Adrenocortical Carcinoma: A Clinician's Perspective

ADRENOCORTICAL CARCINOMA: IN THE SEARCH FOR A PRE-OPERATIVE BIOMARKER

Adrenocortical tumors (ACT) are common malignancies of the cortex adrenal gland frequently non-functioning and benign. Differently, adrenocortical carcinoma (ACC) is a very rare neoplasia with an incidence of 0.7-2.0 cases per million people and an aggressive behaviour. Moreover ACC shows a poor prognosis with an estimated survival of 16-38%. Only surgery and the use of mitotane (sometime associated to standard chemotherapy) can represent a useful tool to fight against this malignancy, nonetheless ACC often metastasizes and recurs, decreasing considerably patient survival prospect. In the search of new potential tools to combat cancer, in the latest years omics works extended our knowledge on the ACC pathogenesis and made possible the investigation of novel ACC biomarkers. In this field of research, epigenetic studies identified a common signature in ACC, where the most altered miRNA found in ACC (miR-483-5p) seems now to represent a concrete biomarker to be used in the pre-operative diagnosis of ACC. A larger patient cohort is necessary to confirm this pivotal data: collaboration between scientific communities will be the key to determine the success of this fundamental discovery.

Cystic adrenal lesions: focus on pediatric population (a review)

BACKGROUND AND AIM

The cysts may potentially affect any organ; adrenals cysts are rare. This is a review of the literature regarding adrenal cysts, focusing on children and young adults.

GENERAL DATA

Three major types have been described: pure cysts (endothelial, epithelial, and hemorrhagic or pseudocyst), parasitic (as hydatid) cysts and cystic part of a tumour (most frequent are neuroblastoma, ganglioneuroma, pheocromocytoma, and teratoma). The complications are: bleeding, local pressure effects; infection; rupture (including post-traumatic); arterial hypertension due to renal vessels compression. Adrenal hemorrhage represents a particular condition associating precipitating factors such as: coagulation defects as Factor IX or X deficiency, von Willebrand disease, thrombocytopenia; antiphospholipid syndrome; previous therapy with clopidogrel or corticosteroids; the rupture of a prior tumour. At birth, the most suggestive features are abdominal palpable mass, anemia, and persistent jaundice. Adrenal insufficiency may be found especially in premature delivery. The hemorrhage is mostly self-limiting. Antenatal ultrasound diagnosis of a cyst does not always predict the exact pathology result. The most important differential diagnosis of adrenal hemorrhage/hemorrhagic cyst is cystic neuroblastoma which is highly suggestive in the presence of distant metastases and abnormal catecholamine profile. The major clue to differentiate the two conditions is the fact that the tumor is stable or increases over time while the adrenal hemorrhage is expected to remit within one to two weeks.

CONCLUSION

Pediatric adrenal cysts vary from simple cysts with a benign behavior to neoplasia- related lesions displaying severe prognosis as seen in cystic neuroblastoma. A multidisciplinary team is required for their management which is conservative as close follow-up or it makes necessary different surgical procedures in cases with large masses or if a malignancy suspicion is presented. Recently, laparoscopic approach is regarded as a safe procedure by some authors but generally, open surgery is more frequent used compare to adults; in most cases the preservation of normal gland is advisable.