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Diagnostics (Basel, Switzerland) Sep 2022Adrenal lesions are frequently incidentally diagnosed during investigations for other clinical conditions. Despite being usually benign, nonfunctioning, and silent, they... (Review)
Review
Adrenal lesions are frequently incidentally diagnosed during investigations for other clinical conditions. Despite being usually benign, nonfunctioning, and silent, they can occasionally cause discomfort or be responsible for various clinical conditions due to hormonal dysregulation; therefore, their characterization is of paramount importance for establishing the best therapeutic strategy. Imaging techniques such as ultrasound, computed tomography, magnetic resonance, and PET-TC, providing anatomical and functional information, play a central role in the diagnostic workup, allowing clinicians and surgeons to choose the optimal lesion management. This review aims at providing an overview of the most encountered adrenal lesions, both benign and malignant, including describing their imaging characteristics.
PubMed: 36140572
DOI: 10.3390/diagnostics12092171 -
Journal of Laboratory Physicians Sep 2022Fine-needle aspiration cytology (FNAC) is an easy, quick, and specialized technique to distinguish neoplastic from non-neoplastic adrenal lesions, yet limited to...
Fine-needle aspiration cytology (FNAC) is an easy, quick, and specialized technique to distinguish neoplastic from non-neoplastic adrenal lesions, yet limited to tertiary care centers. It helps in analyzing symptomatic, as well as incidental adrenal lesions with high sensitivity and specificity. This study was conducted to determine the cytological spectrum of adrenal lesions in a tertiary care center. This was a retrospective study which included a total of 19 cases of adrenal FNAC received from June 2017 till June 2019 in a north Indian tertiary care university hospital. All the lesions were broadly classified into non-neoplastic and neoplastic categories. The non-neoplastic lesions were divided into infective causes and cystic lesions. Neoplastic lesions were further grouped into benign and malignant lesions. Immunohistochemical findings were retrieved from the hospital records wherever accessible. A total of 19 cases were aspirated, of which 16 cases (84.20%) yielded satisfactory material. Six cases (31.57%) showed non-neoplastic pathology of which one was a cystic lesion, three were infective (two histoplasmosis and one tuberculosis), and two showed only benign adrenal cortical cells in a setting of known extra-adrenal primary malignancy. The neoplastic group comprised of 10 cases (52.63%) of which 4 cases showed metastatic carcinomatous deposits from a known extra-adrenal primary malignancy and 6 cases showed primary adrenal neoplasm (one case of myelolipoma, one case of pheochromocytoma, and four cases of adrenal neoplasm) which were then subjected to biopsy and immunohistochemistry. A final diagnosis of pheochromocytoma was made in three cases, adrenocortical carcinoma in one case, and one case was inconclusive because of nonrepresentative biopsy. Image-guided fine-needle aspiration cytology of adrenal lesions helps to determine the exact nature of the infection, avoids unnecessary surgery, and helps in targeted management. However, histopathological evaluation with immunohistochemistry remains the diagnostic modality of choice with regard to neoplastic lesions.
PubMed: 36119427
DOI: 10.1055/s-0041-1741441 -
Laparoscopic adrenalectomy for a giant adrenal teratoma: A case report and review of the literature.International Journal of Surgery Case... Oct 2022Teratomas typically are benign gonadal neoplasms, arising from more than one embryonic germ layer. Extragonadal teratomas are rare and primary adrenal teratomas more so,...
INTRODUCTION AND IMPORTANCE
Teratomas typically are benign gonadal neoplasms, arising from more than one embryonic germ layer. Extragonadal teratomas are rare and primary adrenal teratomas more so, with few documented cases. We present one such case, diagnosed via CT, resected via laparoscopic adrenalectomy, and confirmed on histology. To the best of our knowledge, this is the first case documented in the Caribbean.
CASE PRESENTATION
A 38-year-old obese female with restrictive lung disease presented with right back/flank pain due to a non-functional 10.5 cm right adrenal mass on CT, likely a giant myelolipoma. Further radiologic review suggested this was instead a mature adrenal teratoma. She underwent a laparoscopic adrenalectomy and histology confirmed a mature adrenal teratoma.
CLINICAL DISCUSSION
Most adrenal tumours are incidentalomas and are usually benign adenomas. Primary adrenal teratomas account for 1 % of teratomas and 0.13 % of adrenal tumours. They may be mature or immature; the latter carries a greater risk of malignancy. Benign adrenal teratomas are typically non-functional and commonly mistaken for myelolipomas on imaging. Adrenalectomy is required due to the risk of malignant transformation. The laparoscopic approach depends on size, localized tissue invasion and technical considerations, but offers advantages for the patient if possible.
CONCLUSIONS
Though uncommon, preoperative radiologic diagnosis of an adrenal teratoma is possible and should be completely resected after a functional workup. A laparoscopic adrenalectomy is preferred once this can be done safely, even when very large, with surgical and oncologic outcomes equivalent to an open approach combined with the known advantages of laparoscopic surgery.
PubMed: 36113368
DOI: 10.1016/j.ijscr.2022.107645 -
Translational Cancer Research Aug 2022Teratomas are unusual tumors derived from multiple germ layers but they usually arise from all three germ layers. Knowledge of this disease is still very limited because...
BACKGROUND
Teratomas are unusual tumors derived from multiple germ layers but they usually arise from all three germ layers. Knowledge of this disease is still very limited because of its low incidence. Retroperitoneal teratomas are extremely rare neoplasms, especially adrenal teratomas, which frequently found to be large, cystic or cyst-solid lesions. Adrenal teratomas are easily confused with various benign or malignant tumors, such as myelolipomas, adenomas, and hamartomas.
CASE DESCRIPTION
In this case presentation, we report a rare case in which an adrenal gland mass without apparent discomfort was detected by abdominal computed tomography (CT) for 6 months in a 59-year-old female. Results from the patient's adrenal hormonal evaluation were normal. An abdominal enhanced CT scan revealed a heterogeneous mass in the right adrenal gland. The patient then underwent a laparoscopic right adrenalectomy and the lesion was diagnosed as mature teratoma through histopathological examination. The patient recovered well without any complications.
CONCLUSIONS
Based on our knowledge, surgical resection is the first-choice intervention for the diagnosis and treatment of mature teratoma. Open surgery is the preferred method for the large tumors, while the laparoscopic adrenalectomy can be a better option in the small one. The patient's prognosis is usually good after complete resection, but close follow-up is also recommended.
PubMed: 36093554
DOI: 10.21037/tcr-21-2913 -
International Journal of Surgery Case... Sep 2022Adrenal myelolipomas (AMLs) are rare, non-functional, benign tumours mostly diagnosed incidentally. They present as small and unilateral masses that are histologically...
INTRODUCTION AND IMPORTANCE
Adrenal myelolipomas (AMLs) are rare, non-functional, benign tumours mostly diagnosed incidentally. They present as small and unilateral masses that are histologically composed of mature adipose tissue with admixed haemopoietic elements. In a small percentage of patients, pressure symptoms, retroperitoneal haemorrhage or tumour rupture may occur. However, indications for surgery in the majority of asymptomatic patients are poorly defined.
CASE PRESENTATION
A 44-year old male patient presented with signs of gastroenteritis. Computed tomography (CT) imaging revealed an encapsulated, sharply delineated mass measuring 87 × 76 × 87 mm displacing the right adrenal gland. Average attenuation was -30 Hounsfield units. Given the pathognomonic features, an AML was suspected. The patient underwent open tumour resection and the diagnosis was histologically confirmed.
CLINICAL DISCUSSION
Small (<4 cm), homogeneous, non-hormone secreting incidentalomas with an attenuation of <10 Hounsfield units on non-contrast CT are considered benign requiring neither treatment nor follow-up. Giant AMLs (>10 cm) may cause symptoms or complications and are therefore considered candidates for surgery. The treatment strategy of asymptomatic AMLs ranging from 4 cm to 10 cm, however, is controversial and poorly defined. The role of surgery in this specific subgroup of patients is studied.
CONCLUSION
Surgery is indicated in the presence of a tumour diameter above 6 cm, rapid tumour growth (RECIST 1.1 criteria for progressive disease at 6-12 months follow-up), imaging suspicious of malignancy, radiological signs of local invasion, functioning ipsilateral adrenocortical adenoma, pressure-related symptoms and signs of retroperitoneal bleeding or spontaneous tumour rupture.
PubMed: 36030765
DOI: 10.1016/j.ijscr.2022.107527 -
Indian Journal of Pathology &... 2022Adrenal myelolipoma is a benign tumor-like growth, composed of mature fat cells and bone marrow elements. We report a case of a 44-year lady who presented with a...
Adrenal myelolipoma is a benign tumor-like growth, composed of mature fat cells and bone marrow elements. We report a case of a 44-year lady who presented with a complaint of pain in the abdomen. The only positive finding was contrast-enhanced computed tomography (CECT) whole abdomen, which was suggestive of heterogeneously enhancing hypodense lesion of size 130 mm × 105 mm with few calcifications and 103 mm × 75 mm with intralesional fat attenuation in right and left adrenals. Rest laboratory parameters were normal. Only a few cases so far have been reported for bilateral adrenal myelolipoma but what stands out in our case is its giant size and bilaterality, managed surgically without any complications.
Topics: Adrenal Gland Neoplasms; Adrenal Glands; Humans; Lipoma; Myelolipoma; Tomography, X-Ray Computed
PubMed: 35900504
DOI: 10.4103/ijpm.ijpm_182_21 -
ACG Case Reports Journal Jul 2022A 20-year-old woman with Crohn's disease receiving infliximab therapy presented to the emergency department with lower extremity swelling secondary to compression of the...
A 20-year-old woman with Crohn's disease receiving infliximab therapy presented to the emergency department with lower extremity swelling secondary to compression of the common iliac vein. On magnetic resonance imaging, an enlarging pelvic mass was identified. The pathology of the mass was consistent with myelolipoma. We believe this is the first case of myelolipoma in a patient on immunosuppression with infliximab.
PubMed: 35784510
DOI: 10.14309/crj.0000000000000791 -
Revista Medica Del Instituto Mexicano... Mar 2022Adrenal myelolipomas (ML) are rare benign neoplasms compound of adipose and myeloid tissue. Clinically they are usually asymptomatic, being diagnosed generally by... (Review)
Review
BACKGROUND
Adrenal myelolipomas (ML) are rare benign neoplasms compound of adipose and myeloid tissue. Clinically they are usually asymptomatic, being diagnosed generally by incident. In Mexico, there are only 32 published cases of ML, these occur between 37 and 65 years, with the male-female ratio being 1:1.1, clinically they present with abdominal or lumbar pain, open surgery being the main surgical approach (89%).
CLINICAL CASE
We made a literature review of ML in Mexico and present two clinical cases: a 67-year-old man in followup for diverticular disease and a 40-year-old woman with pain in the left upper quadrant. In both cases, tumor resection was performed measuring 9.5 cm and 13.3 cm long respectively.
CONCLUSIONS
We present two new cases in our country that correspond to incidentalomas. In both cases, surgery was performed to confirm the diagnosis, as well as to prevent possible complications.
Topics: Adrenal Gland Neoplasms; Adult; Aged; Female; Humans; Lipoma; Low Back Pain; Male; Mexico; Myelolipoma
PubMed: 35759694
DOI: No ID Found -
Journal of Bone Oncology Aug 2022Extra-adrenal myelolipomas (EAMs) are rare benign tumors composed of both mature adipose and hematopoietic tissues with unclear etiology. There have been only sporadic...
PURPOSE
Extra-adrenal myelolipomas (EAMs) are rare benign tumors composed of both mature adipose and hematopoietic tissues with unclear etiology. There have been only sporadic case reports about the clinical characteristics and management of EAMs. Here we present our experience and practice in the clinical diagnosis and treatment of 11 consecutive patients with EAMs.
METHOD
We retrospectively reviewed 11 consecutive patients, who received surgeries in our department and were confirmed as having EAMs by postoperative histopathology from April 2016 to December 2021. Clinical information and follow-up data of all patients were collected and analyzed afterwards.
RESULTS
Of the 11 EAM patients (7 male and 4 female) with a mean age of 47.6 years, 3 were asymptomatic and 8 were symptomatic with a mean symptom duration of 6.07 months. EAMs were found in the thoracic spine in 4 cases, paravertebral mediastinal regions in 3 cases, ilium in 2 cases, humerus in 1 case, and rib in 1 case. All patients were initially misdiagnosed as other tumors by radiologists. All 11 patients received gross total excision or curettage with a mean intraoperative blood loss of 781.82 ± 1143.3 ml and a mean operation duration of 180.91 ± 98.41 min. Patients' Frankel scores and Karnofsky Performance Status score were improved or at least preserved postoperatively. No significant complications occurred postoperatively. All the 11 patients survived, and no local recurrence or distant metastasis occurred during the mean follow-up period of 42.0 months.
CONCLUSION
The surgical outcome and prognosis of EAMs are excellent and surgery can serve as the method of radical treatment.
PubMed: 35721369
DOI: 10.1016/j.jbo.2022.100438 -
Journal of Surgical Case Reports May 2022Myelolipoma is a rare, benign, non-secreting tumor and its pathophysiology is of metaplasia of the cells of the adrenal cortex into reticuloendothelial cells. Although...
Myelolipoma is a rare, benign, non-secreting tumor and its pathophysiology is of metaplasia of the cells of the adrenal cortex into reticuloendothelial cells. Although they are often small and asymptomatic, some cases of giant adrenal myelolipoma cause symptoms such as chronic pain. Few cases of adrenal myelolipoma have been reported in the literature. We present a case of a large right adrenal myelolipoma in a 26-year-old female patient, who presented with an adrenal mass, and discuss the challenges of diagnosis and treatment.
PubMed: 35665404
DOI: 10.1093/jscr/rjac213