An Uncommon Presentation of Adrenal Cyst with Subclinical Cushing’s Syndrome: A Diagnosis Dilemma

Tahri, Abir; Abdellaoui, Wahiba; Benyakhlef, Salma; Boujtat, Khadija; Mahroug, I.; Kamaoui, Imane; Barki, Ali; Kettani, Fouad; Rouf, S.; Latrech, H.

doi:10.1155/2021/6662492

Cited by 6 publications

(6 citation statements)

References 27 publications

(46 reference statements)

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“…The morphological distinction is generally straightforward in the presence of a conventional histological component of the individual neoplasms. However, a source of confusion is represented by the rare co-occurrence of a true cystic lesion with an adrenal neoplasm, mostly adrenal cortical adenoma [76][77][78], or, even more rarely, with aldosterone-producing micronodules [79].…”

Section: Question 3: What Are the Pathological Correlates Of Adrenal ...mentioning

confidence: 99%

Overview of the 2022 WHO Classification of Adrenal Cortical Tumors

et al. 2022

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The new WHO classification of adrenal cortical proliferations reflects translational advances in the fields of endocrine pathology, oncology and molecular biology. By adopting a question–answer framework, this review highlights advances in knowledge of histological features, ancillary studies, and associated genetic findings that increase the understanding of the adrenal cortex pathologies that are now reflected in the 2022 WHO classification. The pathological correlates of adrenal cortical proliferations include diffuse adrenal cortical hyperplasia, adrenal cortical nodular disease, adrenal cortical adenomas and adrenal cortical carcinomas. Understanding germline susceptibility and the clonal-neoplastic nature of individual adrenal cortical nodules in primary bilateral macronodular adrenal cortical disease, and recognition of the clonal-neoplastic nature of incidentally discovered non-functional subcentimeter benign adrenal cortical nodules has led to redefining the spectrum of adrenal cortical nodular disease. As a consequence, the most significant nomenclature change in the field of adrenal cortical pathology involves the refined classification of adrenal cortical nodular disease which now includes (a) sporadic nodular adrenocortical disease, (b) bilateral micronodular adrenal cortical disease, and (c) bilateral macronodular adrenal cortical disease (formerly known primary bilateral macronodular adrenal cortical hyperplasia). This group of clinicopathological entities are reflected in functional adrenal cortical pathologies. Aldosterone producing cortical lesions can be unifocal or multifocal, and may be bilateral with no imaging-detected nodule(s). Furthermore, not all grossly or radiologically identified adrenal cortical lesions may be the source of aldosterone excess. For this reason, the new WHO classification endorses the nomenclature of the HISTALDO classification which uses CYP11B2 immunohistochemistry to identify functional sites of aldosterone production to help predict the risk of bilateral disease in primary aldosteronism. Adrenal cortical carcinomas are subtyped based on their morphological features to include conventional, oncocytic, myxoid, and sarcomatoid subtypes. Although the classic histopathologic criteria for diagnosing adrenal cortical carcinomas have not changed, the 2022 WHO classification underscores the diagnostic and prognostic impact of angioinvasion (vascular invasion) in these tumors. Microscopic angioinvasion is defined as tumor cells invading through a vessel wall and forming a thrombus/fibrin-tumor complex or intravascular tumor cells admixed with platelet thrombus/fibrin. In addition to well-established Weiss and modified Weiss scoring systems, the new WHO classification also expands on the use of other multiparameter diagnostic algorithms (reticulin algorithm, Lin–Weiss–Bisceglia system, and Helsinki scoring system) to assist the workup of adrenal cortical neoplasms in adults. Accordingly, conventional carcinomas can be assessed using all multiparameter diagnostic scheme...

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Section: Question 3: What Are the Pathological Correlates Of Adrenal ...mentioning

confidence: 99%

Overview of the 2022 WHO Classification of Adrenal Cortical Tumors

et al. 2022

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“…Adrenal cysts are uncommon lesions, with an incidence of 0.06-0.18%, and account for about 4% of adrenal masses. [1] They may occur at any age, although they are more frequent in young adults with a slight female predilection. The size of the cysts may vastly vary from a few millimeters to over 4 cm, with very few cysts exceeding 10 cm.…”

Section: Discussionmentioning

confidence: 99%

“…While an Vascular cyst with hyaline degeneration (lining cells were CD34 positive) within an adrenocortical adenoma. Immunohistochemical analysis of steroidogenic enzymes showed the expression of P450scc, 3βHSD, P450c17, and P450c21 [1]…”

Section: Discussionmentioning

confidence: 99%

“…Adrenal cysts were originally classified into four major histopathological types: Epithelial cysts, parasitic cysts, (specifically echinococcal type), pseudocysts, and endothelial cysts which were the most common subtype. [1,[4][5][6] Among these, true epithelial adrenal cysts are even rarer, accounting for only 9% of all adrenal cysts. This has further been adopted in the latest WHO classification, which has introduced a new chapter on adrenal cysts.…”

Section: Sri Ramachandra Journal Of Health Sciencesmentioning

confidence: 99%

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Adrenal cyst – A diagnostic quandary

Lakshman

Pavithra

Arun

et al. 2023

SRJHS

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Adrenal cysts are rare benign entities that commonly masquerade as more serious illnesses. They are usually asymptomatic and non-functional. Here, we present a case of a large left adrenal cyst of size 10.8 × 10.2 × 7.8 cm in a 25-year-old male, who initially presented with fever and abdominal pain, with clinical suspicion of an abdominal malignant neoplasm. Laboratory workup was unremarkable, while the histopathological diagnosis was that of a benign true adrenal cyst – epithelial type. This case report highlights the rarity of cysts larger than 4 cm, radiological and pathological features for appropriate diagnosis, as well as subclassification of the cyst, which is essential to institute optimal treatment.

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“…Adrenal cysts are extremely rare retroperitoneal lesions that account for only 4% of all adrenal masses [ 4 ]. They are underrecognized as they present with nonspecific clinical and radiological features.…”

Section: Discussionmentioning

confidence: 99%

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

Zakkor,

Alafandi,

Danial

et al. 2023

Journal of Surgical Case Reports

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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.

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An Uncommon Presentation of Adrenal Cyst with Subclinical Cushing’s Syndrome: A Diagnosis Dilemma

Cited by 6 publications

References 27 publications

Overview of the 2022 WHO Classification of Adrenal Cortical Tumors

Overview of the 2022 WHO Classification of Adrenal Cortical Tumors

Adrenal cyst – A diagnostic quandary

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

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