Adrenalectomy approach and outcomes according to surgeon volume.

BACKGROUND: This study assessed the relationship between surgeon volume, operative management, and resource utilization in adrenalectomy. METHODS: Isolated adrenalectomies performed within our health system were identified (2016-2021). High-volume surgeons were defined as those performing ≥6 cases/year. Outcomes included indication for surgery, perioperative outcomes, and costs. RESULTS: Of 476 adrenalectomies, high-volume surgeons (n â€‹= â€‹3) performed 394, while low-volume surgeons (n â€‹= â€‹12) performed 82. High-volume surgeons more frequently operated for pheochromocytoma (19% vs. 16%, p â€‹< â€‹0.001) and less frequently for metastasis (6.4% vs. 23%, p â€‹< â€‹0.001), more frequently used laparoscopy (95% vs. 80%, p â€‹< â€‹0.001), and had lower operative supply costs ($1387 vs. $1,636, p â€‹= â€‹0.037). Additionally, laparoscopic adrenalectomy was associated with shorter length of stay (-3.43 days, p â€‹< â€‹0.001), lower hospitalization costs (-$72,417, p â€‹< â€‹0.001), and increased likelihood of discharge to home (OR 17.03, p â€‹= â€‹0.008). CONCLUSIONS: High-volume surgeons more often resect primary adrenal pathology and utilize laparoscopy. Laparoscopic adrenalectomy is, in turn, associated with decreased healthcare resource utilization.

[Benign and malignant neoplasms of the adrenal glands from the perspective of pathology]. / Benigne und maligne Neoplasien der Nebenniere aus der Sicht der Pathologie.

In the case of neoplasms of the adrenal glands that are radiologically and clinically unclear, the indications for surgical resection as well as the subsequent clarification of the entity and dignity on the surgical specimen are difficult. The diagnostics of adrenal neoplasms, in particular the clear distinction between an adenoma and a carcinoma are often tricky from the point of view of a pathologist. In the following, not only the problems of classification and the possibilities of diagnostics in pathology but also an overview of the most important differential diagnoses of other benign and malignant tumors of the adrenal cortex and medulla are presented.

[Adrenal myelolipoma, review of the literature in Mexico apropos of two cases]. / Mielolipoma Suprarrenal, revisión de literatura en México a propósito de dos casos.

Background: Adrenal myelolipomas (ML) are rare benign neoplasms compound of adipose and myeloid tissue. Clinically they are usually asymptomatic, being diagnosed generally by incident. In Mexico, there are only 32 published cases of ML, these occur between 37 and 65 years, with the male-female ratio being 1:1.1, clinically they present with abdominal or lumbar pain, open surgery being the main surgical approach (89%). Clinical case: We made a literature review of ML in Mexico and present two clinical cases: a 67-year-old man in followup for diverticular disease and a 40-year-old woman with pain in the left upper quadrant. In both cases, tumor resection was performed measuring 9.5 cm and 13.3 cm long respectively. Conclusions: We present two new cases in our country that correspond to incidentalomas. In both cases, surgery was performed to confirm the diagnosis, as well as to prevent possible complications.

Introducción: los mielolipomas suprarrenales (ML) son neoplasias benignas poco frecuentes constituidas por tejido adiposo y mieloide. Clínicamente asintomáticas, suelen ser diagnosticados incidentalmente. En México existen solo 32 casos publicados de ML, presentándose en pacientes de entre 37 a 65 años, siendo la relación hombre-mujer 1:1.1, el síntoma más comúnmente reportado es dolor abdominal inespecífico, y la cirugía abierta es el principal abordaje quirúrgico empleado en nuestro país (89%). Caso clínico: presentamos una recopilación de la literatura actual sobre ML en México, además de dos casos clínicos de pacientes con ML: un hombre de 67 años con enfermedad diverticular y una mujer de 40 años con dolor en hipocondrio; en ambos se realizó resección tumoral, midiendo 9.5 cm y 13.3 cm, respectivamente. Conclusiones: presentamos dos casos nuevos en nuestro país que corresponden a incidentalomas. En ambos casos la cirugía se realizó para confirmar el diagnóstico, así como para prevenir posibles complicaciones.

Mielolipoma suprarrenal, revisión de literatura en México a propósito de dos casos / Adrenal myelolipoma, review of the literature in Mexico apropos of two cases

Introducción: los mielolipomas suprarrenales (ML) son neoplasias benignas poco frecuentes constituidas por tejido adiposo y mieloide. Clínicamente asintomáticas, suelen ser diagnosticados incidentalmente. En México existen solo 32 casos publicados de ML, presentándose en pacientes de entre 37 a 65 años, siendo la relación hombre-mujer 1:1.1, el síntoma más comúnmente reportado es dolor abdominal inespecífico, y la cirugía abierta es el principal abordaje quirúrgico empleado en nuestro país (89%). Caso clínico: presentamos una recopilación de la literatura actual sobre ML en México, además de dos casos clínicos de pacientes con ML: un hombre de 67 años con enfermedad diverticular y una mujer de 40 años con dolor en hipocondrio; en ambos se realizó resección tumoral, midiendo 9.5 cm y 13.3 cm, respectivamente. Conclusiones: presentamos dos casos nuevos en nuestro país que corresponden a incidentalomas. En ambos casos la cirugía se realizó para confirmar el diagnóstico, así como para prevenir posibles complicaciones.

Background: Adrenal myelolipomas (ML) are rare benign neoplasms compound of adipose and myeloid tissue. Clinically they are usually asymptomatic, being diagnosed generally by incident. In Mexico, there are only 32 published cases of ML, these occur between 37 and 65 years, with the male-female ratio being 1:1.1, clinically they present with abdominal or lumbar pain, open surgery being the main surgical approach (89%). Clinical case: We made a literature review of ML in Mexico and present two clinical cases: a 67-year-old man in followup for diverticular disease and a 40-year-old woman with pain in the left upper quadrant. In both cases, tumor resection was performed measuring 9.5 cm and 13.3 cm long respectively. Conclusions: We present two new cases in our country that correspond to incidentalomas. In both cases, surgery was performed to confirm the diagnosis, as well as to prevent possible complications

Metabolic Subtyping of Adrenal Tumors: Prospective Multi-Center Cohort Study in Korea.

BACKGROUND: Conventional diagnostic approaches for adrenal tumors require multi-step processes, including imaging studies and dynamic hormone tests. Therefore, this study aimed to discriminate adrenal tumors from a single blood sample based on the combination of liquid chromatography-mass spectrometry (LC-MS) and machine learning algorithms in serum profiling of adrenal steroids. METHODS: The LC-MS-based steroid profiling was applied to serum samples obtained from patients with nonfunctioning adenoma (NFA, n=73), Cushing's syndrome (CS, n=30), and primary aldosteronism (PA, n=40) in a prospective multicenter study of adrenal disease. The decision tree (DT), random forest (RF), and extreme gradient boost (XGBoost) were performed to categorize the subtypes of adrenal tumors. RESULTS: The CS group showed higher serum levels of 11-deoxycortisol than the NFA group, and increased levels of tetrahydrocortisone (THE), 20α-dihydrocortisol, and 6ß-hydroxycortisol were found in the PA group. However, the CS group showed lower levels of dehydroepiandrosterone (DHEA) and its sulfate derivative (DHEA-S) than both the NFA and PA groups. Patients with PA expressed higher serum 18-hydroxycortisol and DHEA but lower THE than NFA patients. The balanced accuracies of DT, RF, and XGBoost for classifying each type were 78%, 96%, and 97%, respectively. In receiver operating characteristics (ROC) analysis for CS, XGBoost, and RF showed a significantly greater diagnostic power than the DT. However, in ROC analysis for PA, only RF exhibited better diagnostic performance than DT. CONCLUSION: The combination of LC-MS-based steroid profiling with machine learning algorithms could be a promising one-step diagnostic approach for the classification of adrenal tumor subtypes.

Spontaneous rupture of adrenal myelolipoma as a cause of acute flank pain: A case report.

BACKGROUND: Adrenal myelolipoma is a rare, benign, non-functioning mass that occurs in the adrenal gland. It is composed of an admixture of hematopoietic elements and mature adipose tissue, similar to bone marrow. Even at large sizes, adrenal myelolipomas are usually asymptomatic and often incidentally found by ultrasonography or computed tomography (CT) scan. This paper describes an unusual case of adrenal myelolipoma presenting as flank pain. CASE SUMMARY: A 50-year-old male with severe right flank pain underwent a CT scan revealing a huge mass extending into the suprarenal space. The mass showed a fat component with retroperitoneal hemorrhage. The tumor was treated laparoscopically, and pathologic examination revealed features of myelolipoma originating from the adrenal gland. CONCLUSION: Adrenal myelolipomas are generally asymptomatic and can be treated conservatively. However, rupture and hemorrhage of the tumor can cause symptoms requiring surgical removal.

Dexamethasone suppression test versus selective ovarian and adrenal vein catheterization in identifying virilizing tumors in postmenopausal hyperandrogenism - a systematic review and meta-analysis.

OBJECTIVE: The diagnostic accuracy of tests in identifying virilizing tumors in postmenopausal hyperandrogenism is limited. This systematic review compares the dexamethasone suppression test against selective ovarian and adrenal vein sampling of androgens in distinguishing neoplastic from non-neoplastic causes of postmenopausal hyperandrogenism. METHODS: Diagnostic test accuracy studies on these index tests in postmenopausal women were selected based on pre-established criteria. The true positive, false positive, false negative, and true negative values were extracted and meta-analysis was conducted using the hierarchical summary receiver operator characteristics curve method. RESULTS: The summary sensitivity of the dexamethasone suppression test is 100% (95% CI 0-100%) and that for selective venous sampling is 100% (95% CI 0-100%). The summary specificity of the dexamethasone suppression test is 89.2% (95% CI 85.3-92.2%) and that for selective venous sampling is 100% (95% CI 0.3-100%). CONCLUSION: There is limited evidence for the use of dexamethasone suppression test or selective venous sampling in identifying virilizing tumors in postmenopausal hyperandrogenism.

Oncocitoma suprarrenal / Adrenal oncocytoma

Introducción: El oncocitoma suprarrenal es un tumor infrecuente e incidental y sin manifestaciones clínicas propias. Objetivo: Presentar un caso de oncocitoma suprarrenal y sus particularidades diagnósticas y terapéuticas. Caso clínico: Paciente masculino de 34 años de edad con antecedentes de salud, que se presentó por dolor lumbo-abdominal derecho, sin irradiación ni otros síntomas acompañantes. El examen físico fue normal. El ultrasonido informó un tumor de unos 7 cm de diámetro, localizado hacia el polo superior del riñón derecho. El origen suprarrenal se definió con la tomografía abdominal contrastada. Los valores sanguíneos de hormonas de la corteza suprarrenal fueron normales. Se hizo la exéresis total del tumor, mediante laparotomía convencional. El riñón estaba normal. El examen histopatológico notificó oncocitoma suprarrenal y lo ratificó la inmunohistoquímica. El paciente evolucionó satisfactoriamente. Conclusiones: El oncocitoma suprarrenal es un tumor infrecuente y de hallazgo fortuito. La tomografía abdominal contrastada no tiene alta especificidad para diferenciarlo de otros tumores suprarrenales. El perfil inmunohistoquímico del tumor es concluyente en el diagnóstico definitivo(AU)

Introduction: Adrenal oncocytoma is a rare and incidental tumor without its own clinical manifestations. Objective: To present a case of adrenal oncocytoma and its diagnostic and therapeutic characteristics. Clinical case: 34-year-old male patient with a medical history, who presented with right lumbo-abdominal pain, without radiation or other accompanying symptoms. The physical exam was normal. The ultrasound reported a tumor of about 7 cm in diameter, located towards the upper pole of the right kidney. The adrenal origin was defined with contrast abdominal tomography. The blood levels of hormones of the adrenal cortex were normal. Total excision of the tumor was performed by conventional laparotomy. The kidney was normal. Histopathological examination reported adrenal oncocytoma and immunohistochemistry confirmed it. The patient evolved satisfactorily. Conclusions: Adrenal oncocytoma is a rare and fortuitous tumor. Contrast abdominal tomography does not have high specificity to differentiate it from other adrenal tumors. The immunohistochemical profile of the tumor is conclusive in the definitive diagnosis(AU)

Gonadotropin-Releasing Hormone Analogue Stimulation Test Versus Venous Sampling in Postmenopausal Hyperandrogenism.

Postmenopausal hyperandrogenism can be due to excessive androgen secretion from adrenal or ovarian virilizing tumors or nonneoplastic conditions. The etiology of postmenopausal hyperandrogenism can be difficult to discern because of limited accuracy of current diagnostic tests. This systematic review compares the diagnostic accuracy of the gonadotropin-releasing hormone (GnRH) analogue stimulation test against selective ovarian and adrenal vein sampling of androgens in distinguishing neoplastic from nonneoplastic causes of postmenopausal hyperandrogenism. Diagnostic test accuracy studies on these index tests in postmenopausal women were selected based on preestablished criteria. The true positive, false positive, false negative, and true negative values were extracted and meta-analysis was conducted using the hierarchical summary receiver operator characteristics curve method. The summary sensitivity of the GnRH analogue stimulation test is 10% (95% confidence interval [CI], 1.1%-46.7%) and that for selective venous sampling is 100% (95% CI, 0%-100%). Both tests have 100% specificity. There is limited evidence for the use of either test in identifying virilizing tumors in postmenopausal hyperandrogenism.

Adrenal metastasis from endometrial cancer: A case report.

BACKGROUND: Metastases to adrenal glands originate principally from lung, breast, or gastrointestinal cancers, followed by malignant melanoma and thyroid neoplasms. We present an unusual case of uterine cancer metastasizing to the adrenal glands with a review of the English literature on the management of this rare disease. CASE SUMMARY: A 53-year-old Caucasian woman with a history of endometrial cancer (grade 2; International Federation of Gynecology and Obstetrics III A) was hospitalized in November 2017 for a left adrenal mass found on a follow-up computed tomography scan 3 years after her gynecological surgery. Laboratory test results were normal. A laparoscopic left adrenalectomy was performed. The postoperative course was uneventful, and no chemotherapy was administered. The pathological report confirmed an adrenal endometrioid metastasis. At 36 mo of follow-up, the patient is alive and well, with no evidence of recurrent disease. A literature review identified only 11 previously-published cases of adrenal metastases from uterine cancer. CONCLUSION: Adrenal metastasis from uterine cancer is very rare. Laparoscopic adrenalectomy may be an effective treatment in selected cases of localized adrenal metastasis.

[Are large adrenal neoplasms technical limitation for laparoscopic adrenalectomy?] / Iavliaiutsia li bol'shie razmery novoobrazovaniia nadpochechnika tekhnicheskim ogranicheniem k vypolneniiu laparoskopicheskoi adrenaléktomii.

AIM: To study surgical features of laparoscopic adrenalectomy in patients with large adrenal neoplasms. MATERIAL AND METHODS: The results of 32 laparoscopic adrenalectomy procedures were analyzed in patients with adrenal neoplasms over 5 cm. The control group consisted of 67 patients with adrenal neoplasms up to 5 cm. RESULTS: There were significant differences in duration of operations (96.3±13.44 min vs. 67.2±11.07 min; p<0.05) and some postoperative variables. Postoperative morbidity was similar (9.4% vs. 7.5%; p>0.05). CONCLUSION: Laparoscopic adrenalectomy for adrenal neoplasms from 5 to 8-9 cm is feasible, effective and safe surgical procedure.

Laparoscopic retroperitoneal adrenalectomy for adrenal mass：report of 130 cases / 中国癌症杂志

Background and purpose:Laparoscopic retroperitoneal adrenalectomy makes access to the adrenal glands easier and less invasive than open surgery. The aim of this study was to evaluate the clinical efifcacy of laparoscopic retroperitoneal adrenalectomy.Methods:A total of 130 patients who underwent retroperitoneal adrenalectomy for adrenal mass from Jan. 2007 to Dec. 2012 in Fudan University Shanghai Cancer Center were retrospectively assessed. Their clinicopathological factors, perioperative complications and short-term prognostic data were retrieved from the medical records.Results:One hundred and twenty-seven of 130 patients underwent retroperitoneal adrenalectomy successfully, and 3 patients were converted to open surgery due to severe bleeding. Among 130 patients, 63 were male and 67 were female, with the mean age 50.0 years. The pathological results of the 130 patients indicated adrenocortical adenoma in 68, pheochromocytoma in 15, medullary lipoma in 13, adrenal cysts in 10 , ganglioneuroma in 7, metastatic cancer in 5, adrenal hyperplasia in 4, schwannoma in 3, lymphangioma in 2, adrenal hematoma in 1, adrenal cortical carcinoma in 1, adrenal angiosarcoma in 1 and the deputy spleen in 1 (one patient suffering from both pheochromocytoma and ganglioneuroma). The maximum diameters were ranging from 0.5 to 9.0 cm, and mean diameter was 3.48 cm. The average blood loss in surgery was 62.73 mL. Mean length of stay in hospital was 7 d. GradeⅠ complications occurred in 5 patients, including 2 of fever, 1 of food allergy, 1 of drug allergy and 1 of hypokalemia.Conclusion: Retroperitoneal adrenalectomy should be considered as the procedure of choice for the resection of most adrenal tumors in skilled centers with the advantages of minimal invasion, increased safety and faster recovery.

Clinical analysis of 128 cases of adrenal incidentalomas / 中华泌尿外科杂志

Objective To improve the early diagnosis and differential diagnosis of adrenal incidentalomas to guide clinical management of this disease. Methods One hundred and twenty-eight cases were diagnosed as adrenal incidentalomas due to health examination or treatment of other than adrenal disease,including 60 males and 68 females,whose ages were between 20 and 75 years,with a mean age of 50 years.Tumor diamer:＜3 cm 63 cases,3-6 cm 6 cases,＞6 cm 10 cases.128 patients all had biochemical and electrolyte examination,adrenal cortex and medulla biochemical testing,abdominal ultrasound and CT examination,6 cases with MRI examination.Surgery and post operative pathological examination were performed in all patients. Results Post operative pathology finally diagnosed adrenocortical adenoma in 85 cases,pheochromocytoma in 13 cases,adrenal cyst in 8 cases,paraganglioma and myeiolipoma in 7 eases respectively,adrenal nodular hyperplasia in 4 cases,adrenocortical carcinoma in 2 cases,adrenoconical oncocytoma,cellular Schwannoma and adrenal liposarcoma in 1 case,respectively.One case of pheochromocytoma patients died of intraoperative hypotension,which is not included in the total number. Conclusions The preperative diagnosis of adrenal incidentalomas is difficult.For adrenal incidentalomas with diameter more than 6 cm and those with endocrine function,early surgicM treatment is recommended.

Clinical and pathological characteristics of adrenal lipomatous tumors / 中华泌尿外科杂志

be diagnosed by imaging examination before operation.The ALT patients with large or symptomatic adrenal lipomatous lesions or preoperatively diagnosed teratoma should be given surgical treatment.

Treatment of renal or adrenal tumor with cancer thrombus in the inferior vena cava / 中华泌尿外科杂志

Objective To discuss the treatment of renal or adrenal tumor with cancer thrombus in the inferior vena cava. Methods From Jan 1984 to Apr 2008,29 cases of renal or adrenal malignancy with thrombosis involving the inferior vena cava underwent treatment.The diagnoses were confirmed by Doppler uhrasonography,CT and MRI.In the 29 surgical patiens the tumor thrombus was level I in 7,level Ⅱ in 10,level Ⅲ in 8 and levelⅣin 4.According to TNM classification,23 cases were classified to T2N.M.,1 case was T2Nl Mo,1 case was TzNlMl,1 case was T3NoMo,2 case were T3NlMl and 1 case was T3N2Mo.The mean tumor size was 8.7(4.O-16.O)cm in diameter.The mean tumor thrombosis length was 3.2(2.5-4.0)cm in level I,5.3(4.5-6.0)cm in level Ⅱ,8.2(6.5-9.O)cm in levelⅢand 15.1(12.0-18.5)cm in level IV. Results The operation was performed succesgfullv in 29 patients Patholocieal examination showed that 18 cases of clear cellcarcinoma,3 cases sarcomatoid carcinoma,2 cases renal papillary adenocarcinoma,1 case renal cell carcinoma (undifferentiated),1 case granule carcinoma,3 cases adrenocortical carcinoma and 1 case metastatic malignant melanoma of adrenal gland.Of 29 patients,3 were out of contact.Twenty-six patients were followed up for 35(0-62)months after treatment,3-and 5-year survival rates were 15/26 and 11/26.Three-year survival rates for stage T2 and T3 were 14/22 and 1/4.Five-year survival rates for stage T2 and T3 were 10/22 and 1/4.Three-year survival rates for level I、Ⅱ、Ⅲ andⅣ were 4/6,5/8,5/8 and 1/4.Five-year survival rates for level I,Ⅱ、Ⅲ andⅣ were 3/6,4/8,3/8 and 1/4.Three-year survival rates for a tumor thrombus in the below or above diaphragm were 14/22 versus 1/4,5-year survival rates were 10/22 versus 1/4.Three-year and 5-year survival rates for the patients without distant metastases and lymph node involvement were 12/18 and 9/18.Three-year and 5-year surviral rates for the patients with distant metastases and lymph node involvement were 3/8 and 2/8.The 3 surgical patients with metastatic disease died at 6,10,22 months. Conclusions Surgical treatment could be the preferred approach for the patients of renal or adrenal tumor with cancer thrombus in the inferior vena cava without distant metastases and lymph node involvement.It could improve the quality of life and may prolong survival.

Primary adrenal non-Hodgkin's lymphoma: report of 7 cases / 中华泌尿外科杂志

Objective To discuss the diagnosis and treatment of primary adrenal lymphoma. Methods The clinical data of 7 adrenal primary lymphoma cases were retrospectively analyzed. Five cases were male,2 were female. Age ranged from 33 to 62 years,mean 48 years. Two cases presented with unilateral and 5 cases with bilateral masses. Two cases were found by regular health examination. Two cases had fever and weakness, with body weight loss for 3-4 months. One case had enlarged testis for 1 month. Two cases had lumbar pain accompanied by enlarged spleen. Abdominal ultra-sonography and CT showed adrenal neoplasms. All 7 cases had elevated serum lactate dehydrogenase (367-568 U/L, normal range 100-245 U/L) and β2 microglobulin (5.9-6.3 mg/L, normal range 2.4 mg/L). The CT showed irregular,inhomogeneous adrenal mass which was mildly enhanced. Results Four of the 7 patients were misdiagnosed before operation. Two patients were diagnosed as adrenal lymphoma by biopsy. One patient was diagnosed by testicular biopsy. One was T cell non-Hodgkin's lymphoma. Six cases were diagnosed as diffuse large B cell non-Hodgkin's lymphoma by pathology. Immunohistochemieally,the tumor cells were positive for CD3,CD45-RO, L26 and CD79a. Four patients had their adrenal mass removed and received chemotherapy afterwards. As follow-up of 2 years, 1 patient had no evidence of recurrence. Three patients died after 2,6,20 months after opera-tion. Three cases took chemotherapy and radiation therapy after diagnosed. They died 19,32, 38 months during follow up. Conclusions Because adrenal mass as the primary representation of prima-ry adrenal lymphoma has no characteristic clinical appearance, diagnosis could not be made preopera-tively. The principal treatment consists of adrenalectomy and adjuvant combination chemotherapy.

Composite pheochromoeytoma of adrenal: report of 4 cases / 中华泌尿外科杂志

Objective To discuss the clinical characteristics and management principles of com-posite pheochromoeytoma of adrenal gland (pheochromocytoma-ganglioneuroma). Methods Four cases of composite tumor of adrenal gland diagnosed pathologically were reviewed. All the cases were male, aged 37 to 62 years;three of them had the history of hypertension, one of them accompanied with paroxysmal palpitation, while one case was asymptomatic. Computerized tomography and ultra-sonography showed single tumor in adrenal, the diameter was about 2.5、3.8、6.3、15cm respectively. Two cases showed positive results in 131Ⅰ-metaiodobenzylguanidine (MIBG) scintigraphy. One case showed positive result in 99Tcm-hydrazinonicotinamide-3trysinoctreotide (HTOC) scintigraphy. Twenty-four hours urinary catecholamine examination revealed the average of norepinephrine, epi-nephrine and dopamine were (196.1±92.2)nmol/24 h, (26.6±8.9)nmol/24 h, (1957.9±913.5) nmol/24 h respectively. Two cases were at a little elevated level and the others with normal. All cases were managed with α-adrenergic receptor blocker preoperatively for 2-4 weeks. Results Tumor re-section was performed in all 4 cases, and 3 cases by retroperitoneal laparoscopy, one by open surgery. All 4 cases were diagnosed as composite pheochromocytoma of adrenal (Pheochromocytoma-gangli-oneuroma) by pathology. All patients had no evidence of recurrence or metastasis during follow-up from 15 to 38 months. Two of three cases with hypertension reverted to normotensive. Conclusions Composite pheochromocytoma of adrenal is rare, difficult to be diagnosed preoperatively. Except mild in eatecholamine secretion, which clinical manifestations are similar to pheochromocytoma. Pheochro-mocytoma-ganglioneuroma is no apparent tendency for aggressive behaviors, the results of surgical management are favorable.

Open surgery for huge adrenal tumors: clinical report of 44 cases / 中华泌尿外科杂志

Objective To summarize the experience in open surgery for huge adrenal tumors in order to improve its safety and efficiency of this complicated surgical procedure. Methods Fortyfour consecutive patients with huge adrenal tumors underwent open surgery with mean long tumor diameter of 13 cm (9-34 cm), and autologous blood transfusion was prepared in routine. It was analyzed retrospectively for clinical data, perioperative complications and the effective and safety results of this procedure. Results The incision was oblique in lumbar region in 5 cases, subcostal unilaterally in 32 cases and abdomino-thoracic joint in 7 cases. There were 27 malignant tumors (61.4%) in 44 cases, 3 with hepatic invasion, 6 with thrombi extending into inferior vena cava, among which 2 needed translocation of artificial blood vessels and 3 needed cardio-pulmonary bypass. The mean blood loss was 1309 ml (100-3000 ml) in 41 cases(93.2%)and the autologous blood transfusion was used in 20 case (45.5%). There were 1 diaphragmatic injury, 1 pleura injury, 3 hemorrhage in large amount more than 15 000 ml and 2 peritoneal cavity infection.There were no perioperative deaths and 42 tumors (95.5%) were curatively resected. Conclusions Open surgery for huge adrenal tumors is a complicated surgical technique with high risk and large amount of blood loss. The key points to success are proper selection of incision, routine autologous blood transfusion, perfect surgical skills and good cooperation between different specialties.

Primary adrenal non-Hodgkin iymphoma (two cases report and review of the literature) / 中华泌尿外科杂志

Objective To discuss the diagnosis and treatment of primary adrenal lymphoma(PAL).Methods Two cases of PAL were retrospectively analyzed and the literature was reviewed.Results One patient received laparoscopic right adrenalectomy and was diagnosed as B cell Non Hodgkin's lymphoma by pathology.Immunohistochemical stains showed positive for CD20 (B cell originmarker) but negative for CD3.0ne cycle CHOP ( eyclophosphamide,doxorubicin,vincristine,andprednisone) chemotherapy was given post operation but the patient died three months after operationbecause of dyscrasia.Another patient received 2-stage bilateral laparoscopic adrenalectomy.Immuno histoehemical staining demonstrated positive CD3 (T cell origin marker) activity,but negative CD20 ac tivity and T cell Non l lodgkin's lymphoma was confirmed.Then the patient received four cyclesCHOP chemotherapy and was in good condition during S months follow up.Conclusions PAL is arare disease and has a poor prognosis.Most reported PAL patients who received only one therapeuticmodality have unsatisfactory survival rates.A combination of therapeutic modalities such as surgeryfollowed by chemotherapy and/or radiotherapy may improve prognosis for patients with PAL than sin gle modality therapy.

Spontaneous Rupture of Adrenal Metastasis from Hepatocellular Carcinoma

Rupture of adrenal tumor from various primary origins is a rather rare event. We report here on a ruptured adrenal metastasis from hepatocellular carcinoma, and this ruptured metastasis was observed at the time of the initial diagnosis.