A new risk stratification algorithm for the management of patients with adrenal incidentalomas

Birsen, Onur; Akyüz, Muhammet; Dural, Ahmet Cem; Aksoy, Erol; Aliyev, Shamil; Mitchell, Jamie; Siperstein, Allan; Berber, Eren

doi:10.1016/j.surg.2014.06.042

Cited by 38 publications

(43 citation statements)

References 31 publications

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“…The remaining consists of benign cysts, adrenocortical hyperplasias, schwannomas, ganglioneuromas, lymphangiomas, liposarcomas, lymphomas, cavernous hemangiomas, angiomyolipomas, angiosarcomas and leiomyosarcomas [5,9]. Additionally, there are some rarely seen pathologies, most of which have been presented as case reports, including plasmacytoma, ganglioneuroblastoma, sarcomatoid carcinoma, leiomyosarcoma, cavernous hemangioma, malignant perivascular epithelioid tumor, primitive neuroectodermal tumor, oncocytoma, lymphangioma, fibrous tumor and lymphoma [10,11,12,13,14,15,16,17,18,19,20].…”

Section: Discussionmentioning

confidence: 99%

“…Recent adrenalectomy series reported numerous pathology results, including cortical adenoma, pheochromocytoma, adrenocortical hyperplasia, neurofibroma, myelolipoma, cortical carcinoma, schwannoma, ganglioneuroma, spindle cell tumor, benign cyst, cystic tumor, lipoma, lymphangioma and inflammatory mass [4,5]; however, the primary concern is the malignant character of the lesion, as it is well known that the complete resection of adrenocortical tumors at an early stage improves prognosis [5]. Laparoscopic adrenalectomy (LA) is the gold standard treatment for benign adrenal lesions, but its use in patients with primary or metastatic disease remains controversial.…”

Section: Introductionmentioning

confidence: 99%

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The Pathologic Point of View of Laparoscopic Adrenalectomy in the Era of Radiologic Imaging: A Multicenter Retrospective Study

Tonyalı

Ataç²,

Eroğlu³

et al. 2016

Urol Int

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Introduction/Aim: This study aimed to determine if laparoscopic adrenalectomy (LA) is feasible for the treatment of adrenal malignancies and metastasis, and to review the final pathology findings in order to clarify the indications for surgery. Materials and Method: The medical records of all patients that underwent LA at 3 university hospitals between January 1, 2008, and May 1, 2015, were retrospectively reviewed. Results: In total, 189 laparoscopic adrenalectomies were completed successfully. Mean duration of surgery was 79.3 ± 38.6 min and mean estimated intraoperative blood loss was 39.9 ml. Intraoperatively, 4 patients had major complications: spleen injury (n = 1), renal vein injury (n = 2) and diaphragm injury (n = 2). Histopathological examination showed that there were 20 different types of lesions. Surgical margins (SMs) were tumor free in 95.2% of the patients. Moreover, SMs were tumor free in all patients with adrenocortical carcinomas; however, positive margins were noted in 7 of 23 patients (30.4%) with malignant adrenal tumors. Conclusions: The present findings support the use of laparoscopy for metastatic adrenal masses, despite a high positive margin rate. LA is a safe, feasible and cost-effective procedure for the management of benign and malignant adrenal masses.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Pathologic Point of View of Laparoscopic Adrenalectomy in the Era of Radiologic Imaging: A Multicenter Retrospective Study

Tonyalı

Ataç²,

Eroğlu³

et al. 2016

Urol Int

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“…In recently published guidelines, authors voted against a certain cut-off in diameter of the tumour, and suggested that an individualised approach was most appropriate [12]. It is worth remembering that although attenuation value of < 10 Hounsfield units is the most widely used attenuation value for the diagnosis of lipid-rich benign adenomas, lipid poor adenomas with higher value represent 10-40% of all adenomas [13]. Even such tumours as myelolipomas, although they are benign, are recommended to be surgically removed when they are bigger than 4 cm [14,15].…”

Section: Prace Oryginalnementioning

confidence: 99%

Adrenal tumour bigger than 5 cm — what could it be? An analysis of 139 cases

Cichocki

Samsel

Papierska

et al. 2017

Endokrynologia Polska

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Introduction: There is an increasing number of adrenal being tumours discovered incidentally during imaging examinations performed for many different indications. Radiological findings suggesting adrenal pathology may be caused by true adrenal tumours or by other retroperitoneal masses. Generally, the larger the tumour, the higher the possibility of adrenal cancer. Material and methods: Analysis of our data -139 operations performed over 11 years (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) in patients with tumours in the adrenal area larger than 5 cm. Results: The most common finding was adrenal cancer (25.2%), benign adenoma (24.5%), pheochromocytoma (12.9%), and metastatic cancer (10.1%). In total, there were 19 various histopathological diagnoses in this group. Conclusion: Although adrenal cancer is the most likely diagnosis in large adrenal tumours, a broad spectrum of various adrenal and retroperitoneal tumours with size more than 5 cm can be found in such patients. (Endokrynol Pol 2017; 68 (4): 411-415)

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“…Follow-up has been used in some series as a surrogate for benign disease. [15][16][17] However to be more accurate, imaging features should be compared with final histopathology. Studies that correlated imaging results with pathologic findings have demonstrated that benign CT and MR findings are associated with benign adenomas with high (98-100 %) specificity.…”

Section: Discussionmentioning

confidence: 99%