Adrenal cysts less than 10 cm can be safely observed.

BACKGROUND: Adrenal cysts are rare and appropriate management is unclear due to a lack of data on their natural history. Understanding adrenal cyst growth patterns would assist in clinical management. METHODS: This single-institution study included all adult patients diagnosed with simple adrenal cysts between 2004 and 2021. Baseline characteristics and outcomes of those who underwent resection (ADX) or observation (OBS) were compared using the chi-squared test, student's t-test, and Wilcoxon rank-sum test. Growth curves and sensitivity analysis were plotted for all patients who had follow-up imaging. RESULTS: We identified 77 patients with imaging-confirmed adrenal cysts. The majority were female (75.3%) and more than half were white (55.8%). One-third of patients underwent ADX, and the remaining were observed. ADX patients were younger (median age [IQR]: 55.5 y [45.0-68.2 y] vs. 44.2 y [38.7-55.0 y], p = 0.01) and more likely to be Hispanic (12% vs. 0%, p = 0.05). ADX patients presented with larger cysts (5.6 vs. 2.6 cm, p = 0.002). The median time from diagnosis to last follow-up was 1.1 y for ADX and 4.1 y for OBS. Average growth for OBS was 0.3 cm/y, while average growth for ADX was 3.9 cm/y. In ADX patients, cysts >10 cm grew significantly faster than cysts <10 cm (median growth rate 13.2 cm/y vs. 0.3 cm/y, p < 0.05). There was no adrenal malignancy diagnosis, hyperfunctionality, or observation-related complications (e.g., rupture). CONCLUSION: While size >4-6 cm has guided surgical referral for solid adrenal masses, this study demonstrates a size threshold of 10 cm, below which asymptomatic, simple adrenal cysts can safely be observed.

Non-neoplastic adrenal pseudocysts: A clinicopathologic study of 44 cases with potential insights into pathogenesis.

BACKGROUND: Literature on non-neoplastic adrenal pseudocysts (NNAPC) remains limited and to date no large series have been reported. The pathogenesis of these lesions remains poorly defined, however a vascular origin is most often suggested in the literature. We aimed to evaluate the clinicopathological features and the spectrum of vascular changes within NNAPC, in order to better understand the mechanisms and circumstances of their pathogenesis. METHODS AND RESULTS: We reviewed 44 cases of surgically resected NNAPC. There were 30 females and 14 males ranging from 23 to 82 years (median, 53 years). On the basis of histopathologic and immunohistochemical analysis of the vascular changes the following types were defined: pseudocysts with lymphatic-related changes (type 1, n = 16), pseudocysts with large vein-related changes (type 2, n = 15) and pseudocysts with blood vessel microvasculature-related changes (type 3, n = 13). The median patient age of the latter group was higher than that of type 1 and 2 (64 years versus 51 and 50 years, respectively; p = 0.0002). Type 3 pseudocysts were more frequently associated with a history of systemic vascular and vascular-related disorders than type 1 and type 2 pseudocysts (92% versus 33% and 64%, respectively; p = 0.008). Type 1 pseudocysts were more frequently connected with a history of previous intra-abdominal surgical procedures than type 2 and 3 pseudocysts (60% versus 7% and 25%, respectively; p = 0.0079). CONCLUSIONS: NNAPC are clinically heterogenous and can arise on a background of various vascular changes. They may represent end-stage processes related to lymphangiomatous lesions, changes in adrenal venous structures or microvasculature.

Giant Adrenal Cyst: A Case Report.

Giant adrenal cysts are rare lesions, most often discovered incidentally. In this case report, a patient presenting with nonspecific abdominal distension is described. Imaging studies revealed a vast cystic mass closely attached to the left adrenal gland. Neither routine laboratory tests nor endocrine function tests revealed abnormalities. By performing open surgery, the cystic mass was completely removed. According to the pathological results, the wall of the cystic mass has an endothelial structure and some vascular components. Comprehensive analysis indicated that this case was an angiomatous adrenal endothelial cyst which was an extremely uncommon form of an adrenal cyst. Over a one-year follow-up, no evidence of recurrence was observed in the patient postoperatively. Through this case, we wish to raise awareness of this disease.

Unusual cause of chronic abdominal pain in a 17-year-old female: a case report of an epithelial adrenal cyst.

Adrenal cysts are rare lesions that make up 4% of all adrenal masses. They are often found incidentally during imaging or surgery and can vary in symptoms depending on their size and location; with cysts < 10 cm often being asymptomatic. These cysts are more common in adults in their 30s or 60s and can be divided into four histological subtypes, with epithelial cysts being less common. We present a case of a 17-year-old female who experienced recurrent right flank pain for a year. Ultrasonography revealed a cystic mass on the right kidney, and computerized tomography showed a well-defined suprarenal cyst measuring ~8 cm misdiagnosed as mesenteric cyst. However, during laparoscopy, an adrenal cyst was discovered, which was excised along with the right adrenal gland. Histopathology confirmed the diagnosis of an epithelial adrenal cyst. This case highlights the occurrence of adrenal cysts in younger individuals and the uncertainty of preoperative diagnosis.

Giant pseudocyst of the retroperitoneal space mimicking a lesion arising from the left adrenal gland.

Not required for Clinical Vignette.

Adrenal masses in children: Imaging, surgical treatment and outcome.

BACKGROUND/OBJECTIVE: This study aims to evaluate the current surgical approach to adrenal masses in the pediatric age group. METHODS: We retrospectively analyzed cases that underwent surgery for adrenal masses between 2007 and 2017. Patients were assessed regarding age, sex, primary diagnosis, image defined risk factors (IDRF), surgical treatment method, complications, duration of hospital stay, and follow-up. RESULTS: We examined 50 patients who underwent surgery for adrenal mass (mean age: 4.8 years; range: 5 days-14 years). For IDRF assessment, Ultrasonography was used in 42, Computed Tomography in 36, and Magnetic Resonance Imaging in 36 patients. Lesions were present on the right in 25, left in 21, and bilateral in 4 patients. Histopathological findings were neuroblastoma (n = 29), ganglioneuroma (n = 6), adrenal cortex tumor (n = 5), ganglioneuroblastoma (n = 4), pheochromocytoma (n = 3), cyst (n = 1), and adrenal hematoma (n = 2). Laparotomy was performed on 37 patients, and laparoscopy on 13 patients. None of the cases had any operative complications. CONCLUSION: The crucial factors determining the surgical approach to adrenal masses in pediatric cases are the histopathology of the mass, volume, and IDRF. Minimally invasive procedures could be reliably performed in appropriate cases.

Adrenal Cystic Lymphangioma: An Unexpected Pathological Finding in a Constellation of Uncontrolled Hypertension and Hypercalcemia.

Adrenal cysts are rarely observed lesions. Adrenal cystic lymphangiomas are asymptomatic benign lesions of the lymphatic vessels with the vast majority occurring in women. We herein present a rare case of a middle-aged gentleman with labile blood pressure associated with an incidental finding of an adrenal mass of 4 x 3 x 3 cm. Following surgical resection, pathology revealed the diagnosis of adrenal cystic lymphangioma.

Adrenal cysts - optimal laparoscopic treatment.

INTRODUCTION: Adrenal cysts develop in up to about 0.2% of the overall population. They may account for up to 11% of all pathologies of adrenal glands. AIM: Is laparoscopic resection of adrenal cysts a method for the treatment of these pathologies? MATERIAL AND METHODS: In the years 2010-2017, a total of 27 patients underwent surgery due to adrenal cysts; those included 18 (66.7%) women and 9 (33.3%) men aged 29 to 84 years (mean age: 42.7). Cyst diameter ranged from 55 to 130 mm. After exclusion of hormonal hyperactivity, parasitic cysts, or, to the best possible extent, cancer lesions, patients were qualified for adrenal-sparing laparoscopic surgery. RESULTS: All patients were subjected to laparoscopic surgery. Cystic wall resection was performed in 15 (55.6%) patients while adrenalectomy was performed in the remaining 12 (44.4%) patients. The decision regarding the extent of the surgery was made intraoperatively. Histopathological assessment revealed pathological adrenal lesions in as few as 3 (11.1%) patients, with the rest of the study population, i.e. 24 (88.9%), presenting with normal adrenal tissue. CONCLUSIONS: Laparoscopic resection of adrenal cysts appears to be recommendable as a method for the treatment of these pathologies. It is simpler than adrenalectomy and associated with low risk of any pathological lesion remaining within the adrenal gland following careful intraoperative assessment by an experienced surgeon.

Clinicopathological and immunohistochemical analysis of epithelial-lined (true) cysts of the adrenal gland with proposal of a new histogenetic categorization.

Epithelial- lined (true) cysts are rare lesions and until now the only information we had about their histogenesis was based on the analysis of a few cases. We retrospectively reviewed 8 cases of cysts with a true epithelial lining (confirmed immunohistochemically). The pathological findings and immunohistochemical analysis of the epithelial linings allowed for categorization of the cysts into 3 groups. Five cysts had pure mesothelial lining, which was flattened to cuboidal, and demonstrated a positive reaction for mesothelial markers (eg. calretinin, WT1), and a negative reaction for EpCAM, EMA, PAX8 and ER. Two cysts had cuboidal to flattened lining, the cells of which were diffusely or focally positive for mesothelial markers, for some epithelial markers (eg. EpCAM and EMA) and despite a lack of müllerian-type epithelium demonstrated a positive reaction for PAX8 and focally for ER. A cyst derived from adreno-hepatic fusion (AHF)-related intra-adrenal bile ductules was diagnosed in a right adrenal gland which was directly adherent to the liver, microscopically features of AHF were visible with intermingling of adrenal and liver parenchymal cells. The immunoreactivity pattern was similar among the preserved cells of the cyst-lining, the intra-adrenal bile ductules and the normal bile ductules in the adjoining liver parenchyma. On the basis of this case series from a single institution (8 presented now and 1 reported before) we propose a new histogenetic categorization of adrenal epithelial cysts into: 1. pure mesothelial cysts (the most common type), 2. mesothelial cysts with incomplete or complete müllerian metaplasia 3. AHF-related cysts.

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

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.

Clinical analysis of 17 cases with surgical treatment of adrenal cysts / 中国医师进修杂志

Objective To investigate the clinical characteristics and the effectiveness of surgical treatment of adrenal cysts. Methods The clinical data of adrenal cysts in Affiliated Zhangye people′s Hospital, Hexi College from May 2005 to July 2018 were retrospectively analyzed, including clinical manifestations, diagnosis, surgical methods, postoperative pathological results and follow-up process. Seventeen patients with adrenal cysts were identified including 10 males and 7 females. The median age was 45.6 ranging from 30 to 75. There were 12 left lesions and 5 right lesions. Only 4 patients (23.5% ) had clinical symptoms, including low back pain, abdominal pain and dizziness caused by hypertension. Ultrasound, CT and MRI were the main imaging methods for preoperative diagnosis. Results All patients underwent surgical treatment. Laparoscopic surgery was adapted in 14 cases. The average operation time was (70.2 ± 18.5) min and the average bleeding was (47.0 ± 12.1) ml. For open surgery in 3 cases, the average operation time was (103.5 ± 25.0) min and the average bleeding was (85.6 ± 20.5) ml. Postoperative pathological results showed endothelial cysts in 11 cases, epithelial cysts in 3 cases and pseudocysts in 3 cases. No recurrence of cysts or hypoadrenalism occurred in 3-75 months′follow-up. Conclusions Adrenal cysts are relatively rare and generally benign lesions. Imaging examination, especially abdominal enhanced CT is essential for diagnosis. Laparoscopic surgery is a safe and effective method for the treatment of adrenal cysts.

Clinical analysis of 17 cases with surgical treatment of adrenal cysts / 中国医师进修杂志

Objective@#To investigate the clinical characteristics and the effectiveness of surgical treatment of adrenal cysts.@*Methods@#The clinical data of adrenal cysts in Affiliated Zhangye people′s Hospital, Hexi College from May 2005 to July 2018 were retrospectively analyzed, including clinical manifestations, diagnosis, surgical methods, postoperative pathological results and follow-up process. Seventeen patients with adrenal cysts were identified including 10 males and 7 females. The median age was 45.6 ranging from 30 to 75. There were 12 left lesions and 5 right lesions. Only 4 patients (23.5%) had clinical symptoms, including low back pain, abdominal pain and dizziness caused by hypertension. Ultrasound, CT and MRI were the main imaging methods for preoperative diagnosis.@*Results@#All patients underwent surgical treatment. Laparoscopic surgery was adapted in 14 cases. The average operation time was (70.2 ± 18.5) min and the average bleeding was (47.0 ± 12.1) ml. For open surgery in 3 cases, the average operation time was (103.5 ± 25.0) min and the average bleeding was (85.6 ± 20.5) ml. Postoperative pathological results showed endothelial cysts in 11 cases, epithelial cysts in 3 cases and pseudocysts in 3 cases. No recurrence of cysts or hypoadrenalism occurred in 3-75 months′ follow-up.@*Conclusions@#Adrenal cysts are relatively rare and generally benign lesions. Imaging examination, especially abdominal enhanced CT is essential for diagnosis. Laparoscopic surgery is a safe and effective method for the treatment of adrenal cysts.