Adrenal sparing giant adrenal cyst excision by 3D laparoscopic approach: a case report

Adrenal cyst is rare clinical entity. Usually they are asymptomatic, non-functional, <10 cm in size and often discovered incidentally. We report a left adrenal cyst in 58-year-old woman measuring 23 cm in diameter, displacing left kidney infero-medially and pancreas anteriorly, because of its huge size. She presented with left flank pain over a 6-month period. Serial abdominal ultrasound and CT imaging revealed left suprarenal cystic mass of size 10 cm to begin with and gradually increased to size of 23 cm over period of 10 years when she became symptomatic. All laboratory and endocrine function tests were normal. 3D laparoscopic surgery done and cyst was completely removed with preservation of adrenal gland. Histopathological examination revealed a benign endothelial adrenal cyst. The postoperative course was uneventful and patient had no evidence of recurrence during follow-up. The giant adrenal cysts are relatively rare and represent great surgical challenge during resection.

Hepatic hydatid cyst: a masquerader

Liver is the most common organ involved in echinococcosis. Organs affected by E granulosus are the liver (63%), lungs (25%) and muscles (5%). Rest of the organs are rarely affected.  Adrenal cysts are uncommon. Their size may range widely and the origin of large adrenal cysts is often difficult to distinguish from other organs, including the kidney, pancreas, spleen, and liver. A large right-sided adrenal cystic mass can rarely be mistaken for a hepatic cyst by imaging. In this report, authors have described an adrenal cyst in a 28 year old lady, who was diagnosed preoperatively to have a hepatic hydatid cyst but intraoperatively it was found to be of adrenal origin. The size of the adrenal cyst can vary from a few millimetres up to 50 cm in diameter. Majority of the adrenal cysts are unilateral, while 8-10% of those cysts have been noted to be present bilaterally. The majority of cases are diagnosed between the 3rd and 6th decades. Although uncommon, Adrenal cyst should be considered as one of the differential diagnosis of upper abdominal cysts. Surgical excision is advisable when the cysts are symptomatic, greater than 5 cm in diameter and in the case of suspecting malignancy.

Manejo quirúrgico del quiste adrenal gigante: reporte de caso y revisión de la literatura / Surgical management of giant adrenal cyst: case report and review of the literature

OBJETIVO: Presentar un caso de quiste adrenal (QA) gigante resecado por vía mínimamente invasiva y realizar una revisión narrativa de la literatura disponible al respecto. MATERIALES Y MÉTODOS: Se presenta el caso de un paciente de sexo masculino de 54 años, con una masa retroperitoneal izquierda de crecimiento lento, asintomático, con imágenes y biopsia sugiriendo un QA complejo con sospecha de infiltración renal. Se indica una resección laparoscópica transabdominal. RESULTADOS: Se encuentra como hallazgo intraoperatorio un QA complejo hemorrágico de 9 cm de diámetro, con adherencia a la fascia de Gerota izquierda, logrando exéresis completa del QA por mínima invasión. El paciente evolucionó satisfactoriamente y fue dado de alta al segundo día posoperatorio. Es asintomático en 19 meses de seguimiento. Si bien los QA son benignos, los QA gigantes con crecimiento rápido, sintomáticos o de conversión hemorrágica, pueden ser resecados por adrenalectomía laparoscópica sin aumento de morbimortalidad. DISCUSIÓN: El abordaje laparoscópico de los QA no funcionales gigantes debe ser considerado como el manejo de elección. Es necesaria más evidencia sobre resultados en diferentes abordajes para generar recomendaciones claras. CONCLUSIÓN: Este reporte se suma a la evidencia actual en cuanto al abordaje mínimamente invasivo para QA gigantes hemorrágicos.

OBJECTIVE: Present a giant adrenal cyst (AC) case treated with minimally invasive resection and to perform a narrative literature review available. MATERIAL AND METHODS: A 54 year-old male presents with a left retroperitoneal slow growing mass, no symptoms, with a complex AC evidenced by previous images and mass biopsy, with suspected renal infiltration. A transabdominal laparoscopic resection is indicated. RESULTS: A complex hemorrhagic 9 cm diameter AC was found, with adhesions to left Gerota's fascia. Complete resection of the AC was achieved through minimally invasive approach. The patient had an uneventful clinical recovery and was discharged on the second postoperative day. On 19th month of follow-up is completely asymptomatic. Even though the AC are benign lesions, the symptomatic giant AC, with fast growing ratio, and/or hemorrhagic conversion could be resected though laparoscopic adrenalectomy, with no increased morbidity or mortality. DISCUSSION: The laparoscopic approach for giant non-functional AC should be considered as the standard of care. More evidence is required in terms of surgical approach outcomes to define clear recommendations. CONCLUSION: This report adds to the actual evidence in terms of minimally invasive approach for hemorrhagic giant AC.

Incidentally found cystic lymphangioma of the adrenal gland in an elderly male cadaver / 영남의대학술지

Adrenal cystic lymphangiomas are extremely rare entities that are often identified incidentally, with less than 60 cases reported to date. We found a protruding ovoid mass consisting of a multiloculated cystic lesion within right adrenal gland in the cadaver of a 75-year-old Korean man. The epithelial cells lining the adrenal cyst were diffusely positive for cluster of differentiation 31 and podoplanin, and negative for pan-cytokeratin. The histopathological diagnosis confirmed a cystic lymphangioma arising from the adrenal gland. Post-mortem findings of the present case are discussed based on the clinicopathological features of adrenal cystic lymphangiomas.

Diagnosis and treatment of 3 cases with cystic lymphangiomas of adrenal gland / 中华内分泌代谢杂志

Objective To investigate the clinical features, diagnosis, differential diagnosis, treatment, and prognosis of adrenal lymphangioma. Methods Three cases of adrenal lymphangioma were reported, and the clinical features, treatment and prognosis were analyzed. Results Three cases were incidentally discovered, laboratory tests and endocrine hormone examinations were normal, CT or MRI showed lesions with low density, no reinforced or mild enhancement. All 3 cases underwent laparoscopic adrenalectomy, postoperative pathology supported the diagnosis of adrenal lymphangioma. They were followed up for 8-months, 1-year, and 4-years respectively, with no recurrence. Conclusions Adrenal lymphangioma is a rare benign adrenal leison, with no typical clinical manifestations. Preoperative diagnosis depends on imaging examinations. Histopathological examination is essential in making final diagnosis. Surgery is the preferred treatment option. The prognosis is relatively good.

Cirugía laparoscópica de quistes adrenales: resultados de una serie de 18 pacientes / Laparoscopic surgery of adrenal cysts: results of a series of 18 patients

Introduction: Adrenal cysts have an incidence of 0.064 percent to 0.18 percent at autopsy. Aim: To show our experience in 18 patients with an adrenal cyst operated by laparoscopy. Material and Methods: The series consisted of 18 patients operated, in a series of 344 laparoscopic adrenalectomy performed between 1993 and 2011. The age range was 20 to 61 years with an average of 38 years, 11 women and 7 men. Results: Thirteen cysts were left and 5 were right sided. The lesion size varied between 4.5 and 12.5 cm, with an average of 9.2 cm. Eight patients complained of abdominal discomfort and in the remaining 12 patients there were no signs or symptoms of clinical suspicion. The surgery performed was a laparoscopic decortication-marsupialization in 11 patients, laparoscopic adrenalectomy in 8 cases and partial adrenalectomy in 1 case. Mean operative time was 83.1 minutes (30-180 minutes), and mean hospital stay was 36 hours. Intraoperative complications occurred in 2 patients: 1 diaphragm injury and one renal vein injury, repaired in the same surgery. Postoperative complications occurred in 2 patients, both Clavien 3a, treated by conservative management. Conclusion: Small and non-functional lesions require observation. Partial or total laparoscopic adrenalectomy is indicated in large lesions or in functional and suspected malignant lesions.

Introducción: Los quistes suprarrenales tienen una incidencia de 0,064 por ciento a 0,18 por ciento en autopsias. El objetivo de este trabajo es mostrar nuestra experiencia en 18 pacientes portadores de un quiste adrenal operados por vía laparoscópica. Material y Métodos: La serie está constituida por 18 pacientes, de una serie de 344 adrenalectomías laparoscópicas realizadas entre los años 1993 y 2011. El rango de edad fue de 20 a 61 años, con un promedio de 38 años, 11 mujeres y 7 hombres. Resultados: Trece quistes eran del lado izquierdo y 5 del derecho. El tamaño de la lesión varió entre 4,5 y 12,5 cm, con un promedio de 9,2 cm. En 8 pacientes hubo molestias abdominales vagas y en los restantes 12 pacientes no hubo signos ni síntomas de sospecha clínica. La cirugía realizada fue una decorticación-marsupialización laparoscópica en 11 pacientes, adrenalectomía laparoscópica en bloque en 8 casos y adrenalectomía parcial en 1 caso. El tiempo operatorio promedio fue de 83,1 min (30-180 min), y el tiempo medio de hospitalización fue de 36 h. Complicaciones intraoperatorias ocurrieron en 2 pacientes: 1 lesión de diafragma y 1 lesión de vena renal, reparadas en el mismo acto quirúrgico. Complicaciones postoperatorias ocurrieron en 2 pacientes, ambas Clavien 3a y de manejo conservador. Conclusión: Las lesiones pequeñas y no funcionantes requieren observación. La adrenalectomía laparoscópica parcial o total está indicada en lesiones de gran tamaño, con importante compromiso de la glándula o ante la sospecha de lesión funcionante o malignidad.

Surgical Approach of the Rare Benign Adrenal Tumor / 대한내분비외과학회지

PURPOSE: Benign adrenal tumors other than hyper-functioning tumor and non-functioning cortical adenoma are extremely rare. The purpose of this study is to review the clinical features of these rare benign adrenal tumors and to analyze their prevalence and the proper surgical approach for them. METHODS: Among patients who underwent adrenalectomy in Samsung Medical Center, between 1997 and 2013, patients with benign adrenal tumor except non-functioning cortical adenoma, malignancy, and hyper-functioning tumor such as pheochromocytoma, aldosteronoma, and cortisol producing tumor were included. Clinical details, radiologic findings and pathologic findings as well as data associated with the surgical procedure were analyzed retrospectively. RESULTS: The percentage of these tumors among 703 surgically removed adrenal tumors was 10.7% (75 cases). They included 30 adrenal cysts, 18 ganglioneuromas, 11 myelolipomas, seven schwannomas, and the other six were rare adrenal tumors. Approximately 40% of the patients were operated under a diagnosis different from original tumors. Operation time and hospital stay of patients who underwent laparoscopic adrenalectomy were shorter than those of patients who underwent open adrenalectomy. CONCLUSION: These benign adrenal tumors are very rare and difficult to diagnose preoperatively. For the surgical treatment of these tumors, laparoscopic adrenalectomy is more preferable to conventional open adrenalectomy.

Quiste suprarrenal primario / Primary adrenal cyst

Adrenal cyst is the commonest type of benign lesions of adrenal gland, althought is a very rare entity. Tipically, they are presented with abdominal pain or palpable mass, but nowdays they are detected most frecuently an imaging studies like incidentaloma. Adrenal Cyst have a broad differential diagnoses, rendering definitive diagnosis and subsequent management difficult. Are categorized into four subtypes: endothelial, pseudocyst, epithelial, and parasitic. This management paradigm may be summarized as: ruling out functional status of the cyst, evaluating chances of incidental malignancy by imaging, avoiding potential complications of surveillance (hemorrhage, infection), particularly in large cysts. A case of a patient with a left non-functioning adrenal cyst is reported, with abdominal pain. The diagnostic and therapeutic options are discussed and the literature is reviewed.

Los quistes suprarrenales son las lesiones quísticas más frecuentes de la glándula suprarrenal, a pesar de que constituyen una rara entidad. Típicamente se presentan por un cuadro de dolor abdominal o masa palpable, pero en la actualidad se detectan cada vez con más frecuencia en estudios radiológicos como incidentalomas. Los quistes suprarrenales cuentan con amplios diagnósticos diferenciales, lo que hace un difícil diagnóstico definitivo y una dificultad en el manejo posterior. Estos quistes se clasifican en cuatro subtipos: endoteliales, pseudoquiste, epiteliales y parasitarios. El manejo de un quiste suprarrenal se puede resumir en tres pilares fundamentales: descartar el estado funcional del quiste, evaluación de eventual malignidad por imágenes, y evitar las posibles complicaciones (hemorragia, infección), sobre todo en los quistes de gran tamaño. Se presenta el caso de una paciente con quiste suprarrenal izquierdo no funcionante asociado a dolor abdominal. Se realiza revisión de la literatura y se plantean los distintos diagnósticos y alternativas terapéuticas.

Two Cases of Adrenal Cysts Assessed by Endoscopic Ultrasound-Guided Fine Needle Aspiration for Diagnostic and Therapeutic Purposes / 대한소화기내시경학회지

Adrenal cyst is a rare disease and its incidence rate is about 0.06~0.18%. Many cases of adrenal cysts are diagnosed incidentally. Surgical excision is generally performed to rule out malignancy when an adrenal cyst is detected. However, a reviewing the overall cases revealed that only 7% of adrenal cysts were malignant or potentially malignant. Thus, it has been suggested to observe an asymptomatic simple benign cyst after aspiration. From this point of view, it is necessary to perform a functional hormonal test and fine needle aspiration cytology for investigating the nature of adrenal cysts. Adrenal cyst drainage can be performed when surgical resection is not indicated. Computed tomography or ultrasonography guided percutaneous aspiration and drainage has been performed, but linear endoscopic ultrasound has not yet been used for this purpose. We have performed endoscopic ultrasound guided fine needle aspiration of adrenal cysts for cytologic and hormonal examination and endoscopic ultrasound guided adrenal cyst drainage, and we report here on our experiences with this technique.

Adrenal Pseudocyst Mistaken as Mucinous Cystadenoma of the Pancreas: A Case Report / 대한내분비외과학회지

Adrenal cysts are a relatively uncommon disorder and most such cases are discovered at autopsy. According to the overseas cases, the reported incidence is 0.06~0.18% and the incidence is increasing due to the widespread use of ultrasonography and computed tomography scanning. Adrenal cysts are usually asymptomatic and they need to be differentiated from other cystic lesions including liver, pancreas and kidney cystic lesions. We report here on a case of a 39-year-old female with an adrenal pseudocyst that was misdiagnosed preoperatively as a pancreas mucinous cystic neoplasm.

Laparoscopic Resection of Adrenal Cyst Mistaken as Intrahepatic Biliary Cystadenoma

Adrenal cysts are a rare disease, and its prevalence is reported to be 0.06~0.18%. Its frequency of being recognized is increasing due to the widespread use of ultrasonography and computed tomography (CT) scans. We report here on a case of adrenal cyst that was mistaken as biliary cystadenoma prio-ocation and features. Laparoscopic exploration was performed via the transabdominal approach and this revealed a right adrenal cystic mass in the retroperitoneum beneath the liver (segment IV). We present here a case of adrenal cyst with endothelial lining along with a review of the literature to address the clinical presentation, histology, imaging features and differential diagnosis of this interesting and rare entity.

A case of adrenal cystic lymphangioma / 대한내과학회지

Cystic lesions of adrenal gland are rare and those are most often identified incidentally during radiological investigation, surgery for unrelated process or at the time of autopsy. Most of cystic lesions are usually asymptomatic and less than 10 cm in diameter. Clinical management of an adrenal cyst can be aided by the imaging findings. Surgery is indicated for large and complicated cysts, parasitic cysts, uncertain cyst, and functioning or malignant cysts. We present a case of a 36-year-old female with the benign and non-functioning cyst that was detected by clinical assay and imaging study. The 4 X 2 cm right adrenal cyst contained linear calcification and septation. Laparoscopic resection and histologic findings were compatible with epithelial cyst of lymphangiomatous type of adrenal gland. With this case, diagnostic features of adrenal cysts are discussed.

A case of endothelial cyst of the adrenal gland / 대한내과학회지

Adrenal cysts are rare lesions usually discovered incidentally during surgery, or at the time of autopsy. Most adrenal cysts are generally asymptomatic and small, less than 10 cm in diameter. When adrenal cysts enlarge sufficiently, they cause pain and gastrointestinal disturbances or become palpable. When cystic lesions in upper abdomen are found, many cystic lesions such as hepatic, splenic, renal and pancreatic cysts should be considered. It's difficult to differentiate between benign and malignant lesions. Usually these cystic lesions have been excised to rule out malignancy. Herein we report a case of adrenal endothelial cyst which was detected in a 63-year-old female patient during a routine health examination by ultrasonography.

A Case of Traumatic Nonfuctional Adrenal Pseudocyst / 대한내분비학회지

The adrenal glands are rarely injured by blunt trauma, because they are well protected by the ribs, paraspinal muscles, and the overlying abdominal contents. Although most of adrenal cysts are clinically silent, the number of incidentally detected adrenal cysts have increased due to advanced and widespread application of various sensitive imaging methods. Recently, we have encountered a case of a 62-year-old man who have developed a left adrenal pseudoeyst one and a half months after the blunt trauma from a pedestrian traffic accident. The pseudocyst was non-functional and measured about 5 * 4 cm in size with the same fluid density of a gall bladder in abdominal computerized tomography(CT). Turbid cystic fluid was aspirated by CT-guided method, and the aspirate was composed of degenerated old blood cells without any malignant cells. Since the cyst was developed following trauma and its microscopic content showed blood cells, impending rupture was anticipated. Hence, a laparoscopic adrenalectomy was performed.

Pyogenic Adrenal Cyst in Newborn / 대한비뇨기과학회지

Cysts of the adrenal gland are often misinterpreted and misdiagnosed because of their rarity. There are few reports in the literature of adrenal cyst in children, especially in the newborn. Adrenal cysts in the newborn are usually of the pseudocyst due to adrenal hemorrhage and have tendency to become adherent to surrounding structure, mimicking malignant tumor. We report a cases of pyogenic adrenal cyst in the newborn which was suspected malignancy because of adherence to adjacent organ.

A Case of Adrenal Cyst / 대한비뇨기과학회지

Adrenal cyst is a rare pathologic lesion in all patients which can pose difficult problems in terms of diagnosis and treatment. Most are small and found incidentally on autopsy. We report one case of a large adrenal cyst in a 54-year- old female with review of the literature.