted: 07/04/2007] [Indexed: 12/09/2022]
Affiliation(s)
- Vanessa M Shami
- Department of Medicine, Division of Gastroenterology, University of Virginia Health Sciences, Charlottesville, VA 22908, USA.
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46
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DeWitt JM. Endoscopic ultrasound-guided fine-needle aspiration of right adrenal masses: report of 2 cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:261-267. [PMID: 18204017 DOI: 10.7863/jum.2008.27.2.261] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Although transgastric endoscopic ultrasound (EUS)-guided biopsy is a safe and accurate method for sampling of the left adrenal gland, only 2 reports describing EUS-guided fine-needle aspiration (FNA) of the right adrenal gland have been published to date. The aim of this series was to report 2 additional successful cases of EUS-FNA of right adrenal masses. METHODS In this retrospective single-center case series, prospectively updated cytology and EUS databases between January 1997 and September 2007 were reviewed to identify all patients who underwent attempted EUS-FNA of either adrenal gland. Those who underwent EUS-FNA of the right adrenal gland were identified and reviewed. RESULTS Of 52 consecutive patients who underwent EUS-FNA of either adrenal gland, 2 had attempted biopsy of the right adrenal gland and constituted the study population. The first patient had a history of colon cancer and was found to have a right adrenal mass during workup of jaundice. The second patient also had a history of colon cancer and was found to have an enlarging right adrenal mass and a subcarinal mass during follow-up computed tomography. Endoscopic ultrasound-guided FNA showed a pheochromocytoma in the first patient and metastatic colon cancer in the second patient. No complications were encountered during either procedure. CONCLUSIONS This series further shows that EUS-FNA of right adrenal masses is feasible and may be an option for sampling of these lesions. Prospective studies comparing EUS with percutaneous FNA of adrenal masses are indicated to help delineate the indications and limitations of each technique.
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Affiliation(s)
- John M DeWitt
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis 46202-5121, USA.
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Grimbizis G, Mikos T, Pantazis K, Athanassiou E, Sevastiadou P, Papanicolaou A, Polychronou P, Goulis DG, Tarlatzis B, Bontis JN, Papadimas I. ThinPrep are superior to conventional smears in the cytological diagnosis of subfertile men by testicular fine-needle aspiration. Diagn Cytopathol 2007; 36:1-7. [PMID: 18064691 DOI: 10.1002/dc.20728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this study was the comparison of liquid-based cytology (ThinPrep, TS) to conventional smears (CS) in the investigation of subfertile men with testicular fine-needle aspiration (FNA). Between January and December 2004, testicular FNA biopsies were performed in 30 subfertile men. Both TS and CS were diagnosed according to Meng classification. Features specifically recorded in each smear included sample adequacy, tissue cells preservation, contamination with red blood cells, quality of smear background, ease of cell recognition, and the cytological diagnosis. There was agreement in the cytological diagnosis between TS and CS (P = 0.88) and sample adequacy (P = 0.73). TS was superior to CS regarding cell preservation, presence of red blood cells or tissue artifacts, quality of the smear background, and cell recognition (P < 0.0001). In testicular FNA cytology, TS appear to be superior to CS in respect to cell preservation, absence of red blood cells, background quality, and cell recognition. These advantages, however, are not translated in improved cytological diagnosis.
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Affiliation(s)
- Grigoris Grimbizis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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Ang TL, Chua TS, Fock KM, Tee AKH, Teo T, Mancer K. EUS-FNA of the Left Adrenal Gland is Safe and Useful. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2007. [DOI: 10.47102/annals-acadmedsg.v36n11p954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Introduction: There are limited data on the use of endosonography-guided fine-needle aspiration (EUS-FNA) to determine the nature of left adrenal lesions. We described our experience in performing EUS-FNA of left adrenal lesions.
Clinical Picture: During a 20-week period, data on consecutive patients who underwent EUS with or without EUS-FNA were prospectively captured. Patients with a left adrenal mass and who underwent EUS-FNA formed our study population.
Treatment: EUS-FNA.
Outcome: A total of 119 consecutive patients underwent diagnostic EUS +/- FNA, during which the left adrenal gland was routinely examined. Twelve of these patients underwent EUS as part of lung cancer staging and among these 12 lung cancer patients, 2 had left adrenal masses detected by computed tomography (CT). EUS detected left adrenal nodules in 2 other patients which were not visualised by CT. The overall prevalence of a left adrenal mass was 3.4%; in the subgroup with confirmed lung cancer, the prevalence was 33.3%. All 4 patients were male, with a mean age of 76.3 years (range, 67 to 87). The mean size of the left adrenal lesion was 30.4 mm (range, 9 to 84.8). EUS-FNA of the left adrenal lesions was performed under Doppler guidance. The mean number of needle passes was 2 (range, 1 to 4). A cellular aspirate was obtained in all patients. No procedural complications occurred. Metastatic non-small cell lung cancer was diagnosed in 2 patients, including a lesion missed on CT. For the other 2 cases, EUS-FNA revealed benign adrenal cells.
Conclusions: EUS-FNA appears safe and useful for the evaluation of left adrenal masses.
Key words: Adrenal gland neoplasms, Endosonography
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Affiliation(s)
| | | | | | | | - Tee Teo
- Changi General Hospital, Singapore
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Jhala NC, Eltoum IA, Eloubeidi MA, Meara R, Chhieng DC, Crowe DR, Jhala D. Providing on-site diagnosis of malignancy on endoscopic-ultrasound-guided fine-needle aspirates: should it be done? Ann Diagn Pathol 2007; 11:176-81. [PMID: 17498591 DOI: 10.1016/j.anndiagpath.2006.03.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rapid and accurate tissue diagnosis for a deep-seated malignancy would allow treating physicians to provide disease-specific interventions and help patients make early informed management decisions. Providing on-site tissue diagnosis for fine-needle aspirate samples obtained with endosonography would help develop such efficient patient management issues. Here we report our experience of prospectively providing on-site diagnosis on 485 endoscopic ultrasound fine-needle aspirate samples. METHODS Four hundred eighty-five endoscopic ultrasound fine-needle aspirates from the pancreas (n= 305), lymph nodes (n = 91), biliary tree (n = 47), liver (n = 15), gastrointestinal tract (n = 19), and adrenal gland (n = 8) were reviewed. For all aspirates, the cytologic diagnoses, both preliminary and final, were categorized into the following: positive for malignancy, positive for neoplastic process, suspicious for malignancy, atypical cells, reactive process, and nondiagnostic. RESULTS Of the 485 cases, 163 (33.6%) were diagnosed as benign, 43 (8.8%) as atypical, 21 (4.3%) as suspicious, 18 (3.7%) as positive for neoplasm, and 230 (47.4%) as malignant after final cytologic interpretation. A significantly (P < .001) higher degree of concordance was noted for unequivocal diagnosis of malignancy (196/198, 98.9%) vs nonmalignancy (200/250, 67.2%) between on-site and final cytologic diagnosis. Of the 52 discordant cases, 12 (2.6%) diagnoses were downgraded and 40 (8.9%) were upgraded from preliminary on-site diagnosis. Our overall sensitivity (87 vs 92), specificity (95% vs 100%), and accuracy (90% vs 94%) improved for final cytologic diagnosis. CONCLUSION On-site diagnosis of malignancy could be used to initiate informed patient management decisions. Cases where a diagnosis of malignancy is not rendered at on-site interpretation need further cytologic evaluation.
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Affiliation(s)
- Nirag C Jhala
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
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50
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Abstract
The available tools for diagnosing and staging lung cancer patients can be broadly categorized into non-invasive, minimally invasive and invasive (surgical) modalities. Non-invasive modalities include CT and PET. Minimally invasive modalities are endoscopic approaches, including endoscopic ultrasound, endobronchial ultrasound and transbronchial fine needle aspiration without ultrasound guidance. This review focuses on the non-invasive and minimally invasive techniques involving imaging. Application of Bayesian principles indicates that tests with a high sensitivity and specificity for detection of both systemic metastases and mediastinal nodal involvement are required for treatment selection and planning in patients with non-small cell lung cancer who would be considered for treatment with curative intent. Combined PET/CT using the glucose analogue fluorine-18 fluorodeoxyglucose currently provides the best diagnostic performance for this purpose and should now be considered the standard of care for staging non-small cell lung cancer. Endoscopic ultrasound and endobronchial ultrasound have important complementary roles to allow further evaluation of equivocal nodal abnormalities on PET or CT and to allow pathological samples to be obtained. Diagnostic CT has an important role in defining tumour relations for patients deemed suitable for surgical resection and as the initial investigation for patients with potential symptoms of lung cancer or proven lung cancer that would not be considered for curative treatment on medical grounds.
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Affiliation(s)
- Rodney J Hicks
- Centre for Molecular Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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