Cystic adrenal lesions: clinical and surgical management. The experience of a referral centre.

Abstract

BACKGROUND:

Cystic adrenal lesions (CALs) represent a rare entity having heterogeneity in etiology and clinical manifestations. Due to their very low incidence and heterogeneity in clinical aspects, many controversials still exist about their management.

METHODS:

From 1984 to 2012, 21 patients (7 M, 14 F, mean age 48.2 years) underwent adrenalectomy for CALs. 9 patients suffered from hypertension, and 7 were affected by thyroid disorders.

RESULTS:

4 patients presented with vague abdominal pain, while in 17 patients the CAL was incidentally identified during imaging examinations. All patients underwent evaluation of adrenal functionality and imaging study. We found 1 case of cystic pheochromocytoma (confirmed by urinary and blood sampling, and MIBG-scan). All patients underwent adrenalectomy (open approach in the first 10 patients treated from 1984 to 1996, laparoscopic lateral transabdominal approach in the other 11 cases). Indication to surgery included: size over 4.5 cm in 16 cases, suspected malignancy at imaging evaluation (not confirmed by histology) in 4 cases, cystic pheochromocytoma in 1 case. Histology revealed 11 endothelial cysts, 3 pseudocysts, 6 epithelial cysts and 1 cystic pheochromocytoma.

CONCLUSIONS:

The presence of CAL, even asymptomatic, requires complete endocrinological evaluation and imaging study. In the presence of large size, endocrine activity or any suspicion of malignancy, patients must be referred to surgery.

• Authors: Giuseppe Cavallaro, Daniele Crocetti, Annalisa Paliotta, Antonietta De Gori, Maria Rita Tarallo, Claudio Letizia, Giorgio De Toma
• Journal: International journal of surgery (London, England) (Int J Surg) Vol. 13 Pg. 23-26 (Jan 2015) ISSN: 1743-9159 [Electronic] United States
• PMID: 25447606 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Topics

• Adrenal Gland Diseases (surgery)
• Adrenal Gland Neoplasms (surgery)
• Adrenalectomy (methods)
• Adult
• Asymptomatic Diseases
• Cysts (surgery)
• Female
• Humans
• Laparoscopy
• Male
• Middle Aged
• Pheochromocytoma (surgery)
• Referral and Consultation
• Retrospective Studies