1
|
Samsel R, Nowak K, Papierska L, Karpeta E, Roszkowska-Purska K, Smiertka W, Ostrowski T, Chrapowicki E, Grabowski A, Leszczyńska D, Cichocki A. Risk of malignancy in adrenal tumors in patients with a history of cancer. Front Oncol 2023; 13:1018475. [PMID: 37051540 PMCID: PMC10083405 DOI: 10.3389/fonc.2023.1018475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
PurposeAdrenal gland is a common site of metastasis and on the other hand, metastases are the most frequent malignant adrenal tumors. The aim of this study was to estimate the risk of malignancy in suspicious adrenal mass in patients with a history of cancer.MethodsThis is a single-center retrospective analysis of patients with adrenal tumors treated previously for different types of cancers. Between 2004 and 2021 a hundred and six such patients were identified. Mean age of patients was 62.6 years (30-78), and mean time from oncologic treatment was 55.8 months (0-274). The most common primary cancer was kidney (RCC): 29 (27.4%), colon/rectum (CRC): 20 (18.9%) and lung (NSCLC): 20 (18.9%).ResultsOf 106 patients, 12 had hormonally active (HA) (11,3%) and 94 (88,7%) non active (HNA) tumors In group of patients with HA tumours 4 had hypercortisolaemia and 8 had elevation of urinary metanephrines. In the first group of HA patients pathology confirmed preoperative diagnosis of adrenocortical cancer and no metastasis was found. In all patients from the second group pheochromocytomas were confirmed. Primary (PM) and secondary (SM) malignancies were found in 50 patients (47.2%). In hormone inactive group only SM - 46/94 (48.9%) were diagnosed. The odds that adrenal lesion was a metastasis were higher if primary cancer was RCC (OR 4.29) and NSCLC (OR 12.3). Metastases were also more likely with high native tumor density, and bigger size in CT. The cut-off values for tumor size and native density calculated from receiver operating characteristic (ROC) curves were 37mm and 24, respectively.ConclusionRisk of malignancy of adrenal mass in a patient with a history of cancer is high (47,2%), regardless of hormonal status. 47,2% risk of malignancy. In preoperative assessment type of primary cancer, adrenal tumour size and native density on CT should be taken into consideration as predictive factors of malignancy. Native density exceeding 24 HU was the strongest risk factor of adrenal malignancy (RR 3.23), followed by history of lung or renal cancer (RR 2.82) and maximum tumor diameter over 37 mm (RR 2.14).
Collapse
Affiliation(s)
- Radosław Samsel
- Department of Surgery, Clinic of Surgical Oncology and Neuroendocrine Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- *Correspondence: Radosław Samsel,
| | - Karolina Nowak
- Department of Endocrinology, Medical Centre of Postgraduate Education, Bielański Hospital, Warsaw, Poland
| | - Lucyna Papierska
- Department of Endocrinology, Medical Centre of Postgraduate Education, Bielański Hospital, Warsaw, Poland
| | - Edyta Karpeta
- Department of Surgical and Transplantation Nursing and Extracorporeal Therapies, Medical University of Warsaw, Warsaw, Poland
- Department of General and Transplant Surgery , Medical University of Warsaw, Warsaw, Poland
| | | | - Wacław Smiertka
- Department of Surgery, Clinic of Surgical Oncology and Neuroendocrine Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Tomasz Ostrowski
- Department of Surgery, Clinic of Surgical Oncology and Neuroendocrine Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Eryk Chrapowicki
- Department of Surgery, Clinic of Surgical Oncology and Neuroendocrine Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Alan Grabowski
- Department of Surgery, Clinic of Surgical Oncology and Neuroendocrine Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Dorota Leszczyńska
- Department of Endocrinology, Medical Centre of Postgraduate Education, Bielański Hospital, Warsaw, Poland
| | - Andrzej Cichocki
- Department of Surgery, Clinic of Surgical Oncology and Neuroendocrine Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| |
Collapse
|
2
|
Corwin MT, Kadivar SC, Graves CE, Kamangar E, Carney BW, Campbell MJ. CT of hemorrhagic adrenal adenomas: radiologic-pathologic correlation. Abdom Radiol (NY) 2023; 48:680-687. [PMID: 36380211 DOI: 10.1007/s00261-022-03741-9] [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: 06/08/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the appearance of chronically hemorrhagic adenomas on adrenal protocol CT and correlate imaging with pathologic findings. METHODS Retrospective case series of adult patients with resected adrenal adenomas showing internal hemorrhage at histology. Seven of nine patients underwent pre-operative adrenal protocol CT and 2/7 underwent unenhanced CT with portal venous phase CT. Two abdominal radiologists in consensus assessed the CT images for the presence of calcifications, macroscopic fat, cystic/necrotic appearance, and the presence, pattern, and percent nodule volume of areas < 10 HU on unenhanced CT. Absolute washout was calculated using a large ROI, and ROIs on the highest and lowest attenuating regions on the portal venous phase. RESULTS Mean adenoma length was 4.9 cm. All adenomas had areas measuring < 10 HU on unenhanced CT, ranging from < 20 to > 80% nodule volume. Calcifications were present in 4/9 adenomas and gross fat in 4/9 on CT. Of the seven cases with adrenal protocol CT, the absolute washout was < 60% in 5/7 using the large ROI, 5/7 using the low attenuation ROI, and 7/7 using the high attenuation ROI. At histology, all nine cases had microscopic evidence of hemorrhage, lipid rich adenoma cells, and fibrosclerosis. Myelolipomatous changes were identified in 4/9 cases, with the remaining five cases showing lipomatous metaplasia without a myeloid component. CONCLUSION Chronically hemorrhagic adrenal adenomas demonstrated variable areas < 10 HU on unenhanced CT corresponding to lipid rich adenoma cells. Absolute washout was most often < 60%, hypothesized to be due to fibrosclerosis within the adenomas.
Collapse
Affiliation(s)
- Michael T Corwin
- Davis Medical Center, Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA.
| | - Sohrab C Kadivar
- Davis Medical Center, Department of Pathology, University of California Davis Medical Center, 4400 V Street, Pathology Building, Sacramento, CA, 95817, USA
| | - Claire E Graves
- Davis Medical Center, Department of Surgery, University of California Davis Medical Center, 2221 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Elham Kamangar
- Davis Medical Center, Department of Pathology, University of California Davis Medical Center, 4400 V Street, Pathology Building, Sacramento, CA, 95817, USA
| | - Benjamin W Carney
- Davis Medical Center, Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Michael J Campbell
- Davis Medical Center, Department of Surgery, University of California Davis Medical Center, 2221 Stockton Blvd, Sacramento, CA, 95817, USA
| |
Collapse
|
3
|
Corwin MT, Schieda N, Remer EM, Caoili EM. Management of incidental adrenal nodules: a survey of abdominal radiologists conducted by the Society of Abdominal Radiology Disease-Focused Panel on Adrenal Neoplasms. Abdom Radiol (NY) 2022; 47:1360-1368. [PMID: 35150313 DOI: 10.1007/s00261-022-03439-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 12/21/2022]
Abstract
Adrenal incidentalomas are common findings discovered at abdominal CT and MRI, yet the most appropriate management remains controversial and guidelines vary. The Society of Abdominal Radiology (SAR) Disease-Focused Panel on Adrenal Neoplasms sought to determine the practice patterns of abdominal radiologists regarding the interpretation and management of adrenal incidentalomas. An electronic survey consisting of eleven multiple choice questions about adrenal incidentalomas was developed and distributed to the email list of current and past SAR members. The response rate was 11.8% (423/3581) and most respondents were academic radiologists (80.6%). The 2017 American College of Radiology White Paper was the most used guideline, yet the management of indeterminate adrenal incidentalomas was highly variable with no single management option reaching a majority. Hormonal evaluation and endocrinology consultation was most often rarely or never recommended. The results of the survey indicate wide variability in the interpretation of imaging findings and management recommendations for incidental adrenal nodules among surveyed radiologists. Further standardization of adrenal incidentaloma guidelines and education of radiologists is needed.
Collapse
|
4
|
Lam AKY. Adrenocortical Carcinoma: Updates of Clinical and Pathological Features after Renewed World Health Organisation Classification and Pathology Staging. Biomedicines 2021; 9:biomedicines9020175. [PMID: 33578929 PMCID: PMC7916702 DOI: 10.3390/biomedicines9020175] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 12/20/2022] Open
Abstract
Adrenocortical carcinoma (ACC) is a heterogenous group of diseases with different clinical behaviour between adult and paediatric patients. In addition, three histological variants, oncocytic, myxoid and sarcomatoid are noted on the recent World Health Organisation (WHO) classification of ACC. A review of recent literature showed that the different types of ACC have distinctive demographic data, clinical presentation, pathology, biological behaviour, genomic and patients' prognosis. In addition, recent updates of pathology staging for ACC allow refinement of prognostic grouping for planning treatment of the patients with ACC. These advances in genomic, pathology and staging have driven the development of standardisation of pathology reporting. International standardisation of pathological reporting of adrenocortical carcinoma and adaption to local pathology communities provide universal platforms for clinicians and researchers involved in the management of patients with ACC. To conclude, all these advances in the field of pathology will improve development of management strategies including improvement of clinical care, development of prognostic markers and testing of novel therapeutic approaches for patients with adrenocortical carcinoma.
Collapse
Affiliation(s)
- Alfred King-yin Lam
- School of Medicine, Griffith University, Gold Coast, QLD 4222, Australia;
- Pathology Queensland, Gold Coast University Hospital, Southport, Gold Coast, QLD 4215, Australia
- Faculty of Medicine, The University of Queensland, Herston, Brisbane, QLD 4006, Australia
| |
Collapse
|