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Chirurgia (Bucharest, Romania : 1990) 2017Laparoscopic adrenalectomy became the gold standard for adrenal disease, from incidentaloma to cancer. Partial adrenalectomy is difficult to accept due to its technical...
Laparoscopic adrenalectomy became the gold standard for adrenal disease, from incidentaloma to cancer. Partial adrenalectomy is difficult to accept due to its technical difficulties as well as hemorrhagic risk and a consensus has not been reached. On the other hand, in selected cases of benign adrenal tumors, adrenalectomy may be futile, partial resections being perfectly justified and with lower hemorrhagic risks. For functioning tumors smaller than 3 cm with an anterior or lateral location, partial adrenalectomy may be indicated. The key points reside in adenoma identification, preservation of the remaining glandular parenchyma and its blood supply with dissection in the space between the adenoma and the normal parenchyma. Laparoscopic partial adrenalectomy is feasible and effective for the treatment of benign tumors. Although partial resections have clear-cut advantages over conventional adrenalectomy especially for bilateral tumors, it remains a difficult intervention.
Topics: Adrenal Gland Diseases; Adrenal Gland Neoplasms; Adrenalectomy; Feasibility Studies; Humans; Laparoscopy; Treatment Outcome
PubMed: 28266298
DOI: 10.21614/chirurgia.112.1.77 -
JSLS : Journal of the Society of... 2009Advances in imaging have improved early detection of primary and metastatic adrenal tumors. The laparoscopic approach, the gold standard for benign adrenal diseases, is... (Review)
Review
Advances in imaging have improved early detection of primary and metastatic adrenal tumors. The laparoscopic approach, the gold standard for benign adrenal diseases, is controversial for malignant adrenal tumors. A prospective randomized study of the role of laparoscopic surgery in adrenal cancer is not feasible because of the rarity of the disease. A review of the literature demonstrates the safety and efficacy of laparoscopic adrenalectomy for solitary adrenal tumors. In primary adrenal malignancies, the laparoscopic approach should be considered cautiously, only when it can achieve complete tumor resection with an intact adrenal capsule. Conversion to an open procedure should be an early decision, prior to tumor morcellation or fracture of the tumor capsule. Patients who have local invasion, tumors that are too large, or require organ resection require an open procedure.
Topics: Adrenal Cortex Neoplasms; Adrenal Gland Neoplasms; Adrenalectomy; Adrenocortical Carcinoma; Humans; Laparoscopy; Pheochromocytoma; Treatment Outcome
PubMed: 19660215
DOI: No ID Found -
Journal of Cancer Research and... Sep 2022Primary adrenal lymphoma (PAL) is an extremely rare malignancy, and it accounts for approximately 1% of non-Hodgkin's lymphoma (NHL). The growth of adrenal lymphoma is... (Review)
Review
Primary adrenal lymphoma (PAL) is an extremely rare malignancy, and it accounts for approximately 1% of non-Hodgkin's lymphoma (NHL). The growth of adrenal lymphoma is characterized by rapid infiltration in the adrenal gland and further involvement and metastasis in other tissues and organs. This report describes the case of a 67-year-old man with fatigue, poor appetite, and weight loss. Positron emission tomography and computed tomography (PET-CT) scan showed irregular mass-like soft tissue density shadows were noted in the bilateral adrenal glands and immunohistochemical (IHC) studies confirmed the diagnosis of PAL with multiple metastases throughout the body. This report characterizes the clinical manifestations in patients with PAL. When the disease progresses to bilateral adrenal involvement, it may be accompanied by adrenal insufficiency or even adrenal crisis occurred.
Topics: Adrenal Gland Neoplasms; Adrenal Insufficiency; Aged; China; Humans; Lymphoma; Male; Positron Emission Tomography Computed Tomography
PubMed: 36204896
DOI: 10.4103/jcrt.jcrt_878_22 -
The Kaohsiung Journal of Medical... Jul 2012Adrenal myelolipoma is a rare, nonfunctioning, and benign tumor. We report our experience of surgically treated patients from a single institute and review the... (Review)
Review
Adrenal myelolipoma is a rare, nonfunctioning, and benign tumor. We report our experience of surgically treated patients from a single institute and review the literature. Six patients (three men and three women) were diagnosed and received surgical intervention. A retrospective analysis was done by reviewing medical records. In our series, three patients were diagnosed incidentally and the others were discovered due to symptoms. All received surgery, including laparoscopic adrenalectomy. There was no recurrence. In the literature review, right adrenal gland was dominant and the prevalent age was from the fourth to sixth decades. The most common symptoms were abdominal and flank pain. Adrenal myelolipoma is uncommon and easily confused with malignancy when of large size (≥ 6 cm). Surgery may be reserved for symptomatic cases and those lesions that cannot reliably be diagnosed. Large tumors (≥ 6 cm) can be excised surgically or laparoscopically.
Topics: Adrenal Gland Neoplasms; Adult; Female; Humans; Male; Middle Aged; Myelolipoma; Tomography, X-Ray Computed
PubMed: 22726900
DOI: 10.1016/j.kjms.2012.02.005 -
Clinics (Sao Paulo, Brazil) Dec 2018Malignancy must be considered in the management of adrenal lesions, including those incidentally identified on imaging studies. Adrenocortical carcinomas (ACCs) are rare... (Review)
Review
Malignancy must be considered in the management of adrenal lesions, including those incidentally identified on imaging studies. Adrenocortical carcinomas (ACCs) are rare tumors with an estimated annual incidence of 0.7-2 cases per year and a worldwide prevalence of 4-12 cases per million/year. However, a much higher incidence of these tumors (>15 times) has been demonstrated in south and southeastern Brazil. Most ACCs cause hypersecretion of steroids including glucocorticoids and androgens. ACC patients have a very poor prognosis with a 5-year overall survival (OS) below 30% in most series. Pheochromocytoma or paraganglioma (PPGL) is a metabolically active tumor originating from the chromaffin cells of the adrenal medulla. The incidence of PPGL is 0.2 to 0.9 cases per 100,000 individuals per year. Pheochromocytomas are present in approximately 4-7% of patients with adrenal incidentalomas. Classically, PPGL manifests as paroxysmal attacks of the following 4 symptoms: headaches, diaphoresis, palpitations, and severe hypertensive episodes. The diagnosis of malignant PPGL relies on the presence of local invasion or metastasis. In this review, we present the clinical and biochemical characteristics and pathogenesis of malignant primary lesions that affect the cortex and medulla of human adrenal glands.
Topics: Adrenal Cortex Neoplasms; Adrenal Gland Neoplasms; Adrenocortical Carcinoma; Antineoplastic Agents, Hormonal; Humans; Mitotane; Paraganglioma; Pheochromocytoma
PubMed: 30540124
DOI: 10.6061/clinics/2018/e756s -
Current Opinion in Endocrinology,... Jun 2021To summarise the emerging role of thermal ablation as a therapeutic modality in the management of functioning adrenal tumours and metastases to the adrenal gland. (Review)
Review
PURPOSE OF REVIEW
To summarise the emerging role of thermal ablation as a therapeutic modality in the management of functioning adrenal tumours and metastases to the adrenal gland.
RECENT FINDINGS
Observational evidence has demonstrated the benefit of thermal ablation in (i) resolving adrenal endocrinopathy arising from benign adenomas, (ii) treating solitary metastases to the adrenal and (iii) controlling metastatic adrenocortical carcinoma and phaeochromocytoma/paraganglioma.
SUMMARY
Microwave thermal ablation offers a promising, minimally invasive therapeutic modality for the management of functioning adrenocortical adenomas and adrenal metastases. Appropriate technological design, treatment planning and choice of imaging modality are necessary to overcome technical challenges associated with this emerging therapeutic approach.
Topics: Ablation Techniques; Adrenal Gland Diseases; Adrenal Gland Neoplasms; Humans; Hyperthermia, Induced; Microwaves; Radiofrequency Ablation
PubMed: 33741778
DOI: 10.1097/MED.0000000000000627 -
Endocrine Reviews Dec 2017A molecular biology-based taxonomy has been proposed for pheochromocytoma and paraganglioma (PPGL). Data from the Cancer Genome Atlas revealed clinically relevant... (Review)
Review
A molecular biology-based taxonomy has been proposed for pheochromocytoma and paraganglioma (PPGL). Data from the Cancer Genome Atlas revealed clinically relevant prognostic and predictive biomarkers and stratified PPGLs into three main clusters. Each subgroup has a distinct molecular-biochemical-imaging signature. Concurrently, new methods for biochemical analysis, functional imaging, and medical therapies have also become available. The research community now strives to match the cluster biomarkers with the best intervention. The concept of precision medicine has been long awaited and holds great promise for improved care. Here, we review the current and future PPGL classifications, with a focus on hereditary syndromes. We discuss the current strengths and shortcomings of precision medicine and suggest a condensed manual for diagnosis and treatment of both adult and pediatric patients with PPGL. Finally, we consider the future direction of this field, with a particular focus on how advanced molecular characterization of PPGL can improve a patient's outcome, including cures and, ultimately, disease prevention.
Topics: Adrenal Gland Neoplasms; Biomarkers, Tumor; Genetic Predisposition to Disease; Humans; Molecular Diagnostic Techniques; Mutation; Paraganglioma; Pheochromocytoma; Precision Medicine
PubMed: 28938417
DOI: 10.1210/er.2017-00062 -
Surgical Endoscopy Feb 2022Some authors consider adrenal lesions size of less than 4 cm as a positive cut-off limit to set the indications for minimally invasive surgery due to a lower risk of...
BACKGROUND
Some authors consider adrenal lesions size of less than 4 cm as a positive cut-off limit to set the indications for minimally invasive surgery due to a lower risk of malignancy. Aim of this study is to report the risk of cancer for adrenal lesions measuring 4 cm or more in diameter, assessed as benign at preoperative workup (primary outcome), and to evaluate the feasibility and safety of laparoscopic adrenalectomy (LA) in these cases (secondary outcome).
METHODS
From January 1994 to February 2019, 579 patients underwent adrenalectomy. Fifty patients with a preoperative diagnosis of primary adrenal cancer or metastases were excluded. The remaining 529 patients were included and divided in five subgroups based on adrenal lesion size at definitive histology: group A, 4-5.9 cm (137 patients); group B, 6-7.9 cm (64 patients); group C, 8-9.9 cm (13 patients); group D, ≥ 10 cm (11 patients); group E, < 4 cm (304 patients). Each group was further divided based on diagnosis of benign or malignant lesions at definitive histology.
RESULTS
Four (2.9%) malignant lesions were observed in group A, 5 (7.8%) in group B, 2 (15.4%) in Groups C and D (18.2%) and 13 (4.3%) in Group E. Comparing the cancer risk among the groups, no statistically significant differences were observed. Operative time increased with increasing lesion size. However, no statistically significant differences were observed between benign and malignant lesions in each group comparing operative time, conversion and complication rates, postoperative hospital stay and mortality rate.
CONCLUSIONS
Adrenal lesions measuring 4 cm or more in diameter are not a contraindication for LA neither in terms of cancer risk nor of conversion and morbidity rates, even if the operative time increases with increasing adrenal lesion diameter. Further prospective studies with a larger number of patients are required to draw definitive conclusions.
Topics: Adrenal Gland Neoplasms; Adrenalectomy; Contraindications; Humans; Laparoscopy; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 33650006
DOI: 10.1007/s00464-021-08380-7 -
Journal of Endocrinological... Mar 2014Adrenocortical carcinoma (ACC) is a devastating tumor for either patients or their families because of short life expectancy and severe impact on quality of life. Due to... (Review)
Review
Adrenocortical carcinoma (ACC) is a devastating tumor for either patients or their families because of short life expectancy and severe impact on quality of life. Due to the rarity of ACC, with a reported annual incidence of 0.5-2 cases per million population, progress in the development of treatment options beyond surgery has been limited. Up to now, no personalized approach of ACC therapy has emerged, apart from plasma level-guided mitotane therapy, and no simple targetable molecular event has been identified from preclinical studies. Complete surgical removal of ACC is the only potentially curative approach and has the most important impact on patient’s prognosis. Despite the limits of the available evidence, adjuvant mitotane therapy is currently recommended in many expert centers whenever the patients present an elevated risk of recurrence. The management of patients with recurrent and metastatic disease is challenging and the prognosis is often poor. Mitotane monotherapy is indicated in the management of patients with a low tumor burden and/or more indolent disease while patients whose disease show an aggressive behavior need cytotoxic chemotherapy. The treatment of patients with advanced ACC may include loco-regional approaches such as surgery and radiofrequency ablation in addition to systemic therapies. The present review provides an updated overview of the management of ACC patients following surgery and of the management of ACC patients with advanced disease.
Topics: Adrenal Gland Neoplasms; Disease Management; Humans; Neoplasm Staging; Prognosis; Time Factors
PubMed: 24458831
DOI: 10.1007/s40618-013-0049-2 -
Cancer Imaging : the Official... Oct 2007With the increasing use of abdominal cross-sectional imaging, incidental adrenal masses are frequently detected. The commonest clinical question is whether these are... (Review)
Review
With the increasing use of abdominal cross-sectional imaging, incidental adrenal masses are frequently detected. The commonest clinical question is whether these are benign adenomas or malignant primary or secondary masses. The nature of incidentally detected adrenal masses can be determined with a high degree of accuracy using computed tomography (CT) and magnetic resonance imaging (MRI) as benign adrenal masses such as myelolipomas, lipid-rich adenomas, adrenal cysts and adrenal haemorrhage which have pathognomonic imaging findings. However, there remains a significant overlap between the imaging features of some lipid-poor adenomas and malignant lesions. We review the recent advances in CT, MRI and positron emission tomography (PET) which can be used to distinguish between benign adenomas and malignant lesions of the adrenal gland.
Topics: Adrenal Gland Diseases; Adrenal Gland Neoplasms; Contrast Media; Diagnosis, Differential; Humans; Incidental Findings; Magnetic Resonance Imaging; Neoplasms; Radiopharmaceuticals; Tomography, Emission-Computed; Tomography, X-Ray Computed
PubMed: 17921094
DOI: 10.1102/1470-7330.2007.9017