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Saudi Journal of Biological Sciences Mar 2023To determine the nature of adrenal pathology in patients undergoing adrenalectomy in Saudi Arabia over the last decade and compare it with the literature. We compared...
OBJECTIVE
To determine the nature of adrenal pathology in patients undergoing adrenalectomy in Saudi Arabia over the last decade and compare it with the literature. We compared perioperative outcomes between minimally invasive adrenalectomy (MIA) and open adrenalectomy (OA).
METHODS
This retrospective study included patients who underwent adrenalectomy at five tertiary care centers in Saudi Arabia from 2010 to 2020. We collected patients' baseline and perioperative characteristics and detailed hormonal evaluation of adrenal masses.
RESULTS
Among 160 patients (mean age 44 ± 14.5 years; mean BMI 29.17 ± 5.96 kg/m), 84 (51.5 %) were men and 51.5 % had left-sided adrenal masses. The mean tumor size was 6.1 ± 4.2 (1.0-19.5) cm, including 60 (37.5 %) incidentalomas and 65 (40.6 %) functioning masses. Histopathology revealed 74 (46.2 %) adenomas and 24 (15 %) cancers or metastases from other primary organs; 20 %, 8.8 %, and 2.5 % of patients had pheochromocytoma, myelolipoma, and 2.5 % ganglioneuroblastoma, respectively. MIA and OA were performed in 135 (84.4 %) and 21 (15.6 %) patients, respectively. Adrenalectomy was increasingly performed over three equal periods in the last decade (17.5 % vs 34.4 % vs 48.1 %), with increasing numbers of MIAs to replace OAs. OA patients had larger tumors and needed blood transfusion more frequently (47.6 % vs 10.8 %, p< 0.001). MIA was significantly associated with shorter operative time, shorter length of stay, and less blood loss. Postoperative complications occurred in 10 (6.2 %) patients and were significantly higher for OA (24 % vs 3.0 %, p< 0.001).
CONCLUSIONS
The majority of adrenal masses are benign. Herein, the observed functional and perioperative outcomes were comparable to those of available -analyses.
PubMed: 36844643
DOI: 10.1016/j.sjbs.2023.103575 -
Journal of Medical Case Reports Feb 2023Presacral myelolipomas form a rare disease and are often found incidentally in imaging diagnostics. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Presacral myelolipomas form a rare disease and are often found incidentally in imaging diagnostics.
CASE PRESENTATION
In this study, we report the case of a 71-year-old caucasian female with an incidental finding of a retroperitoneal tumor on magnetic resonance imaging scan. This report aimed at presenting the clinical course of this patient with emphasis on analysis of pathological, clinical, and epidemiological features in a meta-analysis of reported cases.
CONCLUSION
Presacral myelolipomas are rare and its etiology remains unclear. Surgical resection is indicated in symptomatic lesions and lesions > 4 cm. More clinical and pathological research on this rare entity is warranted.
Topics: Humans; Female; Aged; Myelolipoma; Rare Diseases; Retroperitoneal Neoplasms; White People; Adrenal Gland Neoplasms
PubMed: 36721209
DOI: 10.1186/s13256-022-03746-4 -
Acta Endocrinologica (Bucharest,... 2022An adrenal collision tumor is a rare entity. We present a rare combination of giant adrenal ganglioneuroma (GN) and myelolipoma. GN is a rare benign tumor of the adrenal...
BACKGROUND
An adrenal collision tumor is a rare entity. We present a rare combination of giant adrenal ganglioneuroma (GN) and myelolipoma. GN is a rare benign tumor of the adrenal medulla that originates from primitive neural crest cells, while myelolipoma is a benign tumor of the adrenal cortex comprising of mature adipose tissue and blood components.
CASE REPORT
We present a case of a 52-year-old male who presented with generalized body swelling with episodes of vomiting and diarrhea. There was no history of abdominal pain or any significant history. Routine laboratory investigations and endocrine workup were within normal limits. MRI was performed for unexplained symptoms, and which revealed a solid homogeneous mass measuring 9x7x4.5cm arising from the adrenal gland. A diagnosis of myxoid adrenocortical neoplasm was suggested, and laparoscopic left adrenalectomy was performed based on imaging findings. The final diagnosis of coexisting giant adrenal GN with myelolipoma was made on histopathological examination, which was further confirmed by immunohistochemistry.
CONCLUSION
Ganglioneuroma coexistence with myelolipoma is a rare finding in the adrenal gland. Therefore, histopathology is imperative in such cases for a definitive diagnosis.
PubMed: 36699157
DOI: 10.4183/aeb.2022.379 -
Topics in Companion Animal Medicine 2023This paper describes the clinical and pathological features of 4 different tumors, located in the integumentary, digestive, and endocrine systems, presenting in a North...
This paper describes the clinical and pathological features of 4 different tumors, located in the integumentary, digestive, and endocrine systems, presenting in a North African hedgehog (Atelerix algirus). A 3.5-year-old female hedgehog was presented with a cutaneous mass on the right flank. The lesion consisted of a well-differentiated dermal mast cell tumor with no recurrence and metastasis after complete surgical excision. Six months later, the hedgehog developed a mass in the left lower jaw, lethargy, anorexia, and progressive weight loss. Clinical and radiographic evaluations revealed swelling, ulceration, displacement, and destruction of subjacent bone tissue, and the animal died 1 month after the onset of clinical signs. At necropsy, 2 neoplasms in the oral cavity (squamous cell carcinoma and histiocytic sarcoma) and multiple myelolipomas in the adrenal glands were detected. Metastasis of the oral squamous cell carcinoma was observed in the lungs. Although neoplasms are frequent in this species, and more than 1 type of tumor in a single individual has been occasionally reported, this is the first description of both myelolipoma and multiple concurrent neoplasms involving various organs and different cellular origins in a hedgehog.
Topics: Animals; Female; Carcinoma, Squamous Cell; Hedgehogs; Mouth Neoplasms
PubMed: 36587869
DOI: 10.1016/j.tcam.2022.100758 -
Frontiers in Oncology 2022Adrenal myelolipomas are benign tumors composed mainly of lipomatous elements with myeloid cells. With the development of medical imaging technology, the detection rate...
INTRODUCTION
Adrenal myelolipomas are benign tumors composed mainly of lipomatous elements with myeloid cells. With the development of medical imaging technology, the detection rate has gradually increased. We report a case of adrenal myelolipoma successfully excised through the laparoscope and reviewed existing literature in recent ten years to summarize the feasibility of the laparoscopic approach for this tumor.
CASE PRESENTATION
Herein, we described a case of adrenal myelolipoma resected by laparoscope in a 63-year-old male patient. He did not have any other symptoms except the incidental finding of a left adrenal mass. An abdominal CT examination revealed a mixed-density lesion containing some amount of adipose tissue. In conjunction with the patient's willingness, we performed a laparoscopic operation to remove the lump. The definite diagnosis was confirmed as an adrenal myelolipoma according to the pathology. The patient recovered well postoperatively and without signs of recurrence at a 5-month follow-up.
CONCLUSION
Adrenal myelolipoma is commonly benign, asymptomatic, and hormonal inactivity. A surgical strategy is suggested for high-complication-risk patients. The laparoscopic approach is safe and effective with an obvious advantage over open procedures.
PubMed: 36544699
DOI: 10.3389/fonc.2022.1058211 -
Journal of Surgical Case Reports Dec 2022Adrenal myelolipomas are rare, hormonally silent, adipose and myeloid-containing lesions that are mostly asymptomatic. If they do present it is usually with mass-related...
Adrenal myelolipomas are rare, hormonally silent, adipose and myeloid-containing lesions that are mostly asymptomatic. If they do present it is usually with mass-related flank pain or spontaneous haemorrhage. A 55-year-old female presented with right flank pain after a fall from a static pushbike. Computer tomography identified a large adrenal lesion with surrounding acute retroperitoneal haemorrhage. A conservative approach to treatment was decided on as the patient remained haemodynamically stable. The patient developed a pulmonary embolism during the time of conservative management and therefore had to be anticoagulated with close monitoring. Outpatient surveillance imaging was reassuring, hormonal screening was negative and biopsy confirmed myelolipoma. We report a rare presentation of adrenal myelolipoma with the sequelae of haemorrhage from low-impact trauma and the challenges of conservative management.
PubMed: 36518644
DOI: 10.1093/jscr/rjac554 -
Frontiers in Endocrinology 2022While it is known that inaccurate evaluation for retroperitoneal laparoscopic adrenalectomy (RPLA) can affect the surgical results of patients, no stable and effective...
A nomogram for evaluation and analysis of difficulty in retroperitoneal laparoscopic adrenalectomy: A single-center study with prospective validation using LASSO-logistic regression.
BACKGROUND
While it is known that inaccurate evaluation for retroperitoneal laparoscopic adrenalectomy (RPLA) can affect the surgical results of patients, no stable and effective prediction model for the procedure exists. In this study, we aimed to develop a computed tomography (CT) -based radiological-clinical prediction model for evaluating the surgical difficulty of RPLA.
METHOD
Data from 398 patients with adrenal tumors treated by RPLA in a single center from August 2014 to December 2020 were retrospectively analyzed and divided into sets. The influencing factors were selected by least absolute shrinkage and selection operator regression model (LASSO). Additionally, the nomogram was constructed. A receiver operating characteristic curve was used to analyze the prediction efficiency of the nomogram. The C-index and bootstrap self-sampling methods were used to verify the discrimination and consistency of the nomogram.
RESULT
The following 11 independent influencing factors were selected by LASSO: body mass index, diabetes mellitus, scoliosis, hyperlipidemia, history of operation, tumor diameter, distance from adrenal tumor to upper pole of kidney, retro renal fat area, hyperaldosteronism, pheochromocytoma and paraganglioma, and myelolipoma. The area under the curve (AUC) of the training set was 0.787, and 0.844 in the internal validation set. Decision curve analyses indicated the model to be useful. An additional 117 patients were recruited for prospective validation, and AUC was 0.848.
CONCLUSION
This study developed a radiological-clinical prediction model proposed for predicting the difficulty of RPLA procedures. This model was suitable, accessible, and helpful for individualized surgical preparation and reduced operational risk. Thus, this model could contribute to more patients' benefit in circumventing surgical difficulties because of accurate predictive abilities.
Topics: Humans; Models, Statistical; Retrospective Studies; Prognosis; Adrenalectomy; Adrenal Gland Neoplasms
PubMed: 36506074
DOI: 10.3389/fendo.2022.1004112 -
Polish Archives of Internal Medicine Jan 2023
Topics: Humans; Myelolipoma; Adrenal Gland Neoplasms; Adrenal Hyperplasia, Congenital; Mixed Function Oxygenases
PubMed: 36382926
DOI: 10.20452/pamw.16369 -
JFMS Open Reports 2022A 15 shorthair cat presented after having fallen down the stairs. Examination by the referring veterinarian had demonstrated tachycardia and a large abdominal mass. The...
CASE SUMMARY
A 15 shorthair cat presented after having fallen down the stairs. Examination by the referring veterinarian had demonstrated tachycardia and a large abdominal mass. The cat was referred for investigations. Blood tests demonstrated hyperthyroidism. A large, poorly vascularised abdominal mass was identified on ultrasonography. The mass was hyperechoic compared with the normal liver; however, the origin could not be determined. Fine-needle aspirate biopsies of the mass demonstrated extramedullary haematopoiesis. Surgical exploration revealed a 12 cm × 8 cm × 8 cm pale mass arising from the spleen. Histopathology determined this was a giant splenic myelolipoma.
RELEVANCE AND NOVEL INFORMATION
Splenic myelolipoma is rarely reported in the domestic cat, with only five cases documented within the literature, and none of these having described giant myelolipoma. Indeed, giant myelolipomas are rarely reported in the human literature and are most commonly adrenal in origin. The pathogenesis of these masses is unclear; there have been several incidences in people with endocrine disorders, and it has been hypothesised that their occurrence may be related to endocrine stimulation. Here we report the first case of giant myelolipoma in a hyperthyroid cat.
PubMed: 36249674
DOI: 10.1177/20551169221127889 -
Endocrine, Metabolic & Immune Disorders... 202311β hydroxylase deficiency (11βOHD) ranks as the second most common enzyme deficiency that causes congenital adrenal hyperplasia. Depending on the severity of the...
BACKGROUND
11β hydroxylase deficiency (11βOHD) ranks as the second most common enzyme deficiency that causes congenital adrenal hyperplasia. Depending on the severity of the enzyme deficiency, it can lead to cortisol deficiency, androgen excess and hypertension due to increased mineralocorticoid precursor levels. Many different types of mutations in the CYP11B1 gene located on chromosome 8q24.3 have been shown to cause 11βOHD. Here, we report a novel missense mutation that leads to 11βOHD in a female patient.
CASE PRESENTATION
A 35-year-old female patient was admitted to the Endocrinology Department with a complaint of abdominal pain. The patient had a history of genital reconstruction surgery twice in childhood. On physical examination, an abdominal mass was detected. Laboratory examination of the patient revealed low levels of cortisol, potassium and high levels of ACTH, 11-deoxycortisol and androstenedione, suggesting 11βOHD. Genotyping showed a novel homozygous missense mutation (c.1385T>C L462P variant) detected on the 8th chromosome where the CYP11B1 gene is located. Glucocorticoid therapy was commenced for the patient whose diagnosis of 11βOHD was confirmed by both hormonal and genetic tests. A mass originating from the left adrenal gland with the largest diameter of 7 cm was compatible with myelolipoma.
CONCLUSION
In this case report, we aimed to contribute to the literature by reporting a new missense mutation in the CYP11B1 gene, leading to classic type 11βOHD that has not been described before.
Topics: Humans; Female; Adult; Adrenal Hyperplasia, Congenital; Steroid 11-beta-Hydroxylase; Hydrocortisone; Mutation
PubMed: 36214299
DOI: 10.2174/1871530322666221007145410