Giant adrenal pseudocyst harbouring adrenocortical cancer

Fanning, Deirdre Mary; Moloney, James; Flood, Hugh D.

doi:10.1136/bcr.05.2011.4169

Cited by 6 publications

(7 citation statements)

References 14 publications

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“…On the other hand, adrenal pseudocysts are cystic lesions surrounded by a fibrous tissue wall with an absence of a recognizable epithelial or endothelial lining layer that characterizes true cysts. Adrenal pseudocysts are associated with malignant ACC in 7% of cases [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

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Giant nonfunctioning adrenal tumors: two case reports and review of the literature

et al. 2018

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BackgroundThere are an estimated 1–2 cases per million per year of adrenocortical carcinoma in the USA. It represents a rare and aggressive malignancy; it is the second most aggressive endocrine malignant disease after anaplastic thyroid carcinoma. Non-secretory adrenal masses are diagnosed late due to a mass effect or metastatic disease or found incidentally (adrenal incidentalomas).Case presentationThe first case report describes a 39-year-old Greek woman who presented to our department with complaints of repeated symptoms of flatulence and epigastric discomfort over a few months. The second case report is about a 67-year-old Greek woman who presented to our department after being evaluated for fatigue, mass effect, and epigastric discomfort. Both of them were diagnosed as having a nonfunctioning adrenocortical carcinoma and underwent open adrenalectomy.ConclusionsApproximately 60% of patients with adrenocortical carcinoma present with symptoms and signs of hormonal secretion. Our cases’ adrenocortical carcinomas were not functional. Hormone secretion is not a discriminating feature between benign and malignant adrenocortical masses. The silent clinical nature of nonfunctioning adrenocortical carcinoma results in late diagnosis, while the majority of patients present with locally advanced and/or metastatic disease.Adrenocortical carcinoma is a rare endocrine tumor with a poor prognosis that can be diagnostically challenging and demands high clinical suspicion. The work-up for adrenal masses must include determination of whether the mass is functioning or nonfunctioning and whether it is benign or malignant.

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Section: Discussionmentioning

confidence: 99%

“…The silent clinical nature of nonfunctioning ACC results in poor outcomes, while the majority of patients present with locally advanced and/or metastatic disease. The work-up for adrenal masses must include determination of whether the mass is functioning or nonfunctioning and whether it is benign or malignant [ 1 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

Giant nonfunctioning adrenal tumors: two case reports and review of the literature

et al. 2018

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“…They have long been known to be associated with malignancy, with an estimated incidence of approximately 7%. Among the malignancies found in adrenal pseudo cysts, adrenocortical carcinoma (ACC) is by far the most common 14 …”

Section: Discussionmentioning

confidence: 99%

“…Among the malignancies found in adrenal pseudo cysts, adrenocortical carcinoma (ACC) is by far the most common. 14 As per guidelines, assessment of hormonal levels is to be done in all patients with adrenal incidentaloma. In all the five cases discussed here, hormonal assessment was done and the entire adrenal lesion was nonfunctional.…”

Section: Discussionmentioning

confidence: 99%

Cystic adrenal lesions: A report of five cases

et al. 2020

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Background Cystic adrenal lesions are rare and uncommon manifestation with few cases reported so far. Different types of adrenal cysts have been described with heterogeneous etiology and overlapping clinical findings, ranging from benign to malignant cystic neoplasm. They are usually asymptomatic or may rarely present with abdominal pain or fullness. Optimum management of adrenal cysts still remain controversial, owing to its low incidence. In this study, we report our institutional experience on diagnosis and management of different histological types of cystic adrenal lesions. Cases During 4 years period, 55 patients underwent adrenalectomy with five cases presenting as adrenal cysts. All the five patients were biochemically nonfunctional and underwent adrenalectomy (laparoscopic anterior n = 2, retroperitoneoscopic approach n = 1, and open anterior transperitoneal approach n = 2). The primary indications for surgery were larger size and/or suspicion of malignancy. Histological evaluation revealed two epithelial cysts, one endothelial cyst, one pseudocyst, and a very rare case of adrenocortical carcinoma arising in a pseudocyst. Conclusion Cystic adrenal lesions are rare with varied etiologic and clinical presentation that may sometimes lead to diagnostic and management dilemma. These cases must undergo biochemical and radiological evaluation to rule out underlying malignancy followed by referral for surgical intervention.

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“…However, the diagnosis of nonfunctional adrenocortical carcinomas using FDG-PET is sometimes difficult because adrenal hematomas can also avidly take up fluorodeoxyglucose [ 18 ]. Histopathological diagnosis by adrenal biopsy is also difficult because the distinction between adrenal hyperplasia, adenoma, and carcinoma cannot typically be made on a limited biopsy specimen [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Hemorrhagic Adrenal Pseudocyst Mimicking Solid Tumor

et al. 2017

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Patient: Female, 78Final Diagnosis: Adrenal pseudocystSymptoms: NoneMedication: —Clinical Procedure: OperationSpecialty: UrologyObjective:Mistake in diagnosisBackground:Adrenal pseudocysts are often discovered incidentally on imaging, but the diagnosis and treatment can be challenging. A case of adrenal pseudocyst with hemorrhage is presented that mimicked a solid tumor on imaging, resulting in adrenalectomy.Case Report:A 78-year-old woman was found to have a right adrenal lesion on abdominal imaging. Enhanced computed tomography (CT) showed a heterogeneously enhanced mass, and magnetic resonance imaging (MRI) showed a high-intensity T1-weighted and T2-weighed image, with an irregular enhanced margin. The imaging findings were suggestive of a solid tumor of the adrenal gland. Although full endocrine serological studies were negative, the lesion increased in size at two-year follow-up. Right laparoscopic adrenalectomy was performed, and a benign hemorrhagic adrenal pseudocyst was diagnosed histologically.Conclusions:Adrenal pseudocyst can be associated with acute intracystic hemorrhage, and imaging will show contrast enhancement, suggesting malignancy. In such cases, surgical excision is both diagnostic and curative.

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Giant adrenal pseudocyst harbouring adrenocortical cancer

Cited by 6 publications

References 14 publications

Giant nonfunctioning adrenal tumors: two case reports and review of the literature

Giant nonfunctioning adrenal tumors: two case reports and review of the literature

Cystic adrenal lesions: A report of five cases

A Case of Hemorrhagic Adrenal Pseudocyst Mimicking Solid Tumor

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