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Endokrynologia Polska 2021There is an increasing number of adrenal tumours discovered incidentally during imaging examinations performed for many different indications. Based on imaging results,...
INTRODUCTION
There is an increasing number of adrenal tumours discovered incidentally during imaging examinations performed for many different indications. Based on imaging results, it is possible to differentiate benign from malignant adrenal masses, although there is still a number of equivocal imaging findings. Our study presents 77 cases of adrenal tumours in which imaging was inconclusive and the final diagnosis was stated only after surgery and histopathological examination.
MATERIAL AND METHODS
Retrospective data analysis: 77 cases of indeterminate adrenal tumours with a presumptive diagnosis of "nonadenoma" in patients operated within a 16-year period (2004-2019). None of the patients had a history of malignancy, and all tumours were hormonally inactive. On contrast-enhanced computed tomography (CT), the native density of all tumours was higher than 10 Hounsfield Units (HU), and the absolute percentage washout (APW) and relative percentage washout (RPW) were lower than 60% and 40%, respectively.
RESULTS
The most common findings were adrenal adenoma (25.9%), macronodular adrenal hyperplasia (16.9%), ganglioneuroma (15.6%), and haemorrhage with posthaemorrhagic changes (13%). In total, there were 12 various histopathological diagnoses in this group. There were only 2 (2.6%) malignant (adrenal cancer and leiomyosarcoma) and 3 (3.9%) potentially malignant (pheochromocytoma) lesions in this group.
CONCLUSIONS
It is often impossible to make a correct diagnosis in a clinical setting until it is histologically verified. "Nonadenoma" adrenal tumours constitute a heterogeneous group including very rare pathologies. The risk of malignancy in indeterminate adrenal tumours is relatively low.
Topics: Adrenal Gland Diseases; Adrenal Gland Neoplasms; Adrenal Glands; Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 34292568
DOI: 10.5603/EP.a2021.0063 -
Hormones & Cancer Dec 2011
Topics: Adrenal Gland Neoplasms; Animals; Biomarkers, Tumor; Carcinoma; Cell Transformation, Neoplastic; Disease Models, Animal; Endocrinology; Humans; Medical Oncology; Molecular Targeted Therapy; Prognosis
PubMed: 22173667
DOI: 10.1007/s12672-011-0092-4 -
Cancer Oct 2004Cystic lesions of the adrenal gland are uncommon and demonstrate a spectrum of histologic changes and may vary from pseudocysts to malignant cystic neoplasms.
BACKGROUND
Cystic lesions of the adrenal gland are uncommon and demonstrate a spectrum of histologic changes and may vary from pseudocysts to malignant cystic neoplasms.
METHODS
The authors analyzed a series of primary cystic lesions of the adrenal gland to evaluate the clinicopathologic features and histologic spectrum and to determine features that are helpful in distinguishing benign from malignant cystic adrenal tumors.
RESULTS
A total of 41 cases of macroscopically cystic lesions among patients who underwent surgery at the Mayo Clinic were identified over a 25-year period. Of these 41 cases, 32 were pseudocysts, 8 were endothelial cysts, and 1 was an epithelial cyst. Of the 32 pseudocysts, 6 were associated with adrenal neoplasms, including 2 adrenal cortical carcinomas, 2 adrenal cortical adenomas, and 2 pheochromocytomas. One pheochromocytoma case was identified in association with an endothelial cyst. Both patients with cystic adrenal cortical carcinomas died of disease.
CONCLUSIONS
Adrenal neoplasms, including adrenal cortical carcinomas, may be associated with benign-appearing cysts. Extensive pathologic sampling of resected tissues is important to rule out malignancy in patients with cystic adrenal lesions.
Topics: Adolescent; Adrenal Cortex Neoplasms; Adrenal Gland Diseases; Adrenal Gland Neoplasms; Adrenocortical Carcinoma; Adult; Aged; Aged, 80 and over; Cysts; Female; Humans; Male; Middle Aged; Pheochromocytoma
PubMed: 15378490
DOI: 10.1002/cncr.20555 -
International Journal of Cancer Jun 2016The pathogenetic mechanisms underlying the onset of adrenocortical tumors (ACTs) are still largely unknown. Recently, more attention has been paid to the role of insulin... (Review)
Review
The pathogenetic mechanisms underlying the onset of adrenocortical tumors (ACTs) are still largely unknown. Recently, more attention has been paid to the role of insulin and insulin-like growth factor (IGF) system on general tumor development and progression. Increased levels of insulin, IGF-1 and IGF-2 are associated with tumor cell growth and increased risk of cancer promotion and progression in patients with type 2 diabetes. Insulin resistance and compensatory hyperinsulinemia may play a role in adrenal tumor growth through the activation of insulin and IGF-1 receptors. Interestingly, apparently non-functioning ACTs are often associated with a high prevalence of insulin resistance and metabolic syndrome. However, it is unclear if ACT develops from a primary insulin resistance and compensatory hyperinsulinemia or if insulin resistance is only secondary to the slight cortisol hypersecretion by ACT. The aim of this review is to summarize the current evidence regarding the relationship between hyperinsulinemia and adrenocortical tumors.
Topics: Adrenal Cortex Neoplasms; Adrenal Gland Neoplasms; Animals; Humans; Hydrocortisone; Insulin; Insulin Resistance
PubMed: 26637955
DOI: 10.1002/ijc.29950 -
Clinical Medicine (London, England) Mar 2023With the increasing volume of diagnostic imaging undertaken in an ageing population, adrenal incidentalomas (AIs) are increasingly commonly seen. These masses are most...
With the increasing volume of diagnostic imaging undertaken in an ageing population, adrenal incidentalomas (AIs) are increasingly commonly seen. These masses are most likely to be benign, but a small proportion may be malignant. Similarly, they are usually non-functional, but ∼14% are functional, ie hormone-secreting tumours. Clinical, biochemical and radiological assessment is mandated to stratify patients into those requiring radiological surveillance, medical management or surgical intervention or who can be discharged. Mass characteristics on cross-sectional (CT/MRI) imaging influence the need for radiological surveillance. Functional tumours where excess cortisol, aldosterone or catecholamine are secreted should be excluded, with mild autonomous cortisol secretion (MACS) and primary aldosteronism (PA) as the two most common functional states. MACS and PA are associated with an increased risk of cardiometabolic disease (eg hypertension, type 2 diabetes) and cardiovascular morbidity/mortality (eg coronary heart disease). Multidisciplinary management is critical for selected cases; the majority of adrenal incidentalomas only require a single assessment.
Topics: Humans; Hydrocortisone; Adrenal Gland Neoplasms; Diabetes Mellitus, Type 2; Cross-Sectional Studies
PubMed: 36958837
DOI: 10.7861/clinmed.2023-0042 -
The Journal of Urology May 2011
Topics: Adrenal Gland Neoplasms; Age Factors; Biomarkers, Tumor; Diagnosis, Differential; Humans; Mutation; Pheochromocytoma; Prognosis
PubMed: 21419442
DOI: 10.1016/j.juro.2010.12.107 -
Ugeskrift For Laeger Aug 2020With wider application and technical improvement of imaging the discovery of adrenal incidentalomas (AI) has been skyrocketing. AI need to be investigated for evidence... (Review)
Review
With wider application and technical improvement of imaging the discovery of adrenal incidentalomas (AI) has been skyrocketing. AI need to be investigated for evidence of hormonal hypersecretion and malignancy, and this causes a considerable use of health resources and potential medicalisation. In the "no-need-to-see" process, the clinical assessment of the citizen will only take place, if the diagnostic tests are abnormal. In this review, we examine the predictive values of imaging and paraclinical testing and argue, that normal test results in people without extra-adrenal cancer exclude disease.
Topics: Adrenal Gland Neoplasms; Humans; Incidental Findings
PubMed: 33000724
DOI: No ID Found -
Frontiers in Endocrinology 2021
Topics: Adrenal Gland Neoplasms; Carcinogenesis; Combined Modality Therapy; Endocrinology; Humans; Molecular Targeted Therapy; Mutation; Pheochromocytoma; Preoperative Care; Prognosis; Receptors, G-Protein-Coupled; Risk Assessment; Succinate Dehydrogenase; Tumor Hypoxia
PubMed: 34497588
DOI: 10.3389/fendo.2021.720983 -
Discovery Medicine Jan 2010Unanticipated adrenal masses are frequently encountered in modern, high resolution diagnostic imaging. Most often, these masses are benign adrenal adenomas, but when... (Review)
Review
Unanticipated adrenal masses are frequently encountered in modern, high resolution diagnostic imaging. Most often, these masses are benign adrenal adenomas, but when detected they necessitate a clinical evaluation sufficient to exclude subclinical endocrine disease, primary adrenal cancer, and remote metastases to the adrenal glands from other malignancies. These "incidentally-discovered" adrenal masses or so-called "adrenal incidentalomas" can be further evaluated with CT, MRI, and nuclear medicine imaging techniques. A substantial literature supports the use of each of these modalities to non-invasively characterize these neoplasms that have been considered by some as a 'disease' of modern imaging technology.
Topics: Adrenal Gland Diseases; Adrenal Gland Neoplasms; Humans; Incidental Findings; Magnetic Resonance Imaging; Tomography, X-Ray Computed
PubMed: 20102682
DOI: No ID Found -
Turk Patoloji Dergisi 2015Genomic studies in the recent decades lead to the identification of new genetic mutations that have been shown to play detrimental roles in the formation of... (Review)
Review
Genomic studies in the recent decades lead to the identification of new genetic mutations that have been shown to play detrimental roles in the formation of pheochromocytoma or paraganglioma. The majority of these genetic mutations detected affect two major cellular pathways - pseudo hypoxic pathway and kinase signalling pathway. Genetic mutations also resulted in syndromes related to paraganglioma/pheochromocytoma. The classical syndromes comprise - neurofibromatosis, multiple neuroendocrine neoplasia (MEN) (II and III) syndromes and von Hippel-Lindau syndrome. Also, mutations in succinate dehydrogenase genes contribute to the understanding of hereditary paragangliomapheochromocytoma syndromes, Carney's triad and Carney- Stratakis syndrome. Lesions newly known to be associated with the genetic mutations in pheochromocytoma/ paraganglioma include gastrointestinal stromal tumour and renal cell carcinoma. Pathological features, proliferative index, genetic and biochemical parameters could help to predict the malignant potential of paraganglioma and pheochromocytoma. Different predictive systems have been proposed and with the help of immunochemical studies. Pathologist should be aware of the advances in knowledge and contribute to the validation of the pathological features and markers for prediction of malignant potential of this group of tumours.
Topics: Adrenal Gland Neoplasms; Biomarkers, Tumor; Biopsy; Genetic Predisposition to Disease; Humans; Immunohistochemistry; Molecular Diagnostic Techniques; Paraganglioma, Extra-Adrenal; Phenotype; Pheochromocytoma; Predictive Value of Tests; Prognosis
PubMed: 26177321
DOI: 10.5146/tjpath.2015.01318