Surgical removal of giant adrenal lipoma with gallstones in limited resources areas: A case report.

INTRODUCTION AND IMPORTANCE: Adrenal Lipoma (LA) is a benign very rare tumor that accounts for 0.7 % of primary adrenal tumors and 4 % of adrenal fatty tumors. They are asymptomatic and discovered accidentally by a CT scan or the US. CASE PRESENTATION: This case report describes an incidentally discovered giant adrenal lipoma in a 45-year-old Asian woman with no prior medical history, presenting with episodic blood pressure fluctuations and abdominal pain attributed to coexisting gallstones. Imaging revealed a heterogeneous, well-demarcated adrenal mass measuring 17 × 14 × 11 cm with a 2 × 3 cm nodular density. Histopathological examination confirmed a 15 cm lipoma with ischemic changes, devoid of atypical features. This case underscores the importance of thorough investigation for adrenal masses, even in asymptomatic individuals. DISCUSSION: This case report details a rare instance of a giant adrenal lipoma (17 × 14 × 11 cm, 870 g) co-occurring with gallstones in a 45-year-old woman experiencing chronic abdominal pain. Computed tomography revealed a characteristic homogenous fatty lesion, prompting open surgical resection due to the tumor's size. Hormonal evaluation confirmed a non-functioning tumor. This case emphasizes the challenges in diagnosing and managing giant adrenal lipomas, advocating for comprehensive investigation of adrenal masses, particularly with concurrent hypertension. CONCLUSION: Giant adrenal lipomas (LAs) are rare, benign tumors often presenting asymptomatically. This report documents the fifth largest and third heaviest LA reported, notably co-occurring with gallstones. While laparoscopic resection is ideal, delayed diagnosis due to insidious presentation can lead to increased tumor size, potentially precluding minimally invasive approaches.

Primary adrenal Ewing sarcoma: A systematic review of the literature.

BACKGROUND: Ewing sarcoma (ES) is a malignant neoplasm of neuroectodermal origin and is commonly observed in children and young adults. The musculoskeletal system is the main body system impacted and ES is rarely seen in the visceral organs particularly the adrenal gland. AIM: To present a comprehensive review of primary adrenal ES, with emphasis on diagnosis, therapy and oncological outcomes. METHODS: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020. PubMed/ MEDLINE, EMBASE and Google Scholar bibliographic databases were searched to identify articles from 1989 to 2022 and included patients with ES/primitive neuroectodermal tumor (PNET) of the adrenal gland. PubMed, Google Scholar and EMBASE medical databases were searched, combining the terms "adrenal", "ES" and "PNET". Demographic, clinical, pathological and oncological data of patients were analyzed by SPSS version 29.0. RESULTS: A total of 52 studies were included for review (47 case reports and 5 case series) with 66 patients reported to have primary adrenal ES. Mean age at diagnosis was 26.4 ± 15.4 years (37.9% males, 57.6% females, sex not reported in 3 cases). The most frequent complaint was abdominal/flank pain or discomfort (46.4%) followed by a palpable mass (25.0%), and the average duration of symptoms was 2.6 ± 3.1 mo. The imaging modality of choice was computed tomography scan (81.5%), followed by magnetic resonance imaging (20.4%). Preoperative staging revealed that 17 tumors (27.9%) were metastatic and 14 patients had inferior vena cava or renal vein neoplastic thrombus at initial diagnosis. Open adrenalectomy was performed in the majority of cases (80.0%), of which 27.9% required more extensive resection. Minimally invasive surgery was attempted in 8.2% of tumors. Complete surgical resection was achieved in 89.4% of the patients. Adjuvant therapy was administered to 32 patients, in the form of chemotherapy (62.5%), radiotherapy (3.1%) or combination (34.4%). Median overall survival was 15 mo and 24-mo overall survival was 40.5%. Median disease-free survival was 10 mo and 24-mo disease-free survival was 33.3%. CONCLUSION: The significant progress in molecular biology and genetics of ES does not reflect on patient outcomes. ES remains an aggressive tumor with a poor prognosis and high mortality.

Role of 18F-FDG PET/CT in the differential diagnosis of primary benign and malignant unilateral adrenal tumors.

BACKGROUND: This retrospective study was performed to estimate the clinical role of whole-body positron emission tomography/computed tomography (PET/CT) using 2-[18F] fluoro-2-deoxy-D-glucose (FDG) in the differential diagnosis of primary benign and malignant unilateral adrenal tumors. METHODS: A total of 64 patients (31 male, 33 female; age range: 3-76 years, mean: 48.5) with a confirmed unilateral adrenal tumor underwent 18F-FDG PET/CT examination for diagnosis and staging. The whole-body 18F-FDG PET/CT examination excluded metastasis, and all patients were confirmed by operation and biopsy pathology. Their clinical data and pathological results were collected. On visual analysis of PET/CT imaging, adrenal uptake was based on a three-scale grading system. The region of interest (ROI) was delineated in the liver and the renal lesion site. Standardized uptake value (SUV) measurements were determined on a standardized reconstruction, and the maximum values (SUVmax) of the lesion and liver were measured. The ratio of tumor to the liver was defined as T/L. Visual interpretation, SUVmax-receiver operating characteristics (ROC) method, and T/L-ROC method were used to analyze the diagnostic accuracy. RESULTS: A total of 64 lesions (48 benign, 16 malignant lesions) were detected. The visual analysis found that 100% of Grade I cases were benign, 90.9% of Grade II cases were benign, and 65.1% of Grade III cases were benign. The SUVmax of malignant lesions (10.0±5.8) was higher than that of benign lesions (5.4±5.3, P<0.05). The T/L was 3.39±1.79 for malignant lesions and 1.99±2.09 for benign lesions (P<0.05). In the differentiation of primary benign and malignant unilateral adrenal tumors, the sensitivity, specificity, and accuracy of the SUVmax-ROC method (cut-off value =5.65) were 81.25%, 72.91%, 75.00%, and the positive and negative predictive values were 50.00% and 92.11%, respectively. The sensitivity, specificity, and accuracy of the T/L-ROC method (cut-off value =1.52) were 93.73%, 62.50%, 70.31%, and the positive and negative predictive values were 46.88% and 96.77%, respectively. CONCLUSIONS: 18F-FDG PET/CT improved diagnostic accuracy in differentiating primary benign and malignant unilateral adrenal tumors. There was a high negative predictive value, and for positive prediction, other tracer imaging is needed for differential diagnosis.