Adrenal incidentaloma: differential diagnosis and management strategies

Incidental Unilateral Macular Lesions in Children

BACKGROUND

This study aims to examine the rare entity of unilateral macular lesions in the pediatric population and describe the distinct diagnoses and characterizations related to these findings.

METHODS

A retrospective cohort design. The database of the ophthalmology clinic in a tertiary medical center was reviewed to identify all children with incidental unilateral macular findings, examined during 2016 through 2021.

RESULTS

Twenty children were included. Mean age was 7.8 ± 3.4 years, 50% were girls. The most common macular lesion was torpedo maculopathy (50%), followed by pigmentary changes (25%), discoid maculopathy (15%), macular scar and combined hamartoma of the retina and retinal pigment epithelium (RPE) (5% each). None of the lesions changed after a mean follow-up duration of 2.3 ± 1.5 years. Visual acuity in the involved eye was equal to that in the contralateral eye in 90% of patients and did not change from initial to final visit.

CONCLUSION

Incidental unilateral macular lesions in the pediatric population are usually benign, stable, and do not affect vision. Long-term follow-up is advised, as vision-threatening alterations may appear. [Ophthalmic Surg Lasers Imaging Retina 2023;54:346-352.].

Experience in the application of laparoscopic anatomical adrenalectomy via the renal cortex surface monolayer

Objective:

To discuss the clinical application of laparoscopic anatomical adrenalectomy via the renal cortex surface in the operation of adrenal masses.

Methods:

A retrospective analysis was performed on 231 patients with adrenal masses who were received and cured in the urology department of the Affiliated Hospital of Hebei University from July 2016 to January 2019. All patients received retroperitoneal adrenalectomy by means of laparoscopic anatomical adrenalectomy via the renal cortex surface. Operation duration, bleeding volume, postoperative complications, retention time of the drainage tube were measured and analyzed, and postoperative follow-up surveys were administered.

Results:

All cases were successfully operated. Two cases were converted to open surgery due to the presence of large adrenal tumors, and the patients suffered no significant complications. The mean operation duration, bleeding volume and retention time of the drainage tube were 31 minutes, 20 mL and 1.2±0.6 d, respectively. In terms of the postoperative pathology of adrenal tumors, 183 cases were shown to have adenomas, 34 had pheochromocytomas, nine had schwannomas, 3 had metastases from lung cancer, and two had sarcomas. A total of 174 patients were followed up for three to 18 months. Only one case with sarcoma that relapsed within half a year of the operation.

Conclusion:

In the treatment of adrenal masses, laparoscopic anatomical adrenalectomy via the renal cortex surface has many advantages including the large operation space, clear view of anatomical markers, little bleeding, small trauma, few postoperative complications, simple operational procedures and short learning curves. This technique needs clinical promotion.