Clinical analysis of adrenal lesions larger than 5 cm in diameter (an analysis of 251 cases)

Abstract

BackgroundTo describe the pathological distribution, imaging manifestations, and surgical managements and prognosis of large adrenal tumors (LATs) ≥ 5 cmMethodsA total of 251 patients with LATs were analyzed on the basis of pathological or clinical diagnosis. Regarding surgery, open adrenalectomy was performed on 89 patients, and laparoscopic adrenalectomy was performed on 89 patients. Thirty-two patients with bilateral tumors were analyzed in terms of clinical characteristics. The survival rate was determined for 43 patients with adrenal metastases and 29 patients with primary adrenal malignancies. The CT characteristics including tumor diameter, shape, edge, heterogeneity, necrosis, calcification, pre-contrast attenuation, and contrast attenuation were analyzed for 117 patients.ResultsThe majority of LATs were still benign, but they had a higher probability to be malignant. Benign LATs made up 68.13% of all cases, mainly adrenal cysts (19.52%), pheochromocytoma (18.73%), benign adenoma (16.73%), and myelolipoma (7.17%). Malignant LATs accounted for 28.69% of cases, mainly including adrenocortical carcinoma (8.76%) and metastases (17.13%). Laparoscopic surgery was found to involve less trauma than open surgery. It was also safer and postoperative recovery was faster, but it had drawbacks and could not completely replace open surgery. CT features had obvious specificity for the diagnosis of benign and malignant tumors. For example, benign adenomas had a smaller pre-contrast (< 10 Hu) whereas malignant adrenal tumors had, on the contrary, higher attenuation. Regarding adrenal malignant carcinoma, adrenal primary malignant tumors showed a better prognosis than adrenal metastases (mean survival of 19.17 months vs 9.49 months). Primary adrenal cortical carcinoma without metastasis had a better prognosis than primary adrenal cortical carcinoma metastasis (mean survival of 23.71 months vs 12.75 months), and adrenal solitary metastasis had a better prognosis than general multiple metastatic carcinoma (mean survival of 14.95 months vs 5.17 months).ConclusionLATs were more likely to be benign; however, they still had a high probability of being a malignant tumor. Understanding the clinicopathological characteristics of LATs can facilitate selection of more effective clinical treatment options.

A Nomogram for Predicting Intraoperative Hemodynamic Instability in Patients With Pheochromocytoma

“…In our study, lobular type and irregular type were associated with IHD with regard to tumor shape. The present analyses showed that round type was frequently found in pheochromocytomas ( 9 , 12 ). To the best of our knowledge, the shape of lesions was not adopted into reports on risk factors of IHD in patients with pheochromocytoma.…”

Synchronous gastric cancer and primary lymphoma of right adrenal gland: a case report

“…With the development of diagnostic imaging, the number of adrenal tumors found by chance is increasing [ 24 , 25 ]. Among adrenal lesions larger than 5 cm in diameter on CT, 28.69% are malignant adrenal tumors, including adrenal lymphoma, accounting for 1.20% of all cases [ 26 ]; however, CT findings of primary adrenal lymphoma are not specific. Rashidi et al have reported that in CT studies of primary adrenal lymphomas, the frequency of homogeneous and heterogeneous appearing masses is similar; most masses are hypodense, whereas some are hyperdense; and most enhancement patterns are “slight to moderate enhancement,” whereas some are “no or poor enhancement [ 27 ].” Therefore, a definitive diagnosis is only established by resection or biopsy [ 27 ].…”

Approach to large adrenal tumors

“…The data about adrenal tumors homogeneity/ heterogeneity is very limited. In one series of 117 lesions above 5 cm, ACA's were homogenous only in 55%, ganglioneuroma's in 85%, PHEO's in 2%, ACC in 2%, and metastases in 1% [5]. Such high percentage of heterogeneity seen in large ACA's may be a result of local intra-tumoral bleeding in growing lesion and secondary calcifications.…”

“…Pheochromocytomas (PHEOs), adrenocortical cancer (ACC), and metastases account for 7%, 5%, and 8% respectively [4]. Large adrenal tumors (LAT's) defined as more than 4-6 cm are rare, with the incidence from 8.6-38.6% of adrenal tumors [5]. Although the risk of malignancy clearly correlates with the size of a lesion, tumor size of more than 4 cm represents only 31-61% specificity for the diagnosis of malignant tumor [6,7].…”

“…Although the risk of malignancy clearly correlates with the size of a lesion, tumor size of more than 4 cm represents only 31-61% specificity for the diagnosis of malignant tumor [6,7]. Nonetheless, among LAT's prevalence of malignancy is much higher, being reported for ACC 8.8-44% and metastases 17.1-27% [5,8]. Diagnosis of PHEOs is also more frequent among LAT's 18.7-42%.…”