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Wang SR, Morris R, Taraif S, Aneja A. Adrenal cortical adenoma arising in the setting of renal-adrenal fusion: a case report and review of the literature. J Med Case Rep 2023; 17:533. [PMID: 38151746 PMCID: PMC10753841 DOI: 10.1186/s13256-023-04287-0] [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: 07/02/2022] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Renal-adrenal fusion is a rare entity resulting from incomplete encapsulation of the adrenal gland and kidney. Only 18 cases have been reported in English literature to date. CASE PRESENTATION Our patient is a 77-year-old African American female who presented with a systolic blood pressure of 200 mmHg. Computed tomography showed an enhancing 9 × 6 cm mass anterior and medial to the left kidney. The patient underwent a left adrenalectomy with partial nephrectomy. Gross and histologic examinations revealed an adrenal cortical adenoma and renal-adrenal fusion. CONCLUSION Renal-adrenal fusion may pose a diagnostic challenge, particularly when there is a concurrent adrenal adenoma. It is important to be aware of this uncommon anomaly to avoid misdiagnosis and overtreatment.
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Affiliation(s)
- Samuel R Wang
- School of Arts and Sciences, Rutgers University, New Brunswick, NJ, 08854, USA.
| | - Richard Morris
- Office of The Chief Medical Examiner of The State of Maryland, Baltimore, MD, 21223, USA
| | - Suad Taraif
- Department of Pathology, Cooper University Health Care, Camden, NJ, 08103, USA
| | - Amandeep Aneja
- Department of Pathology, Cooper Medical School of Rowan University and Cooper University Health Care, Camden, NJ, 08103, USA
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2
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Khan T, Sabu B, Ranganayaki V, Rafeekha P, Thomas R. Management of giant adrenal pseudocyst in pregnancy - A unique approach and review of literature. Obstet Med 2023; 16:52-55. [PMID: 37139502 PMCID: PMC10150310 DOI: 10.1177/1753495x221089210] [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: 07/09/2021] [Revised: 02/24/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
Pseudocysts of the adrenal gland are rare and in the majority of cases are non- functioning. They become symptomatic only when they are complicated by hormonal excess, rupture, haemorrhage or infection. Described here is a 26-year-old woman who developed an acute abdomen at 28 weeks of gestation due to a left adrenal haemorrhagic pseudocyst. A conservative approach was adopted, which was followed by elective term caesarean delivery with surgical intervention at the same time. The described case is unique in terms of strategizing timing and mode of management and thus minimizing the risk of prematurity and maternal morbidity associated with interval surgery.
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Affiliation(s)
- Tazeen Khan
- Department of High-Risk pregnancy and
Perinatology, KIMS Health, Trivandrum, Kerala, India
| | - Brinda Sabu
- Department of High-Risk pregnancy and
Perinatology, KIMS Health, Trivandrum, Kerala, India
| | | | - P Rafeekha
- Department of Obstetrics and Gynaecology, KIMS Health, Trivandrum, Kerala, India
| | - Renu Thomas
- Department of Urology, KIMS Health, Trivandrum, Kerala, India
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3
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De Marchi D, Tafuri A, Mantica G, Shakir A, Scarfò F, Passaretti G, Smelzo S, Proietti S, Rigatti L, Luciano R, Antonelli A, Pagliarulo V, Leonardi R, Giusti G, Gaboardi F. Ectopic adrenal tissue in the kidney: A systematic review. Arch Ital Urol Androl 2021; 93:481-488. [DOI: 10.4081/aiua.2021.4.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 09/23/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: Ectopic adrenal tissue in the kidney, including “Ectopic adrenal tissue” and “Adrenal-renal fusion”, is a rare event with a specific behavior which may be difficult to distinguish clinically from renal neoplasms. We performed a systematic review on ectopic adrenal tissue variants reported in the literature underlining its clinical aspects. Methods: Manuscripts which presented a case report or case series of ectopic adrenal tissue in the kidney were included even if published in original articles, reviews, or letters to the editor. A specific search on SCOPUS®, PubMed®, and Web of Science® database was performed. Only English language papers published in a period ranging between August 1991 and April 2020 were considered. Additionally, a case we had at our institution is described, and its characteristics are included. Data on clinical presentation, type of adrenal anomaly, location, anatomopathological and immune-histotype characteristics were collected. Results: We identified 888 manuscripts. Among these 29 were included in this systematic review. Overall, 39 patients with renal adrenal fusion or adrenal ectopia were considered. In most cases, the diagnosis was made incidentally, or following investigation for flank pain, abdominal pain, or endocrinological disorders. CT scan frequently identified a solid vascularized lesion that was difficult to distinguish from renal neoplasm. Adrenal fusion was mostly located at the level of the upper pole. Adrenal rest was found in the renal parenchyma, renal hilum, or retroperitoneum in close proximity to the renal peduncle. Often these ectopic adrenal tissue lesions follow a benign behavior and can be classified as functioning or non-functioning adenomas. Rarely, they may experience neoplastic degeneration. The most frequently positive markers were inhibin, vimentin, melan-A, synaptophysin and anti-p450 scc. Conclusions: Ectopic adrenal tissue in the kidney is a rare event with specific clinical characteristics that need to be identified in order to arrive at a correct diagnosis and carry out appropriate treatment management.
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4
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Ates E, Kol A, Gokce GS, Yıldız AE, Erol H. A giant adrenal hemorrhagic pseudocyst mimicking a parapelvic renal cyst: A case report and review of the literature. ACTA ACUST UNITED AC 2020; 92. [PMID: 33016061 DOI: 10.4081/aiua.2020.3.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/24/2020] [Indexed: 11/22/2022]
Abstract
Adrenal pseudocysts are rare, nonfunctional, asymptomatic cystic masses that originate from the adrenal gland and are usually located in the suprarenal area. They are usually incidentally discovered during imaging, but diagnosis can be challenging because they are similar to benign and malignant cystic lesions of the adrenal gland and adjacent organs. We describe a giant, adrenal hemorrhagic pseudocyst that was atypically located, extending from the middle to the lower poles of the kidney, admixed with a renal cortical cyst.
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Affiliation(s)
- Erhan Ates
- Department of Urology, Aydin Adnan Menderes University School of Medicine, Aydin.
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5
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Bamford R, Bretherton J, Rosenfelder N, Bell J. Bilateral adrenal-renal fusion: A radiological diagnosis. BJR Case Rep 2019; 5:20180108. [PMID: 31501707 PMCID: PMC6726182 DOI: 10.1259/bjrcr.20180108] [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: 10/04/2018] [Revised: 11/12/2018] [Accepted: 11/26/2018] [Indexed: 11/25/2022] Open
Abstract
In normal anatomy, the kidneys and adrenal glands are contained within the renal fascia
and separated by a connective tissue capsule derived from mesenchymal tissue. Incomplete
encapsulation can occur during embryonic development, resulting in adrenal-renal fusion.
The true incidence of this developmental anomaly is unknown, as it has primarily been
described in the literature following incidental detection on surgical or histological
examination. We report the first documented case of bilateral adrenal-renal fusion,
diagnosed radiologically.
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Affiliation(s)
| | | | | | - James Bell
- Royal Free NHS Foundation Trust, London, UK
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6
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Abstract
Adrenal - renal fusion is a rare entity defined as incomplete encapsulation of the adrenal gland and kidney with histologically adjacent functional tissue. This report describes the first published intraoperative identification of this anomaly during laparoscopic adrenalectomy. The patient was a 59-year-old man with chronic hypertension refractory to multiple antihypertensives found to be caused by a right-sided aldosterone-producing adrenal adenoma in the setting of bilateral adrenal hyperplasia. During laparoscopic adrenalectomy, the normal avascular plane between the kidney and adrenal gland was absent. Pathologic evaluation confirmed adrenal - renal fusion without adrenal heterotopia. Identified intraoperatively, this may be misdiagnosed as invasive malignancy, and thus awareness of this anomaly may help prevent unnecessarily morbid resection.
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Affiliation(s)
- Griffin Boll
- Department of Surgery, Tufts Medical Center, Boston, MA, USA
| | - Rishi Rattan
- Department of Surgery, Tufts Medical Center, Boston, MA, USA
| | - Osman Yilmaz
- Department of Pathology, Tufts Medical Center, Boston, MA, USA
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7
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Passoni S, Regusci L, Peloni G, Brenna M, Fasolini F. A giant adrenal pseudocyst mimicking an adrenal cancer: case report and review of the literature. Urol Int 2013; 91:245-8. [PMID: 23548497 DOI: 10.1159/000346754] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 12/24/2012] [Indexed: 11/19/2022]
Abstract
Adrenal pseudocysts are rare lesions that develop within the adrenal glands, generally from vessel ectasia or from degenerative adenomas or hematomas. They are usually non-functional and asymptomatic. The reported potential malignant transformation of an adrenal cyst is ca. 7% and indicates radical excision of these masses. We report the case of a 69-year-old man with hypertension, chronic obstructive pulmonary disease, and obesity in whom microscopic hematuria was detected during a routine examination performed by his family doctor. To investigate the cause of this microscopic hematuria, the patient underwent computed tomography of the abdomen, which showed a well-defined 12-cm lesion of the left adrenal gland with calcification and necrotic components that was compressing the left kidney, pancreas, and spleen. Suspecting adrenal carcinoma, after preoperative staging, a left subcostal laparotomy was performed, with resection of the left adrenal gland, a splenectomy, and resection of the pancreatic tail. The histology showed an adrenal pseudocyst with a fibrous capsule containing amorphous eosinophilic material with calcification and cholesterol crystals. The patient's postoperative course was uneventful, and he was discharged 12 days after surgery.
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Affiliation(s)
- S Passoni
- General Surgery Department, Beata Vergine Hospital, Mendrisio, Switzerland.
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8
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Surgery for a pancreatic pseudocyst uncovers an adrenal mass instead. JAAPA 2010; 23:33-7. [PMID: 20214246 DOI: 10.1097/01720610-201002000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Schlittler LA, Dallagasperina VW, Carlotto JRM, Vilarroel RU, Lazaretti NS. True adrenal cyst mimicking renal cancer in a young woman: a case report. CASES JOURNAL 2009; 2:7351. [PMID: 19918521 PMCID: PMC2769351 DOI: 10.4076/1757-1626-2-7351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Accepted: 07/23/2009] [Indexed: 12/28/2022]
Abstract
The adrenal cyst is a rare disease that represents approximately 5% of discovered adrenal lesions, which are usually discovered incidentally. True adrenal cysts originate to cells from mesothelium. The potential of cyst adrenal to become malignant has been reported to be 7% and a radical excision of a potentially malignant mass are indicate. We report a case of a 48 year old woman that presented with pain in left hypochondrium and epigastrium, nausea, vomiting, weight loss and microscopic hematuria. After the diagnosis suspicion surgery was performed with a monoblock resection of left kidney and left adrenal gland because of kidney cancer diagnosis as considered. The microscopically analysis of surgical specimen, diagnosed a true epithelial cyst of adrenal gland.
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Affiliation(s)
- Luis Alberto Schlittler
- Departamento de Oncologia, Hospital da Cidade de Passo FundoRua Tiradentes, 295 - Passo Fundo/RS - Cep 99010-260Brasil
| | | | | | - Rodrigo Ughini Vilarroel
- Departamento de Oncologia, Hospital da Cidade de Passo FundoRua Tiradentes, 295 - Passo Fundo/RS - Cep 99010-260Brasil
| | - Nícolas Silva Lazaretti
- Departamento de Oncologia, Hospital da Cidade de Passo FundoRua Tiradentes, 295 - Passo Fundo/RS - Cep 99010-260Brasil
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10
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Kim BS, Joo SH, Choi SI, Song JY. Laparoscopic resection of an adrenal pseudocyst mimicking a retroperitoneal mucinous cystic neoplasm. World J Gastroenterol 2009; 15:2923-6. [PMID: 19533819 PMCID: PMC2699015 DOI: 10.3748/wjg.15.2923] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Adrenal pseudocysts are rare cystic masses that arise within the adrenal gland and are usually non-functional and asymptomatic. Adrenal pseudocysts consist of a fibrous wall without a cellular lining. We report a patient with a 9 cm, left-sided suprarenal cystic mass who presented with abdominal discomfort of 2 years’ duration. A 38-year-old woman was referred to our service for evaluation of abdominal discomfort and gastrointestinal symptoms. Routine laboratory tests were within normal limits. An abdominal computed tomography scan showed a 9 cm × 8 cm × 8 cm well-defined cystic lesion displacing the left kidney. Magnetic resonance imaging showed a cystic lesion with low signal intensity on the T1-weighted image and high signal intensity on the T2-weighted image. A laparoscopic left adrenalectomy was performed to diagnose the lesion. The final pathology showed an adrenal pseudocyst without a cellular lining. The patient had no postoperative complications and she was discharged four days after surgery.
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11
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Mahadevia S, Rozenblit A, Milikow D, Marinovich A. Renal-adrenal fusion: instance of an adrenal adenoma mimicking a solid renal mass at CT--case report. Radiology 2009; 251:808-12. [PMID: 19261923 DOI: 10.1148/radiol.2511081151] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The authors report an unusual case of unilateral renal-adrenal fusion with a concurrent adrenal adenoma. At computed tomography, this abnormality appeared as a solid enhancing lesion in the upper pole of the kidney, mimicking a renal mass. The ambiguous characteristics of this lesion at cross-sectional imaging, along with alternative diagnostic possibilities, are discussed.
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Affiliation(s)
- Soham Mahadevia
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467, USA
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12
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Abstract
Intrarenal ectopic adrenal tissue and renal-adrenal fusion are rare findings in the adult population. We reviewed seven cases of intrarenal adrenal tissue and two cases of renal-adrenal fusion. Patients ranged in age from 35 to 75 years (mean 55). Ectopic adrenal tissue was identified at the superior pole of the kidney in all but one case, which was located in the mid-portion of the kidney. Ectopic adrenal tissue varied in its growth from subcapsular lesions that were plaque-like (n=3), wedge-shaped (n=2), or spherical (n=1) to irregular nests deep in the renal parenchyma (n=1). In all nine cases, the adherent and intrarenal adrenal tissue was composed of adrenal cortical tissue, with no adrenal medullary tissue present. In six cases, adrenal tissue focally extended into renal parenchyma in an infiltrative manner. Of the nine cases, two were diagnostic problems for the contributing pathologists. In one case, intrarenal adrenal tissue mimicked low-grade clear cell renal cell carcinoma. In another case, an adrenocortical adenoma adherent to the kidney resembled renal invasion by adrenocortical carcinoma. This study summarizes key morphological features of intrarenal ectopic adrenal tissue and renal-adrenal fusion along with histological pitfalls and its differential diagnoses.
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13
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Erbil Y, Salmaslioğlu A, Barbaros U, Bozbora A, Mete O, Aral F, Ozarmağan S. Clinical and radiological features of adrenal cysts. Urol Int 2008; 80:31-6. [PMID: 18204230 DOI: 10.1159/000111726] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Accepted: 11/16/2006] [Indexed: 11/19/2022]
Abstract
Adrenal cysts are very rare lesions, usually asymptomatic or without characteristic symptoms. They are classified as pseudocysts, endothelial cysts, epithelial cysts or parasitic cysts. Although pseudocysts are reported to be the most common clinically recognized adrenal cysts in surgical series, endothelial cysts are more common in autopsy series. We studied 15 consecutive patients with adrenal cysts who underwent surgical resection at our institution from 1990 to 2005. Of 15 patients with adrenal cysts, 10 had pseudocysts, 3 epithelial cysts, 1 an endothelial cyst and 1 a parasitic cyst. In conclusion, a better understanding of cystic adrenal masses is necessary to recognize true adrenal cysts and differentiating them from adrenal carcinoma or adenoma by demonstrating the foci of cystic or degenerative changes.
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Affiliation(s)
- Yeşim Erbil
- Department of General Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
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14
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Suh J, Heimann A, Cohen H. True adrenal mesothelial cyst in a patient with flank pain and hematuria: a case report. Endocr Pathol 2008; 19:203-5. [PMID: 18446449 DOI: 10.1007/s12022-008-9026-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
True mesothelial (epithelial) cysts in the adrenal gland are rare lesions. They represent 9% of adrenal cysts and are much less common than vascular adrenal cysts. We report a case of a true adrenal mesothelial cyst in a patient with flank pain and hematuria that was diagnosed on imaging as a renal cyst. Immunohistochemical studies were performed to investigate the nature of the cyst lining. The positive immunostains for calretinin and WT-1 lend support to the postulate of Medeiros et al nearly 20 years ago of a mesothelial origin for these cysts. The clinical presentation and salient radiologic and pathologic features are described.
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Affiliation(s)
- James Suh
- Department of Pathology, State University of New York, Stony Brook, Stony Brook, NY, USA.
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