1
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He DL, Feng RL, Chai JG, Guo X, Ke CX. Case Report: Adrenal schwannoma associated with ganglioneuroma. Front Surg 2024; 11:1416801. [PMID: 39364374 PMCID: PMC11446904 DOI: 10.3389/fsurg.2024.1416801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 08/28/2024] [Indexed: 10/05/2024] Open
Abstract
Background An adrenal collision tumor (ACT) denotes the presence of distinct tumors with diverse behavioral, genetic, and histological features independently co-existing within the adrenal tissue without intermingling, and occurrences of such cases are infrequent. The concurrent occurrence of adrenal schwannoma and adrenal ganglioneuroma is exceedingly rare, and the diagnosis of these ACTs has been notably challenging due to their atypical clinical manifestations and imaging characteristics. Case summary A 37-year-old man presented to the hospital 3 weeks after a computed tomography (CT) examination that revealed a left adrenal mass. Physical examination findings were unremarkable. Both CT and magnetic resonance imaging scans indicated the presence of a left adrenal mass. Plasma cortisol, adrenocorticotropic hormone, and renin-angiotensin-aldosterone system tests yielded normal results. Preoperative imaging confirmed the diagnosis of left adrenal pheochromocytoma. After thorough surgical preparation, a laparoscopic partial left adrenalectomy was performed. Subsequent postoperative pathological analysis identified adrenal schwannoma in conjunction with adrenal ganglioneuroma. The patient recovered well and was discharged on postoperative day 4. A routine urology clinic visit was included in his postoperative care plan. During follow-up assessments, CT scans of the left adrenal gland revealed no abnormalities. Conclusion Adrenal schwannoma combined with ganglioneuroma represents an exceptionally rare collision tumor characterized by the absence of typical clinical or imaging features, leading to potential misdiagnosis. Adrenal incidentalomas present as multifaceted conditions, and this case serves to heighten awareness of their intricate nature. Due to the challenges in preoperative differentiation of various adrenal mass types, postoperative pathological analysis is imperative for guiding the subsequent treatment course for the patient.
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Affiliation(s)
- Dong-Lin He
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Run-lin Feng
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jia-gui Chai
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xin Guo
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chang-xing Ke
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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2
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Bowling GC, Maloney TJ, Bui QVV, Pavio M, D'Ambrosio D, Chesnut GT. Adrenal cyst presenting with clinical features of a pheochromocytoma. Radiol Case Rep 2024; 19:3855-3860. [PMID: 39035025 PMCID: PMC11259675 DOI: 10.1016/j.radcr.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 07/23/2024] Open
Abstract
Benign adrenal cysts are relatively uncommon variants of all adrenal incidentalomas. When identified, most benign adrenal cysts are asymptomatic, which differentiates them from other functional adrenal lesions. There are various types of adrenal cysts, although the most common being an endothelial cyst. Ultimately, evaluation and management approaches are aimed at ruling out a functional adrenal mass and management of symptoms if present. We present a unique presentation of an otherwise healthy male with a large incidental adrenal cyst, later identified as a benign endothelial cyst, who presented with classic symptoms of catecholamine excess. The patient had a negative hormonal evaluation, and his episodic symptoms were resolved with surgical removal of the adrenal mass. This case report and brief review provides valuable insight into the evaluation and management of a unique clinical scenario, where a benign cystic mass led to compression-related symptoms of catecholamine excess that were resolved after removal of the nonfunctional, cystic, mass.
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Affiliation(s)
- Gartrell C. Bowling
- Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA
| | - Trevor J. Maloney
- Division of Urology, Department of Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Quan VV Bui
- Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA
| | - Michael Pavio
- Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA
- Department of Radiology, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Danielle D'Ambrosio
- Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA
- Department of Pathology and Laboratory Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Gregory T. Chesnut
- Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA
- Division of Urology, Department of Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
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3
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Rueda-de-Eusebio A, de la Torre Serrano M, Victoria Artalejo A, Mendez R. Adrenal Ganglioneuroma With Radiology-Pathology Correlation. Cureus 2024; 16:e69584. [PMID: 39421099 PMCID: PMC11484185 DOI: 10.7759/cureus.69584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2024] [Indexed: 10/19/2024] Open
Abstract
This report presents the case of a 62-year-old male with an incidentally discovered adrenal mass, ultimately diagnosed as a ganglioneuroma after laparoscopic adrenalectomy. Imaging findings, of a 9 cm lobulated mass with heterogeneous enhancement on MRI, were unspecific and malignancy could not be excluded. Histological examination of the specimen revealed a well-demarcated tumor composed of Schwann cells and ganglion cells, confirming the diagnosis. Postoperative follow-up showed no recurrence. This case highlights the critical role of histopathological evaluation for definitive diagnosis, as imaging alone may be insufficient to distinguish adrenal ganglioneuroma from other potential malignancies due to its nonspecific radiological features.
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Affiliation(s)
| | | | | | - Ramiro Mendez
- Department of Radiology, Hospital Clínico San Carlos, Madrid, ESP
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4
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Strikwerda JR, Thompson SM, McKenzie TJ, Shah M, Bancos I, Foster TR. Percutaneous Aspiration and Sclerotherapy as Primary Management for a Symptomatic Benign Adrenal Cyst. JCEM CASE REPORTS 2024; 2:luae110. [PMID: 38989269 PMCID: PMC11234292 DOI: 10.1210/jcemcr/luae110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Indexed: 07/12/2024]
Abstract
Adrenal cysts are a rare benign adrenal pathology. Although the majority of adrenal cysts are asymptomatic, large cysts may present with debilitating symptoms of mass effect. Surgical adrenalectomy or cyst fenestration has been the primary mode of management for such symptomatic cysts, but these interventions can be associated with excessive morbidity, particularly when considered in the context of benign disease. Here, we present a case of a 34-year-old female with a longstanding, growing, benign left adrenal cyst associated with nonspecific abdominal symptoms. After multidisciplinary discussion, the patient was managed with primary ultrasound/fluoroscopic guided percutaneous sclerotherapy of her adrenal cyst. This technique achieved complete cyst resolution that was durable on 7-month follow-up and was associated with significant improvement of the patient's symptoms. This case illustrates the potential for primary percutaneous sclerotherapy for primary management of benign adrenal cysts.
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Affiliation(s)
- John R Strikwerda
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Scott M Thompson
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Travis J McKenzie
- Division of Endocrine and Metabolic Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Meera Shah
- Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Trenton R Foster
- Division of Endocrine and Metabolic Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
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5
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Kanthawang T, Pattamapaspong N, Peh WCG, Hammami N, Bouaziz MC, Ladeb MF. Imaging of infra-thoracic tuberculosis. Br J Radiol 2024; 97:492-504. [PMID: 38288505 DOI: 10.1093/bjr/tqad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/16/2023] [Accepted: 11/29/2023] [Indexed: 03/01/2024] Open
Abstract
Tuberculosis (TB) is a potentially curable disease that is a leading cause of death globally. While it typically affects the lungs, this disease may involve many extra-pulmonary sites, particularly in patients with risk factors. Extra-pulmonary TB often mimics a variety of different diseases, posing a diagnostic dilemma. Imaging aids in early diagnosis of TB, especially in patients with non-specific or atypical symptoms found at extra-pulmonary infra-thoracic locations. Imaging also helps guide appropriate laboratory investigation, monitor disease progress, and response to treatment. This review aims to highlight the imaging spectrum of TB affecting the infra-thoracic region, that is, gastrointestinal tract, abdominal lymph nodes, peritoneal cavity, intra-abdominal solid organs, and urogenital system.
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Affiliation(s)
- Thanat Kanthawang
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore 768828
| | - Nadia Hammami
- Department of Neuroradiology, National Institute of Neurology Mongi Ben Hamida, Tunis 1007, Tunisia
| | - Mouna Chelli Bouaziz
- Department of Radiology, Faculty of Medicine of Tunis, MT Kassab Institute of Orthopaedics, Tunis-El Manar University, Ksar Said, Tunis 2010, Tunisia
| | - Mohamed Fethi Ladeb
- Department of Radiology, Faculty of Medicine of Tunis, MT Kassab Institute of Orthopaedics, Tunis-El Manar University, Ksar Said, Tunis 2010, Tunisia
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6
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Bozic Antic I, Djurisic I, Nikolic S. Adrenal Cysts: To Operate or Not to Operate? J Clin Med 2024; 13:846. [PMID: 38337539 PMCID: PMC10856713 DOI: 10.3390/jcm13030846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Adrenal cysts are uncommon and usually asymptomatic, and therefore are usually incidentally discovered adrenal lesions. They have a broad pathohistological spectrum that includes pseudocysts and endothelial (vascular), parasitic, and epithelial (mesothelial) cysts. Although most adrenal cysts are benign and hormonally non-functional lesions, some can have ambiguous imaging appearances and mimic malignant adrenal neoplasms. On the other hand, the actual malignant neoplasms could undergo cystic transformation. Additionally, immune cell infiltrations, thrombosis, or haemorrhage seen in sepsis can frequently cause adrenal cyst development, raising a question about the possible connection between severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and adrenal cystic lesions. Due to the disease's rarity, the likelihood of malignancy, and the lack of specific guidelines, the management of adrenal cysts is always challenging especially in a young person. This review discusses the important diagnostic and the current treatment possibilities for adrenal cystic lesions. Aiming to emphasize clinical dilemmas and help clinicians navigate the challenges when encountering a patient with an adrenal cyst in everyday practice, we based our review on a practical question-answer framework centred around the case of a young woman with an incidentally discovered large adrenal cyst.
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Affiliation(s)
- Ivana Bozic Antic
- Department of Endocrinology, Euromedik General Hospital, 11000 Belgrade, Serbia
- Faculty of Dentistry Pancevo, University Business Academy, 21000 Novi Sad, Serbia
| | - Igor Djurisic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia
| | - Srdjan Nikolic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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7
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Abstract
Cystic lesions of the adrenal glands are relatively uncommon and most of them are clinically silent. Though rarely associated with malignant changes, they may carry clinically detrimental consequences if misdiagnosed. Cystic adrenal lesions exhibit a broad histomorphological spectrum, ranging from pseudocysts, endothelial cysts, epithelial cysts and parasitic cysts. Here we present the case of a young woman with left-sided abdominal pain and contrast-enhanced CT showing a 10.4×7.7×7.8 cm fluid-filled left suprarenal lesion. The patient underwent exploratory laparotomy with cyst excision, and the histopathological examination of the specimen revealed a pseudocyst of the left adrenal gland. Despite being rare, usually benign and asymptomatic, the diagnosis and management of these cystic lesions of the adrenal glands are often unclear. Any functional lesion, potentially malignant lesion or lesion more than 5 cm deserves surgical management, whereas others can be managed conservatively.
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Affiliation(s)
- Sanket Solanki
- Surgical Gastroenterology, HPB Surgery and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Sonia Badwal
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Samiran Nundy
- Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, Delhi, India
| | - Naimish N Mehta
- Surgical Gastroenterology, HPB Surgery and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
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8
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Feng Q. Right adrenal cystic mature teratoma: Masquerading as high density mass. Am J Med Sci 2023; 365:e73-e74. [PMID: 36574816 DOI: 10.1016/j.amjms.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/30/2022] [Accepted: 12/15/2022] [Indexed: 12/26/2022]
Affiliation(s)
- Qianqian Feng
- Department of Radiology, Affiliated Hospital of Southwest Medical University, LuZhou, Sichuan, China.
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9
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Calissendorff J, Juhlin CC, Sundin A, Bancos I, Falhammar H. Adrenal cysts: an emerging condition. Nat Rev Endocrinol 2023:10.1038/s41574-023-00835-2. [PMID: 37095252 DOI: 10.1038/s41574-023-00835-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 04/26/2023]
Abstract
Adrenal cysts are rare lesions representing approximately 1-2% of adrenal incidentalomas. The majority of these rare lesions are benign. Rarely, phaeochromocytomas and adrenal malignant masses can present as cystic lesions and can occasionally be difficult to distinguish from benign cysts. Histologically, adrenal cysts are subdivided into pseudocysts, endothelial cysts, epithelial cysts and parasitic cysts. The radiological appearance of an adrenal cyst is generally similar to that of cysts in the kidney. They are thus well demarcated, usually rounded, with a thin wall and homogenous internal structure, low attenuating (<20 Hounsfield Units) on CT, low signalling on T1-weighted MRI sequences and high signalling on T2-weighted MRI sequences, and anechoic or hypoechoic on ultrasonography. Benign adrenal cysts have a slight female predominance and are usually diagnosed between the ages of 40 and 60. Most adrenal cysts are asymptomatic and are detected incidentally, although very large adrenal cysts can lead to mass effect symptoms, with surgery required to alleviate the symptoms. Thus, conservative management is usually recommended for asymptomatic cysts. However, when uncertainty exists regarding the benign nature of the cyst, additional work-up or follow-up is needed. The management of an adrenal cyst should preferably be discussed at an adrenal multidisciplinary team meeting.
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Affiliation(s)
- Jan Calissendorff
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Sundin
- Department of Surgical Sciences, Radiology & Molecular Imaging, Uppsala University, Uppsala, Sweden
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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10
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Abstract
Adrenal ganglioneuroma (AGN) are sympathetic differentiated tumors that originate from neural crest cells. It is a rare benign tumor in children and young adults. These lesions are usually asymptomatic and tend to be hormonally silent. Their discovery is fortuitous in imaging examinations. Preoperative diagnosis remains difficult, and the gold standard treatment is adrenalectomy. There is a good prognosis after surgery without recurrence. We herein report a case of adrenal ganglioneuroma in a 40-year-old man who benefited from an abdominal CT scan in the face of a complaint of abdominal discomfort and as part of the extension assessment of his colonic adenocarcinoma. Abdominal CT scan with contrast showed a left retroperitoneal mass of triangular shape within the adrenal lodge of tissue density, containing some calcifications not enhanced after injection of contrast product, measuring 90 x 62 mm in diameter (AP x T) with a relative washout calculated at 30%. Biopsy and histological examination of the mass suggested an adrenal ganglioneuroma.
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11
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Assarrar I, Harhar M, Zerrouki D, Draoui N, Miry A, Bennani A, Rouf S, El Harroudi T, Latrech H. Primary adrenal mature teratoma: A rare case report and review of literature. Ann Med Surg (Lond) 2022; 75:103422. [PMID: 35386796 PMCID: PMC8977937 DOI: 10.1016/j.amsu.2022.103422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Teratoma is a germ cell tumor, deriving from totipotent cells. Teratomas usually occur in gonads and are rarely extra-gonadal. The adrenal location is exceptional. Only few cases of primary adrenal teratomas have been reported in literature, mainly in young patients. Case report We report the case of a 56-year-old female patient who presented with pyrosis, dyspepsia and abdominal pain that was evolving for 5 months. The abdominal computed tomography revealed a voluminous mass of the right adrenal gland and the hormonal evaluation was normal. The patient underwent an open transperitoneal adrenalectomy and the histopathological examination of the specimen confirmed the diagnosis of mature teratoma. Discussion Adrenal teratomas are commonly asymptomatic and their diagnosis depends mostly on radiologic findings. Malignant transformation is very rare. Surgical excision is the mainstay of treatment with a good prognosis. Conclusion Open surgery should always be considered in large and adhering teratoma tumors of the adrenal gland. Some pathologic features and tumorigenesis of adrenal teratomas are not entirely elucidated, thus the importance of larger studies in order to comprehend this pathological entity. The adrenal location of primary adrenal teratomas is exceptional. The preoperative diagnosis is challenging, based mainly on imaging findings. Open surgery should always be considered in large and adhering teratoma tumors of the adrenal gland.
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Affiliation(s)
- Imane Assarrar
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Marouane Harhar
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Surgical Oncology, Regional Oncology Center, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Dounia Zerrouki
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Najat Draoui
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Achraf Miry
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Laboratory of Anatomic Pathology, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Amal Bennani
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Laboratory of Anatomic Pathology, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Siham Rouf
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Tijani El Harroudi
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Surgical Oncology, Regional Oncology Center, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Hanane Latrech
- Department of Endocrinology-Diabetology and Nutrition, Mohammed VI University Hospital Center, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Corresponding author. Mohammed VI University Hospital Center, 4806, 60049, Oujda, Morocco.
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12
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Cystic adrenal masses: spectrum of multimodality imaging features and pathological correlation. Clin Radiol 2022; 77:479-488. [DOI: 10.1016/j.crad.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022]
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13
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Giant symptomatic adrenal myelolipoma: A case report. Ann Med Surg (Lond) 2022; 75:103333. [PMID: 35198182 PMCID: PMC8844840 DOI: 10.1016/j.amsu.2022.103333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
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14
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Gündoğdu E, Oğuzman M, Emekli E, Kebapçı M. Are the washout values currently accepted for lesion characterization in dedicated adrenal CT adequate for diagnosis? DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY (ANKARA, TURKEY) 2021; 27:694-702. [PMID: 34792022 DOI: 10.5152/dir.2021.20508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to investigate the accuracy of density characteristics and washout values of lesions detected on computed tomography (CT) at the cutoff values obtained from the literature by taking the pathological results of adrenalectomy specimens as reference and to determine the cutoff values of parameters evaluated on CT for the differentiation of adenoma and nonadenoma lesions in the study group. METHODS Hospital records and standard CT imaging data (noncontrast early phase [65 s] and late phase [15 min] ) of 84 patients with 87 lesions who underwent adrenalectomy between January 2012 and December 2018 were retrospectively reevaluated by two radiologists in consensus. The patients were categorized as having adenoma and nonadenoma lesions according to the pathology results. The sensitivity, specificity and diagnostic accuracy of CT parameters (density values and washout percentages) were evaluated. Differences in the CT parameters (size, noncontrast and early-late enhancement density and absolute and relative washout values) were investigated. The optimal cutoff values of CT parameters were determined by ROC analysis. RESULTS Noncontrast CT had a specificity of 87.75% and 95.9%, sensitivity of 60% and 48.6%, diagnostic accuracy of 77.7% and 89.47% for adenomas, at the cutoff values of ≤10 HU and ≤0 HU, respectively. For absolute washout value ≥ 60%, the sensitivity, specificity and accuracy were 64.7%, 52.38% and 56.75%, respectively; while these rates were 76.47%, 56.52% and 62.16%, respectively, for relative washout value ≥40%. Adenomas and nonadenomas showed significant difference in terms of size (p < 0.0001), unenhanced attenuation (p < 0.0001), relative washout (p = 0.020) and delay enhancement (p < 0.001). But there were no differences in terms of absolute washout (p = 0.230) and early enhancement (p = 0.264). The cutoff values for the differentiation of adenomas and nonadenomas were as follows: size ≤44 mm, noncontrast density <20 HU, early-phase density ≥45 HU, delayed-phase density ≤44 HU, absolute washout 74.83% and relative washout 57.76%. CONCLUSION The current washout criteria used in the differentiation of adenoma and nonadenoma lesions in dynamic CT imaging can give false negative and positive results. According to the existing criteria, the most reliable parameter in adenoma-nonadenoma differentiation is ≤ 0 HU noncontrast CT density value.
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Affiliation(s)
- Elif Gündoğdu
- Department of Radiology, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Mehmet Oğuzman
- Department of Radiology, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Emre Emekli
- Department of Radiology, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Mahmut Kebapçı
- Department of Radiology, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
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15
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Buryakina SA, Tarbaeva NV, Volevodz NN, Karmazanovsky GG, Kovalevich LD, Shestakova MV, Dedov II. Adrenal incidentaloma. Part 2. Modern concepts of computed tomography semiotics of adrenal gland incidentalomas: algorithm of differential diagnosis. TERAPEVT ARKH 2021; 93:1381-1388. [DOI: 10.26442/00403660.2021.11.201169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 11/22/2022]
Abstract
While accidentally detecting an adrenal gland lesion (incidentaloma) during a routine computed tomography (CT) scan, the radiologist should correctly interpret revealed changes. The most common lesion is adenoma with high lipid content, but a lipid poor adenoma, pheochromocytoma, adrenocortical cancer, metastasis and other less common adrenal diseases are also worth of attention and require detailed knowledge of their CT semiotics. The article presents criteria of differential diagnosis of the adrenal incidentalomas on the basis of which an algorithm of differential diagnosis was proposed for the most common adrenal lesions.
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16
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Janjua A, Sarwar MZ, Naqi SA. Adrenal Schwannoma: A Case Report. Int Med Case Rep J 2021; 14:617-620. [PMID: 34526828 PMCID: PMC8435475 DOI: 10.2147/imcrj.s311777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/18/2021] [Indexed: 01/25/2023] Open
Abstract
Schwannoma of the adrenal gland is very rare, comprising 0.2% of adrenal tumors, presenting usually as non-specific abdominal pain. We report such a rare case in a 50-year-old female. Her only complaint was right lumbar pain. Ultrasonography (USG) and computed tomography (CT) both showed a supra renal cystic mass most likely of adrenal origin. Excision of mass was performed. Post-operative course was uneventful. Histopathology showed a benign tumor of Schwann cell origin. Usually, pre-operative imaging including CT and magnetic resonance imaging (MRI) are inconclusive and diagnosis has to be confirmed on histopathology.
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Affiliation(s)
- Azwa Janjua
- Department of Surgery, East Surgical Ward, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Muhammad Zeeshan Sarwar
- Department of Surgery, East Surgical Ward, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Syed Asghar Naqi
- Department of Surgery, East Surgical Ward, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
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Kim DS, Lee JW, Lee SH. Spontaneous rupture of adrenal myelolipoma as a cause of acute flank pain: A case report. World J Clin Cases 2021; 9:6552-6556. [PMID: 34435025 PMCID: PMC8362562 DOI: 10.12998/wjcc.v9.i22.6552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/02/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adrenal myelolipoma is a rare, benign, non-functioning mass that occurs in the adrenal gland. It is composed of an admixture of hematopoietic elements and mature adipose tissue, similar to bone marrow. Even at large sizes, adrenal myelolipomas are usually asymptomatic and often incidentally found by ultrasonography or computed tomography (CT) scan. This paper describes an unusual case of adrenal myelolipoma presenting as flank pain.
CASE SUMMARY A 50-year-old male with severe right flank pain underwent a CT scan revealing a huge mass extending into the suprarenal space. The mass showed a fat component with retroperitoneal hemorrhage. The tumor was treated laparoscopically, and pathologic examination revealed features of myelolipoma originating from the adrenal gland.
CONCLUSION Adrenal myelolipomas are generally asymptomatic and can be treated conservatively. However, rupture and hemorrhage of the tumor can cause symptoms requiring surgical removal.
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Affiliation(s)
- Dong Soo Kim
- Department of Urology, School of Medicine, Kyung Hee University, Seoul 02447, South Korea
| | - Jeong Woo Lee
- Department of Urology, School of Medicine, Kyung Hee University, Seoul 02447, South Korea
| | - Sang Hyub Lee
- Department of Urology, School of Medicine, Kyung Hee University, Seoul 02447, South Korea
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18
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Karaosmanoglu AD, Onder O, Leblebici CB, Sokmensuer C, Akata D, Ozmen MN, Karcaaltincaba M. Cross-sectional imaging features of unusual adrenal lesions: a radiopathological correlation. Abdom Radiol (NY) 2021; 46:3974-3994. [PMID: 33738556 DOI: 10.1007/s00261-021-03041-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/28/2021] [Accepted: 03/05/2021] [Indexed: 12/11/2022]
Abstract
The detection rates of adrenal masses are increasing with the common and widespread use of cross-sectional imaging. Adrenal adenomas, myelolipomas, metastases, pheochromocytomas, and adrenocortical tumors are well-known and relatively common adrenal tumors. However, there are many less-known neoplastic and nonneoplastic adrenal diseases that might affect the adrenal glands in addition to these common lesions. These rare entities include, but are not limited to, hydatid cysts, congenital adrenal hyperplasia, Wolman disease, adrenal tuberculosis, primary adrenal lymphoma. This article aims to present imaging findings of these unusual lesions in accordance with their pathologic characteristics. We think that the simultaneous presentation of the pathological findings with the imaging features may facilitate the learning process and may potentially enhance the recognition of these entities.
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Affiliation(s)
| | - Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Can Berk Leblebici
- Department of Pathology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Cenk Sokmensuer
- Department of Pathology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
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19
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Zhang QW, Song T, Yang PP, Hao Q. Retroperitoneum ganglioneuroma: imaging features and surgical outcomes of 35 cases at a Chinese Institution. BMC Med Imaging 2021; 21:114. [PMID: 34294064 PMCID: PMC8296746 DOI: 10.1186/s12880-021-00643-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/07/2021] [Indexed: 11/15/2022] Open
Abstract
Background The preoperative evaluation is crucial for diagnosis and surgical plan of retroperitoneum ganglioneuroma (GN). In this study, we reviewed a relatively large series of histopathological proved retroperitoneum GN cases, summarized the imaging features and further depicted risk factors of increased surgical blood loss. Methods A total of 35 (18 male, 17 female) patients were retrospectively enrolled from January 2012 to June 2019 at our institution. Among them, 24 patients had undergone CT scans and 19 patients had undergone MR examination before treatment. The clinical and radiological features were analyzed and the relationships between image features and surgical blood loss were evaluated. Results The media age of the involved 35 patients was 40 years (range, 14–66 years). The histological tumor size was 10.12 ± 4.56 cm for average. Retroperitoneum GN was relatively low density on unenhanced CT images and showed delayed progressive enhancement on enhanced CT and MR images. The whorled sign could be seen in 14 patients. The vessel encasement sign could be found in 17 patients. Univariate analysis revealed maximal tumor size measured on axial image, maximal tumor size measured on coronal image, encasing one or both renal pedicles, encasing the aorta and/or vena cava and whorled sign on MRI showed significant difference between the blood loss ≥ 400 ml and blood loss < 400 ml group. Logistic regression further detected that maximal tumor size measured on axial images (OR: 1.12; 95% CI: 1.02–1.24; P = 0.023) and encasing one or both renal pedicles (OR: 22.39; 95% CI: 1.35–372.99; P = 0.030) were independently correlated with surgical blood loss. Conclusions Preoperative CT and MR imaging analysis was valuable for both diagnosis and surgical risk prediction of retroperitoneum GN.
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Affiliation(s)
- Qian-Wen Zhang
- Department of Radiology, Changhai Hospital, The Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, China
| | - Tao Song
- Department of Radiology, Changhai Hospital, The Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, China
| | - Pan-Pan Yang
- Department of Radiology, Changhai Hospital, The Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, China
| | - Qiang Hao
- Department of Radiology, Changhai Hospital, The Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, China.
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20
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Vassallo L, Fasciano M, Baralis I, Pellegrino L, Fortunato M, Orcioni GF, Sorrentino S. A rare case of adrenal ganglioneuroblastoma-intermixed in an adult and a review of literature. Radiol Case Rep 2021; 16:2351-2356. [PMID: 34306280 PMCID: PMC8258789 DOI: 10.1016/j.radcr.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 11/04/2022] Open
Abstract
Peripheral neuroblastic tumors are extremely rare in the adult with less just over 20 cases involving adrenal gland described in the literature. We reported herewith the case of a 22-year-old young male who presented with epigastric pain and diarrhea. Imaging studies documented a 3.5cm x 3cm x 4cm solid well-circumscribed right adrenal mass, of heterogeneous structure and with fine calcifications. The lesion turned negative at MIBG scintigraphy. A right robotic-assisted adrenalectomy was performed leading to complete excision of the lesion without complications. Histology was consistent with intermixed stroma-rich ganglioneuroblastoma. A wait-and-see strategy was considered adequate. Two years after diagnosis patient is alive disease-free. Although the definitive diagnosis of a peripheral neuroblastic tumor is obtained after histopathological analysis, CT, and MRI are helpful to further characterize masses and useful in pretreatment risk stratification. Clinicians should be aware of the possibility of GNB development in adult population and its malignant potential.
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Key Words
- ADC, Apparent Diffusion Coefficient
- Adrenal gland
- Adult
- CT, Computed Tomography
- Computed tomography
- GN, Ganglioneuroma
- GNB, Ganglioneuroblastoma
- Ganglioneuroblastoma
- INPC, International Neuroblastoma Pathology Classification
- INRG, International Neuroblastoma Risk Group
- INSS, International Neuroblastoma Staging System
- MRI, Magnetic Resonance Imaging
- Magnetic resonance imaging
- NB, Neuroblastoma
- Neuroblastoma
- PNT, Neuroblastic tumors
- RT, Radiotherapy
- US, Ultrasound
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Affiliation(s)
- Lorenzo Vassallo
- Unit of Radiology, S.S. Annunziata Hospital, ASLCN1, Via degli Ospedali 9, 12038, Cuneo, Italy
| | - Mirella Fasciano
- Unit of Radiology, S.S. Annunziata Hospital, ASLCN1, Via degli Ospedali 9, 12038, Cuneo, Italy
| | - Ilaria Baralis
- Department of Diagnostic and Interventional Radiology, S. Croce e Carle Hospital, Via Michele Coppino 26, 12100, Cuneo, Italy
| | - Luca Pellegrino
- General and Oncologic Surgery Unit, Department of Surgery, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100, Cuneo, Italy
| | - Mirella Fortunato
- Department of Pathology, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100, Cuneo, Italy
| | | | - Stefania Sorrentino
- Unit of Pediatric Oncology, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genoa, Italy
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21
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Buryakina SA, Tarbaeva NV, Volevodz NN, Karmazanovsky GG, Kovalevich LD, Shestakova MV, Dedov II. [Adrenal incidentaloma. Part 1. Computed tomography of adrenal incidentaloma: the possibilities and difficulties of differential diagnosis]. TERAPEVT ARKH 2020; 92:185-194. [PMID: 33720593 DOI: 10.26442/00403660.2020.12.200451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 11/22/2022]
Abstract
The adrenal incidentaloma is a lesion of a different etiology and found incidentally in patients who underwent a diagnostic study not about the disease of this organ. Lesions can be both hormonally inactive and hormonally active, can arise from different zones of the adrenal gland or have non-specific organ affiliation, can be benign or malignant. Computed tomography characterization of these lesions, especially the differential diagnosis of benign and malignant, is extremely important for the correct diagnosis in order to provide adequate management of the patient. The article presents the key computed tomography criteria that allow radiologist to characterize the lesion most accurately and consider appropriate diagnosis.
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Affiliation(s)
- S A Buryakina
- Endocrinology Research Centre
- Vishnevsky National Medical Research Centre of Surgery
| | - N V Tarbaeva
- Endocrinology Research Centre
- Vishnevsky National Medical Research Centre of Surgery
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22
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Shao M, Zhang W, Niu Z, Chen S, Jia Y, An Y, Zhu F, Wang J. Computed tomography characteristics of adrenal ganglioneuroma: a retrospective analysis of 30 pathologically-confirmed cases. J Int Med Res 2020; 48:300060520945510. [PMID: 33176508 PMCID: PMC7673062 DOI: 10.1177/0300060520945510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective To investigate the computed tomography (CT) characteristics of adrenal ganglioneuromas (AGNs) and to determine the ability of CT scanning to distinguish between large (>3 cm) and small (≤3 cm) AGNs. Methods This retrospective study searched the electronic medical record system of a hospital between January 2008 and July 2019 in order to identify patients with pathologically-confirmed AGNs that underwent three phases of CT scanning. The CT features were compared between large and small AGNs. Results A total of 30 patients with pathologically-confirmed AGNs were included in the study. The majority of patients (76.7%; 23 of 30) were asymptomatic and there were nonspecific symptoms in seven patients. The ‘pointed peach’ sign appeared in more than half of the patients (53.3%; 16 of 30). The CT value of the arterial phase, progressive enhancement, morphology and calcification in the CT images were found to be significantly different between large and small AGNs. Progressive enhancement was more likely to occur in small AGNs. Most large AGNs had irregular shapes, while small AGNs were likely to be round or oval with a smooth border. Calcifications were noted in large AGNs (42.9%; six of 14). Conclusion CT scanning can show many of the key imaging characteristics of AGNs used to distinguish between large and small AGNs.
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Affiliation(s)
- Meihua Shao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Wenming Zhang
- Department of Radiology, Zhejiang University School of Medicine Sir Run Shaw Hospital, Hangzhou, Zhejiang Province, China
| | - Zhongfeng Niu
- Department of Radiology, Zhejiang University School of Medicine Sir Run Shaw Hospital, Hangzhou, Zhejiang Province, China
| | - Songkuan Chen
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Yuzhu Jia
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Yongyu An
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Fangmei Zhu
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Jian Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
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23
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AT P, Lakshman K. Laparoscopic management of an adrenal cyst – A case report. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2020. [DOI: 10.25083/2559.5555/5.2/116.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Adrenal cysts are generally rare clinical entity, but due to advances in imaging diagnostic methods, detection incidental cases are increasing. Therefore, discussions about the therapeutic management of these cases are more numerous, due to the growing number of cases. We present a case of a 29-year-old woman who has had complaints of headaches and right low back pain in the last week. She had a history of high blood pressure in the past 6 months. Clinical examination was essentially normal. Routine blood investigations including a workup for pheochromocytoma was normal. CT abdomen and pelvis showed 8x8x8cm cyst in the right adrenal gland. We decided to perform a laparoscopic excision of the adrenal cyst and successfully excised the adrenal cyst, fully saving the adrenal gland. Laparoscopic excision of the adrenal cyst seems to be the best recommended treatment option for these pathologies. The probability of recurrence after surgical excision is low.
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24
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Abstract
Adrenal abscesses are extremely rare occurrences with only scattered case reports reported in the literature. Owing to their rarity, they are not usually considered within the typical differential for cystic adrenal masses discovered on computed tomography (CT) or magnetic resonance imaging (MRI). Accurate and timely diagnosis of these lesions is critical to exclude malignancy and ensure appropriate management. In this case report, we describe a post-traumatic case of adrenal abscess associated with Staphylococcus aureus bacteremia and its differentiation from cystic adrenal masses. Specific emphasis is placed on the imaging features seen on CT and MRI and how these features can be utilized to differentiate it from other adrenal pathologies such as adrenal pseudocyst or cystic adrenocortical neoplasm.
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25
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Ahmed AA, Thomas AJ, Ganeshan DM, Blair KJ, Lall C, Lee JT, Morshid AI, Habra MA, Elsayes KM. Adrenal cortical carcinoma: pathology, genomics, prognosis, imaging features, and mimics with impact on management. Abdom Radiol (NY) 2020; 45:945-963. [PMID: 31894378 DOI: 10.1007/s00261-019-02371-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Adrenocortical carcinoma (ACC) is a rare tumor with a poor prognosis. Most tumors are either metastatic or locally invasive at the time of diagnosis. Differentiation between ACC and other adrenal masses depends on clinical, biochemical, and imaging factors. This review will discuss the genetics, pathological, and imaging feature of ACC.
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Affiliation(s)
- Ayahallah A Ahmed
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Aaron J Thomas
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Dhakshina Moorthy Ganeshan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Katherine J Blair
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - James T Lee
- Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| | - Ali I Morshid
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Mouhammed A Habra
- Departments of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
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26
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Dell'Aversano Orabona G, Ricci D, Emili I, Serpi F, Ferrara V, Vanzulli A. Adrenal schwannoma: a case report. BJR Case Rep 2020; 6:20190044. [PMID: 32201601 PMCID: PMC7068090 DOI: 10.1259/bjrcr.20190044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 11/05/2022] Open
Abstract
Retroperitoneum is an uncommon site for Schwannoma tumors and among adrenal incidentaloma the Schwannoma is rare. This condition lacks of a specific clinical and radiological features, but correct diagnosis before pathological examination should be very important for clinical management and surgical decision. We describe a case of voluminous retroperitoneal incidental mass, that was proved to be an adrenal Schwannoma.
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Affiliation(s)
| | - Domenico Ricci
- Department of Biomedical Sciences for Health, University of Milan -Via Carlo Pascal 35, 20133, Milan, Italy
| | - Ilaria Emili
- Department of Biomedical Sciences for Health, University of Milan -Via Carlo Pascal 35, 20133, Milan, Italy
| | - Francesca Serpi
- Department of Biomedical Sciences for Health, University of Milan -Via Carlo Pascal 35, 20133, Milan, Italy
| | - Valerio Ferrara
- Department of Biomedical Sciences for Health, University of Milan -Via Carlo Pascal 35, 20133, Milan, Italy
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27
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Wan S, Liu X, Tian B, Cao D, Li M, He Y, Song B. An Unexpected Case Report of Adrenal Lymphangioma: Mimicking Metastatic Tumor on Imaging in a Patient With Pancreatic Cancer. Front Endocrinol (Lausanne) 2020; 11:610744. [PMID: 33488523 PMCID: PMC7815587 DOI: 10.3389/fendo.2020.610744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/23/2020] [Indexed: 02/05/2023] Open
Abstract
Adrenal lymphangioma is a very rare benign lesion worldwide and remains challenging for early diagnosis, especially when the patient has some complicated clinical disease. This is an unusual case of a 68-year-old man who was admitted to our hospital with a history of pancreatic tumor. Computed tomography (CT) images and subsequent magnetic resonance imaging (MRI) revealed a mass located in the left adrenal gland, presenting a similar enhancement pattern of the pancreatic tumor, and according to the imaging features, the patient was suspected to have an adrenal metastatic tumor originating from the pancreatic tumor. The patient underwent a surgical resection of the pancreatic tumor and the left adrenal gland. The pathologic diagnosis proved to be lymphangioma deriving from the left adrenal gland. This is the first report presenting an atypical adrenal lymphangioma mimicking a metastatic tumor of pancreatic origin, which might be suggestive in the diagnosis of adrenal lesions and the subsequent clinical treatment, especially when patient has a particular medical history. As we know, imaging examination is helpful for accurate preoperative diagnosis; however, the diagnosis of malignant tumor solely based on imaging procedures should be made cautiously by radiologists.
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Affiliation(s)
- Shang Wan
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xijiao Liu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Bole Tian
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Dan Cao
- Department of Oncology, West China Hospital of Sichuan University, Chengdu, China
| | - Mao Li
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yuhao He
- Department of Neurosurgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Bin Song
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Bin Song,
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28
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Ban A, Satapara J, Rathod K, Bahri N. Teratoma involving adrenal gland - A case report and review of literature. Indian J Radiol Imaging 2019; 29:472-476. [PMID: 31949356 PMCID: PMC6958897 DOI: 10.4103/ijri.ijri_452_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 04/26/2019] [Accepted: 06/20/2019] [Indexed: 12/11/2022] Open
Abstract
Teratomas are germ cell tumors which are mainly gonadal in origin. Other common extra-gonadal sites are mediastinal, sacro-coccygeal and pineal regions. Adrenal teratomas are extremely rare and primary adrenal teratomas are even rarer. We reported a case of primary adrenal teratoma in a 60-year-old male. We reviewed literature from 2000 to till date, and found 29 adult cases and 6 paediatric cases of adrenal teratoma. Usually, they are asymptomatic and identified as an incidental finding. Imaging modality such as USG, CT and MRI are useful in diagnosis. Though these tumors are mostly benign, malignant transformation may occur. Treatment includes surgical removal.
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Affiliation(s)
- Amit Ban
- Department of Radiodiagnosis, Shri M.P. Shah Government Medical College and Shri Gurugobind Singh Government Hospital, P.N. Marg, Jamnagar, Gujarat, India
| | - Jay Satapara
- Department of Radiodiagnosis, Shri M.P. Shah Government Medical College and Shri Gurugobind Singh Government Hospital, P.N. Marg, Jamnagar, Gujarat, India
| | - Ketan Rathod
- Department of Radiodiagnosis, Shri M.P. Shah Government Medical College and Shri Gurugobind Singh Government Hospital, P.N. Marg, Jamnagar, Gujarat, India
| | - Nandini Bahri
- Department of Radiodiagnosis, Shri M.P. Shah Government Medical College and Shri Gurugobind Singh Government Hospital, P.N. Marg, Jamnagar, Gujarat, India
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29
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Bhargava P, Sangster G, Haque K, Garrett J, Donato M, D'Agostino H. A Multimodality Review of Adrenal Tumors. Curr Probl Diagn Radiol 2019; 48:605-615. [DOI: 10.1067/j.cpradiol.2018.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 10/16/2018] [Indexed: 12/15/2022]
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30
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Wang J, Zhang J, Xiao C, Fan C. Laparoscopic simultaneous resection of bilateral giant primary mature retroperitoneal teratoma of the adrenal region: A case report. Medicine (Baltimore) 2019; 98:e17836. [PMID: 31689872 PMCID: PMC6946520 DOI: 10.1097/md.0000000000017836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Giant mature retroperitoneal teratoma of the adrenal region is quite rare in adults. In most cases, open adrenalectomy is required to ensure complete resection. We describe a case of bilateral giant primary mature cystic teratoma in the region of both adrenal glands in a 22-year-old female patient. PATIENT CONCERNS A 22-year-old female patient was admitted to our hospital with no complain after detecting to have 2 giant well circumscribed masses in a routine investigation. DIAGNOSES She was diagnosed with bilateral giant primary mature retroperitoneal teratoma of the adrenal region. INTERVENTIONS The patient underwent en bloc excision of the mass through laparoscopic simultaneous resection. OUTCOMES We carefully separated and retained most of the adrenal tissue on both sides during surgery. Pathology reported mature teratomas. Eleven days after operation, the patient made uneventful recovery and left the hospital without any complication. LESSONS Preoperative imaging and histologic analysis confirmed mature retroperitoneal teratomas. It is feasible to treat such giant benign tumors by laparoscopic simultaneous resection.
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Affiliation(s)
| | | | - Chuan Xiao
- Department of Pathology, The Affiliated Suzhou Hospital of Nanjing Medical University, PR China
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31
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Addeo G, Cozzi D, Danti G, Bertelli E, Ferrari R, Pradella S, Trinci M, Miele V. Multi-detector computed tomography in the diagnosis and characterization of adrenal gland traumatic injuries. Gland Surg 2019; 8:164-173. [PMID: 31183326 DOI: 10.21037/gs.2019.01.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Adrenal gland injuries after a blunt abdominal trauma are rare events and represent important indicators for severe trauma. Multidetector CT evolution with high volumetric resolution and fast acquisition with the use of multiplanar reformatted (MPR) visualization allows for an accurate and fast diagnosis of the adrenal gland for post-traumatic pathologies. While, before its introduction the diagnosis was made mainly postmortem or during surgery. Adrenal injuries are unilateral up to 90% of the cases involving most commonly the right gland; thoracoabdominal organs injuries are often also associated. Bilateral adrenal lesions are asymptomatic, potentially leading to the development of acute adrenal insufficiency. The purpose of the present review was to determine the prevalence, the mechanism of injury and the different CT appearances of adrenal trauma. Prognosis and management of adrenal injury will also be reviewed.
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Affiliation(s)
- Gloria Addeo
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Diletta Cozzi
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Elena Bertelli
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Riccardo Ferrari
- Department of Emergency Radiology, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy
| | - Silvia Pradella
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Margherita Trinci
- Department of Emergency Radiology, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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32
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Uneyama M, Chambers JK, Miyama K, Miwa Y, Uchida K, Nakayama H. A histopathological study on adrenal cysts in ferrets. J Toxicol Pathol 2019; 32:49-55. [PMID: 30739995 PMCID: PMC6361667 DOI: 10.1293/tox.2018-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/13/2018] [Indexed: 11/19/2022] Open
Abstract
Adrenal disorders are common in ferrets, but there are few studies on cystic lesions of
the adrenal gland. The present study describes pathological and immunohistochemical
features of adrenal cysts in eleven ferrets and discusses their histogenesis. In nine of
eleven cases examined, which included seven, one, and one right, left, and bilateral
cases, respectively, cysts were in the adrenal cortex and lined with epithelial cells.
These epithelial cells contained an Alcian blue-negative/PAS-positive material and were
positive for cytokeratin (CK) 7. The staining pattern was similar to that of biliary
epithelial cells in the ferret. In five of the cases, there were small ducts adjacent to
the cysts that were positive for CK7 and CK20 and negative for CK19. Based on the
anatomical proximity between the right adrenal and liver, the immunohistochemical features
of the small duct cells were comparable to those of hepatic oval cells. These results
indicate the possibility that these adrenocortical cysts in the ferret originated from the
biliary system. In the other two cases, the cysts lacked an epithelial cell lining, and
there were dilated lymphoid vessels around the cysts. These cysts were assumed to have
developed in the adrenal medulla, because the cyst wall was positive for glial fibrillary
acidic protein and there were adrenal medullary cells positive for synaptophysin in the
cyst wall. Therefore, the medullary cysts may have been associated with dilated
vasculatures.
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Affiliation(s)
- Mizuho Uneyama
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - James K Chambers
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Kouki Miyama
- Miwa Exotic Animal Hospital, 1-25-5 Komagome, Toshima-ku, Tokyo 170-0003, Japan
| | - Yasutsugu Miwa
- Miwa Exotic Animal Hospital, 1-25-5 Komagome, Toshima-ku, Tokyo 170-0003, Japan
| | - Kazuyuki Uchida
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Hiroyuki Nakayama
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
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Albano D, Agnello F, Midiri F, Pecoraro G, Bruno A, Alongi P, Toia P, Di Buono G, Agrusa A, Sconfienza LM, Pardo S, La Grutta L, Midiri M, Galia M. Imaging features of adrenal masses. Insights Imaging 2019; 10:1. [PMID: 30684056 PMCID: PMC6349247 DOI: 10.1186/s13244-019-0688-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/03/2019] [Indexed: 12/14/2022] Open
Abstract
The widespread use of imaging examinations has increased the detection of incidental adrenal lesions, which are mostly benign and non-functioning adenomas. The differentiation of a benign from a malignant adrenal mass can be crucial especially in oncology patients since it would greatly affect treatment and prognosis. In this setting, imaging plays a key role in the detection and characterization of adrenal lesions, with several imaging tools which can be employed by radiologists. A thorough knowledge of the imaging features of adrenal masses is essential to better characterize these lesions, avoiding a misinterpretation of imaging findings, which frequently overlap between benign and malignant conditions, thus helping clinicians and surgeons in the management of patients. The purpose of this paper is to provide an overview of the main imaging features of adrenal masses and tumor-like conditions recalling the strengths and weaknesses of imaging modalities commonly used in adrenal imaging.
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Affiliation(s)
- Domenico Albano
- Unità di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
| | - Francesco Agnello
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Federico Midiri
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Giusy Pecoraro
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Alberto Bruno
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Pierpaolo Alongi
- Department of Radiological Sciences, Nuclear Medicine Service, Fondazione Istituto G. Giglio, Contrada Pietrapollastra-Pisciotto, 90015, Cefalu, Italy
| | - Patrizia Toia
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Giuseppe Di Buono
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Antonino Agrusa
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Luca Maria Sconfienza
- Unità di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Salvatore Pardo
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Ludovico La Grutta
- Department PROMISE, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Massimo Midiri
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Massimo Galia
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
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Zhou W, Zhu Y, Zhang L, Xu S, Zhan W. Sonographic appearances of adrenal schwannomas. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:3-8. [PMID: 30284326 DOI: 10.1002/jcu.22644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/14/2018] [Accepted: 08/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the sonographic ultrasound (US) appearances of adrenal gland schwannomas. MATERIALS AND METHODS This was a retrospective analysis of 15 cases of schwannomas involving the adrenal gland. The following US features were assessed: size, border, echogenicity, homogeneity, intralesional cystic necrosis, presence of septa, intralesional calcification, posterior acoustic enhancement and blood supply. RESULTS Of the 15 tumors, seven (46.7%) were located on the left side, and the remaining eight (53.3%) on the right side. The most frequent US appearance of adrenal schwannoma was a single, well-defined and isoechoic mass. The internal echotexture was homogeneous in 2 cases, and heterogeneous in 13 cases, with intralesional cystic areas (n = 11), septa (n = 10) or calcifications (n = 6). Posterior acoustic enhancement was seen in 12 of the 15 cases (80%). On color Doppler US, 86.7% (13/15) of the lesions did not show any vascularity. CONCLUSIONS Adrenal schwannomas usually present on US as well-defined isoechoic masses often with posterior acoustic enhancement, cystic necrosis with septa and poor blood supply. These appearances should suggest the diagnosis of adrenal schwannomas. Nevertheless, additional information from laboratory tests and CT or MR imaging may be required to avoid unnecessary surgery.
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Affiliation(s)
- Wei Zhou
- Department of Ultrasound, Luwan Branch, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Zhu
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lu Zhang
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shangyan Xu
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Chaudhary V, Anand R, Narula M, Gupta I, Choudhury S, Jain M. Key Imaging Appearances of Commonly Encountered Pediatric Adrenal Masses. MAMC JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.4103/mamcjms.mamcjms_58_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Xie J, Dai J, Zhou WL, Sun FK. Adrenal Ganglioneuroma: Features and Outcomes of 42 Cases in a Chinese Population. World J Surg 2018; 42:2469-2475. [PMID: 29383425 DOI: 10.1007/s00268-018-4499-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adrenal ganglioneuromas (AGNs) are extremely rare benign neoplasms. This study is to share our experience regarding diagnostic and operative management of these tumors. METHODS Clinical details as well as follow-up data were retrospectively analyzed in 42 primary AGN patients who received operative resection at a tertiary referral hospital in China between May 2005 and July 2016. RESULTS The mean age of the patients at diagnosis was 35.3 years (range 13-59 years). Among the patients, 28 were asymptomatic. The mean preoperative size was 5.3 ± 2.2 cm (range 2.1-14.0 cm), and 17 cases were larger than 5 cm. All patients underwent operative resection as open adrenalectomy in 20 patients and laparoscopy in 22 patients. The mean tumor size on pathologic examination was 6.0 ± 2.6 cm (range 2.2-17.0 cm). Laparoscopic operation showed its advantages over open surgery on the postoperative duration (5.0 vs. 7.3 days, p < 0.001) and estimated blood loss (69.5 vs. 157.5 ml, p = 0.047). No patient had recurrence or metastasis during a median follow-up of 70.5 months (range 3.7-164.3 months). CONCLUSIONS We describe the largest AGN series reported to date. The preoperative diagnosis of AGN remains difficult despite of the progression of imaging examination. After complete resection, the prognosis of AGN patients is excellent. Laparoscopic approach has its advantages in the resection of AGNs.
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Affiliation(s)
- Jing Xie
- Department of Urology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Ruijin Second Road No. 197, Shanghai, 200025, China
| | - Jun Dai
- Department of Urology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Ruijin Second Road No. 197, Shanghai, 200025, China
| | - Wen-Long Zhou
- Department of Urology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Ruijin Second Road No. 197, Shanghai, 200025, China
| | - Fu-Kang Sun
- Department of Urology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Ruijin Second Road No. 197, Shanghai, 200025, China.
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Abstract
Various pathologies can affect the adrenal gland. Noninvasive cross-sectional imaging is used for evaluating adrenal masses. Accurate diagnosis of adrenal lesions is critical, especially in cancer patients; the presence of adrenal metastasis changes prognosis and treatment. Characterization of adrenal lesions predominantly relies on morphologic and physiologic features to enable correct diagnosis and management. Key diagnostic features to differentiate benign and malignant adrenal lesions include presence/absence of intracytoplasmic lipid, fat cells, hemorrhage, calcification, or necrosis and locoregional and distant disease; enhancement pattern and washout values; and lesion size and stability. This article reviews a spectrum of adrenal pathologies.
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Affiliation(s)
- Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1473, Houston, TX 77030, USA.
| | - Sally Emad-Eldin
- Department of Diagnostic and Intervention Radiology, Cairo University, Kasr Al-Ainy Street, Cairo 11652, Egypt
| | - Ajaykumar C Morani
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1473, Houston, TX 77030, USA
| | - Corey T Jensen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1473, Houston, TX 77030, USA
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Adrenal Hemangioma: A Case of Retroperitoneal Tumor. Case Rep Med 2018; 2018:8796327. [PMID: 29560018 PMCID: PMC5836307 DOI: 10.1155/2018/8796327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 01/15/2018] [Accepted: 01/21/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction Adrenal hemangioma is a rare disease, with only some 60 cases reported previously. Due to the difficulty of the preoperative diagnosis of adrenal hemangioma, almost all of the cases were diagnosed by a histopathological analysis of surgical specimens. Case Presentation A 52-year-old man was referred to our department for further examination of his left retroperitoneal tumor. He had received hemodialysis due to chronic renal failure resulting from membranous nephropathy. Computed tomography revealed a mass around his left hilum. Magnetic resonance imaging (MRI) and positron-emission tomography (PET)-CT were unable to confirm or deny malignancy, and tumor markers, including CEA and CA19-9, showed slight elevation. His tumor grew from 38 mm to 54 mm in diameter in 7 months of follow-up. We therefore planned retroperitoneal tumor resection with left nephrectomy. Histopathologically, hyperplastic small vessels with hemorrhaging and denaturation were seen. The endothelial cells showed no variants or division of the nucleus. Based on this diagnosis, no further therapy was performed. He has had no recurrence in the eight months since the surgery. Conclusion We herein report a rare case of adrenal hemangioma.
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Krasilnikov DM, Malova II, Dzamukov RA, Borodin MA, Imamova AM. [Adrenal cyst complicated by hemorrhage]. Khirurgiia (Mosk) 2017:97-99. [PMID: 29076492 DOI: 10.17116/hirurgia20171097-99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- D M Krasilnikov
- Chair of Surgical Diseases #1 of Kazan State Medical University of Healthcare Ministry of the Russian Federation, Kazan, Russia; Republican Clinical Hospital of Healthcare Ministry of the Republic of Tatarstan, Kazan, Russia
| | - I I Malova
- Chair of Surgical Diseases #1 of Kazan State Medical University of Healthcare Ministry of the Russian Federation, Kazan, Russia; Republican Clinical Hospital of Healthcare Ministry of the Republic of Tatarstan, Kazan, Russia
| | - R A Dzamukov
- Republican Clinical Hospital of Healthcare Ministry of the Republic of Tatarstan, Kazan, Russia
| | - M A Borodin
- Republican Clinical Hospital of Healthcare Ministry of the Republic of Tatarstan, Kazan, Russia
| | - A M Imamova
- Republican Clinical Hospital of Healthcare Ministry of the Republic of Tatarstan, Kazan, Russia
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Lee JH, Chai YJ, Kim TH, Choi JY, Lee KE, Kim HY, Yoon YS, Kim HH. Clinicopathological Features of Ganglioneuroma Originating From the Adrenal Glands. World J Surg 2017; 40:2970-2975. [PMID: 27431319 DOI: 10.1007/s00268-016-3630-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ganglioneuromas are benign tumors that rarely develop from adrenal glands. In this study, we present our clinical experience of patients with adrenal ganglioneuroma (AGN). METHODS Demographic, diagnostic, surgical, and pathologic findings of patients who were adrenalectomized as a result of AGN were retrospectively reviewed from the database of a tertiary referral hospital. RESULTS Among 1784 patients who underwent an adrenalectomy between 2002 and 2015, 35 (1.9 %; 14 males, 21 females) were diagnosed with AGN. Mean age was 33.4 ± 18.7 years (0-84). Twenty-nine (82.9 %) were asymptomatic, four (11.4 %) complained of abdominal discomfort, and two (5.7 %) had abdominal distension. Preoperative computed tomography (CT) reported AGN in 22 (62.9 %) cases. Precontrast Hounsfield units, increased postcontrast phase attenuation, and well-defined borders were characteristic CT features of AGN. Mean tumor size was 6.3 ± 3.3 cm (range, 1.5-16.0). No recurrence occurred during a median follow-up period of 19 months (range, 1-120). CONCLUSION AGN was asymptomatic in most cases and diagnosis may be challenging. Adrenalectomy is a safe treatment modality for AGN and ensures favorable outcomes when diagnosed.
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Affiliation(s)
- Joon-Hyop Lee
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Young Jun Chai
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, Korea
| | - Tae-Hyung Kim
- Department of Radiology, Seoul National University Hospital and College of Medicine, 101 Daeak-ro, Jongno-gu, Seoul, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Kyu Eun Lee
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
- Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea.
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital and College of Medicine, 101 Daeak-ro, Jongno-gu, Seoul, Korea
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Adrenal Ganglioneuroblastoma in Adults: A Case Report and Review of the Literature. Case Rep Endocrinol 2017; 2017:5796236. [PMID: 28713603 PMCID: PMC5497652 DOI: 10.1155/2017/5796236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 11/24/2022] Open
Abstract
Incidentally discovered adrenal masses are very common given the increased number of imaging studies performed in recent years. We here report a clinical case of a 20-year-old woman who presented with left flank pain. Ultrasound examination revealed a contralateral adrenal mass, which was confirmed at computed tomography (CT) scan. Hormonal hypersecretion was excluded. Given the size (11 × 10 × 7 cm) and the uncertain nature of the mass, it was surgically removed and sent for pathological analyses. Conclusive diagnosis was ganglioneuroblastoma. Ganglioneuroblastoma is an uncommon malignant tumor, extremely rare in adults, particularly in females. This neoplasm is frequently localized in adrenal gland.
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Abstract
Adrenal teratomas are rare neoplasms and there is limited data on their surgical outcomes and long-term prognosis. We aimed to review our institutional experience and compare this to the existing literature on adrenal teratomas in adults and children. An institutional pathology database was searched for cases of adrenal teratoma (June 1956-July 2016). Clinical and imaging data were abstracted from the medical records and pathology slides were obtained for review. In addition, a PubMed search for "adrenal teratoma" from June 1952 to July 2016 was performed to identify reports of primary adrenal teratoma in patients of all ages. Of 7706 patients who underwent adrenalectomy during the study period at our institution, three patients were identified with adrenal teratoma. Patients were 24, 26, and 29 years of age, respectively. Two patients presented with abdominal pain and two of the three underwent a laparoscopic adrenalectomy. A pathologic examination revealed mature cystic teratomas that frequently displayed well-differentiated respiratory, digestive, and squamous epithelia. Eighteen case reports in the literature were identified in patients 17-61 years of age. Patients presented most frequently with abdominal or flank pain (63.6%). Median tumor diameter was 9.0 cm and tumors were frequently left-sided (81.8%), cystic (63.6%), and calcified (72.7%) on either radiologic or pathologic examination. Primary adrenal teratomas are rare neoplasms that typically present as large, left-sided nodules with cystic and calcified components seen radiographically. Although the data are limited, they are generally amenable to laparoscopic resection and have a very favorable prognosis.
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Affiliation(s)
- Eric J Kuo
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, 10833 Le Conte Ave, 72-228 CHS, Los Angeles, CA, 90095, USA
| | - Anthony E Sisk
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Zhiming Yang
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Jiaoti Huang
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Michael W Yeh
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, 10833 Le Conte Ave, 72-228 CHS, Los Angeles, CA, 90095, USA
| | - Masha J Livhits
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, 10833 Le Conte Ave, 72-228 CHS, Los Angeles, CA, 90095, USA.
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Jeon HJ, Lee SY. A CASE OF ADRENAL MYELOLIPOMA A PATIENT WITH BREAST CANCER. ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:90-95. [PMID: 31149154 DOI: 10.4183/aeb.2017.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Adrenal myelolipoma is a rare benign tumor composed of adipose tissue and hematopoetic elements resembling bone marrow. The majority of myelolipoma do not produce adrenal hormones and are only found as a result of evaluation for another disorder. With the widespread use of non-invasive abdominal imaging for various reason, its incidental detection has become more common. There are a few cases of breast cancer with concomitant adrenal myelolipoma in the literature. Case A 43-year-old woman presented to endocrine clinic due to presurgical assessment of adrenal mass prior breast cancer surgery. Abdominal CT showed a 9 x 8 cm sized, lobulated contour heterogeneous fatty density mass with peripheral calcification in right adrenal gland. Hormonal studies for adrenal incidentaloma revealed: Aldosterone/Renin ratio, 0.70 ([normal range < 30]; normal DHEA-S, 85.0 µg/dL ([normal range, 80 -560 µg/dL]), ACTH 25 pg/mL ([normal range, 10 - 60 pg/mL]), morning serum cortisol 8.9 µg/dL ([normal range, 5 - 12 µg/dL]). In 24-hour urine, there revealed free cortisol 21.6 µg/day ([normal range, 10 - 50 µg/day); metanephrine 0.19 mg/day ([normal range < 0.8 mg/day]); 17-ketosteroid 14.06 mg/day ([normal range, 7 - 20 mg/day]). The hormonal results of adrenal mass revealed as nonfunctioning. The adrenal mass was surgically resected in order to rule out malignancy. Pathology report showed myelolipoma. Conclusion We reported a case of adrenal myelolipoma coexisting with breast cancer where the diagnosis was made incidentally based on radiological features, treated with surgical resection.
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Affiliation(s)
- H J Jeon
- Chunbguk National University, Dept. of Internal Medicine, Cheong-Ju, Republic of Korea
| | - S Y Lee
- Hankook General Hospital, Dept. of Internal Medicine, Cheong-Ju, Republic of Korea
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Abstract
Various pathologies can affect the adrenal gland. Noninvasive cross-sectional imaging is used for evaluating adrenal masses. Accurate diagnosis of adrenal lesions is critical, especially in cancer patients; the presence of adrenal metastasis changes prognosis and treatment. Characterization of adrenal lesions predominantly relies on morphologic and physiologic features to enable correct diagnosis and management. Key diagnostic features to differentiate benign and malignant adrenal lesions include presence/absence of intracytoplasmic lipid, fat cells, hemorrhage, calcification, or necrosis and locoregional and distant disease; enhancement pattern and washout values; and lesion size and stability. This article reviews a spectrum of adrenal pathologies.
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Affiliation(s)
- Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1473, Houston, TX 77030, USA.
| | - Sally Emad-Eldin
- Department of Diagnostic and Intervention Radiology, Cairo University, Kasr Al-Ainy Street, Cairo 11652, Egypt
| | - Ajaykumar C Morani
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1473, Houston, TX 77030, USA
| | - Corey T Jensen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street Unit 1473, Houston, TX 77030, USA
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Zhang YM, Lei PF, Chen MN, Lv XF, Ling YH, Cai PQ, Gao JM. CT findings of adrenal schwannoma. Clin Radiol 2016; 71:464-70. [DOI: 10.1016/j.crad.2016.01.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 12/09/2015] [Accepted: 01/12/2016] [Indexed: 10/22/2022]
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Maciel CA, Tang YZ, Coniglio G, Sahdev A. Imaging of rare medullary adrenal tumours in adults. Clin Radiol 2016; 71:484-94. [PMID: 26944698 DOI: 10.1016/j.crad.2016.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/14/2015] [Accepted: 01/26/2016] [Indexed: 12/29/2022]
Abstract
Although adrenal medullary tumours are rare, they have important clinical implications. They form a heterogeneous group of tumours, ranging from benign, non-secretory, incidental masses to hormonally active tumours presenting acutely, or malignant tumours with disseminated disease and a poor prognosis. Increasingly, benign masses are incidentally detected due to the widespread use of imaging and routine medical check-ups. This review aims to illustrate the multimodality imaging appearances of rare adrenal medullary tumours, excluding the more common phaeochromocytomas, with clues to the diagnosis and to summarise relevant epidemiological and clinical data. Careful correlation of clinical presentation, hormone profile, and various imaging techniques narrow the differential diagnosis. Image-guided percutaneous adrenal biopsy can provide a definitive diagnosis, allowing for conservative management in selected cases. A close collaboration between the radiologist, endocrinologist, and surgeon is of the utmost importance in the management of these tumours.
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Affiliation(s)
- C A Maciel
- Department of Radiology, St Bartholomew's Hospital, Barts Health, West Smithfield, London EC1A 7BE, UK.
| | - Y Z Tang
- Department of Radiology, St Bartholomew's Hospital, Barts Health, West Smithfield, London EC1A 7BE, UK
| | - G Coniglio
- Department of Radiology, St Bartholomew's Hospital, Barts Health, West Smithfield, London EC1A 7BE, UK
| | - A Sahdev
- Department of Radiology, St Bartholomew's Hospital, Barts Health, West Smithfield, London EC1A 7BE, UK
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Adrenal Lymphangioma Masquerading as a Catecholamine Producing Tumor. Case Rep Endocrinol 2015; 2015:380151. [PMID: 26618011 PMCID: PMC4651645 DOI: 10.1155/2015/380151] [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: 08/06/2015] [Accepted: 10/21/2015] [Indexed: 11/18/2022] Open
Abstract
Objective. To report the unusual case of an adrenal lymphangioma presenting in a patient
with an adrenal cystic lesion and biochemical testing concerning for pheochromocytoma. The pertinent diagnostic and imaging features of adrenal lymphangiomas are reviewed. Methods. We describe a 59-year-old patient who presented with hyperhidrosis and a 2.2 by 2.2 cm left adrenal nodule. Biochemical evaluation revealed elevated plasma-free normetanephrine, urine normetanephrine, urine vanillylmandelic acid, and urine norepinephrine levels. Elevated plasma norepinephrine levels were not suppressed appropriately with clonidine administration. Results. Given persistent concern for pheochromocytoma, the patient underwent adrenalectomy. The final pathology was consistent with adrenal lymphangioma. Conclusions. Lymphangiomas are benign vascular lesions that can very rarely occur in the adrenal gland. Imaging findings are generally consistent with a cyst but are nonspecific. Excluding malignancy in patients presenting with adrenal cysts can be difficult. Despite its benign nature, the diagnosis of adrenal lymphangioma may ultimately require pathology.
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Imaging Features of Various Adrenal Neoplastic Lesions on Radiologic and Nuclear Medicine Imaging. AJR Am J Roentgenol 2015; 205:554-63. [PMID: 26295641 DOI: 10.2214/ajr.15.14467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of this review is to describe the features of diverse adrenal neoplastic lesions on radiologic and nuclear medicine imaging. CONCLUSION Various neoplastic lesions with or without malignant potential can occur in the adrenal gland. Knowledge of imaging features of adrenal lesions on radiologic and nuclear medicine imaging will facilitate differential diagnosis and assessment of malignant potential.
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Kim KH, Lee JI, Bae JM. Significant growth of adrenal lymphangioma: A case report and review of the literature. Int J Surg Case Rep 2015; 17:48-50. [PMID: 26546871 PMCID: PMC4701751 DOI: 10.1016/j.ijscr.2015.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/11/2015] [Accepted: 10/11/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Adrenal lymphangiomas are benign malformations of lymphatic vessels of adrenal gland. Adrenal lymphangiomas are very rare, although lymphangiomas are most commonly located in the neck, axillary region and mediastinum. PRESENTATION OF CASE A 44-year-old woman presented to the outpatient clinic with dizziness, headache during the last 2 year. We report a significant growth case of an adrenal lymphangioma removed by transperitoneal laparoscopy. At laparoscopy, a well-marginated multicystic lesion was found at suprarenal area with nonviscous, brown colored fluid. The cystic mass was measured as 5.5×3.0cm and histopathological diagnosis was cystic lymphangioma in the right adrenal gland. On immunohistochemical examination, D2-40 cytoplastic staining was positive, whereas calretinin and CD34 were negative, thus, confirming their lymphatic nature. At 11 months of follow up, the patient was recurrence free. DISCUSSION Lymphangiomas are benign malformations of lymphatic vessels and subtype of endothelial adrenal cysts. Adrenal cysts are histologically classified into four main groups: endothelial cysts (45%), pseudocysts (39%), epithelial cysts (9%), and parasitic cysts (7%). Endothelial cysts are divided into two subgroups: lymphangiomatous and angiomatous cysts. Lymphangiomatous adrenal cysts are also known as adrenal lymphangioma. Management of larger lesions or lesions causing symptoms may require surgical resection to determine diagnosis or relieve symptoms. CONCLUSION Lymphangiomas are most commonly located in the neck, axillary region and mediastinum, which are rare at adrenal gland. Transperitoneal laparoscopic removal of the adrenal lymphangiomas is regarded as a safe, effective and minimally invasive approach. In our case, laparoscopic removal of the tumor was successfully performed via a transperitoneal approach.
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Affiliation(s)
- Ki Ho Kim
- Department of Urology, Dongguk University School of Medicine, Gyeongju, Republic of Korea.
| | - Jong Im Lee
- Department of Pathology, Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Jung Min Bae
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Republic of Korea
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Spinelli C, Rossi L, Barbetta A, Ugolini C, Strambi S. Incidental ganglioneuromas: a presentation of 14 surgical cases and literature review. J Endocrinol Invest 2015; 38:547-54. [PMID: 25501841 DOI: 10.1007/s40618-014-0226-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/02/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Ganglioneuromas are benign tumors which originate from the neural crest. This tumor affects mainly young patients rather than adult ones, and its most frequent localizations are mediastinum, retroperitoneum, adrenal glands and cervical region. Usually, ganglioneuromas are discovered as incidentalomas since they are often asymptomatic, even if they could present sympathetic or mass-related symptoms. To obtain a definitive diagnosis, histological exam is necessary since CT scan and MRI are not capable of distinguishing ganglioneuromas from other tumors, such as neuroblastomas or pheocromocytomas. The surgical excision is the chosen treatment and it offers an excellent prognosis. METHODS We conducted a retrospective analysis of our cases of ganglioneuroma from 2004 to 2014; this study aims to compare our experience with literature review (2000-2014). Data about patients' features, tumor localization, symptoms, treatment and follow-up were analyzed and reported in detailed tables. RESULTS Between 2004 and 2014 we treated 14 patients affected by ganglioneuroma. For all of them the diagnosis was incidental; 9 out of 12 (64.3 %) patients presented an adrenal mass; in 2 patients (14.3 %) the tumor was localized in cervical region; in other 2 patients (14.3 %) the tumor was in the retroperitoneum and one patient (7.1 %) presented a ganglioneuroma in the costo-vertebral space. All our patients underwent surgical removal and none of them present surgery-related complications or recurrences to date. CONCLUSIONS Our data widen the knowledge about ganglioneuroma and confirm that the surgical approach has an excellent prognosis with very low incidence of surgery-related complications and recurrences.
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Affiliation(s)
- C Spinelli
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - L Rossi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - A Barbetta
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - C Ugolini
- Department of Laboratory Medicine and Integrated Diagnostics, Section of Experimental Pathology, University of Pisa, Pisa, Italy.
| | - S Strambi
- Department of Surgical, Medical, Pathological, Molecular and Critic Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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