Giant Adrenal Pseudocyst Treated Laparoscopically; Case Report and Review of the Literature

Abstract

We report a case of a giant adrenal pseudocyst, found incidentally in a 45 year old female. Her CT scan showed a 7.5cm x 7.3cm suprarenal mass and she underwent a laparoscopic transperitoneal adrenalectomy. We report this case and review the literature regarding the diagnosis and management of adrenal pseudocysts. CASE REPORTA 45 year old housewife with multiple sclerosis was discovered to have a large right suprarenal mass as an incidental finding on a computed tomography (CT) scan of her lumbosacral spine. On close questioning, she reported a vague history of episodes of right flank pain for the previous 2 years. She also described episodes of flushing and lethargy which raised a suspicion of a possible diagnosis of phaeochromocytoma. There was no prior history of trauma or malignancy. The examination was normal other than a palpable mass in the right upper quadrant.An adrenal protocol CT scan was performed revealing a 7.5cm x 7.3cm suprarenal cystic lesion with a calcified rim (Figs. 1,2). A renal or adrenal origin of the mass was difficult to distinguish. Otherwise, no metastatic disease was seen. The possibility of a phaeochromocytoma was considered, although these tumors normally display enhancement. Figs. (1,2). CT abdomen with contrast showing 7.5cm x 7.3cm mass in the supra-renal area. The calcified rim is well depicted here.

Adrenal pseudocyst: Diagnosis and laparoscopic management – A case report

“…The literature on laparoscopic versus open adrenalectomy appears to favour the laparoscopic approach regardless of tumour size. 3,5,6,16 An evaluation of 242 laparoscopic adrenalectomies over a 15 year period in one centre, demonstrated a low complication rate, low conversion rate and rapid functional recovery. 17 Furthermore, there appears to be no significant difference in outcome for all tumour sizes.…”

“…5 Only 7% of all reported adrenal pseudocysts are malignant or potentially malignant and the risk increases with size, in particular if over 6 cm. 3,6 Commonly adrenal pseudocyst will present to the surgeon once they have reached a significantly large size as to cause pressure effects on nearby organs. Epigastric pain, nausea and vomiting are typical symptoms and a palpable mass on examination may be found.…”

“…14 Patients with smaller tumours less than 4 cm should have repeat CT scan at 3 months after diagnosis and should be monitored for 18 months. 3,15 …”

“…2 They account for just under 6% of all newly discovered incidentalomas. 3 Clinically they are rarely palpable but there is usually tenderness on abdominal examination.…”

Giant Hemorrhagic Adrenal Pseudocyst in Pregnancy

“…3 Adrenal cysts fall under the umbrella of adrenal incidentalomas; however, adrenal cysts only comprise 6% of all worked-up adrenal incidentalomas. 4 We report the case of a 32-year-old woman in her 28th week of pregnancy that presented with what was originally thought to be an adnexal mass and was taken to the operating room for definitive diagnosis and exploration. Upon definitive diagnosis, confirmation of a giant hemorrhagic adrenal pseudocyst was made, yielding the 13th reported case of a giant hemorrhagic adrenal pseudocyst in pregnancy.…”