Sampling of the adrenal glands by endoscopic ultrasound-guided fine-needle aspiration

Abstract

Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) has proven to be a valuable modality for the primary diagnosis and staging of gastrointestinal, and perigastrointestinal malignancy. Aside from assessing thoracic and abdominal lymph nodes and the liver for metastases, EUS can assess and sample the adrenal glands, which are frequently involved by metastatic disease, but can also harbor benign primary neoplasms. The cytology files at our institution were reviewed for all cases of EUS-guided FNA of the adrenal glands. Clinical histories, sonographic findings, and cytologic findings of all cases were reviewed. Results were compared with overall EUS-guided FNA performance and the performance of non-EUS-guided FNA of the adrenal. The utility of cell block immunohistochemistry (IHC) in these cases was reviewed. Between 1/1/00 and 5/15/04 there were 24 cases of EUS-guided FNA of the adrenal gland from 22 different patients (13 men; 9 women) at our institution. This represented 1.4% of overall EUS-guided FNA and 77% of adrenal gland FNA. Patient ages ranged from 37 to 86 yr (mean 69 +/- 11 yr). Most patients had other cancers or mass lesions and were being staged at the time of the procedure (19 of 22). Almost all FNAs were of the left adrenal gland (23 of 24). Lesion size ranged from 0.9 to 7.9 cm (mean 2.5 +/- 1.6 cm). Diagnostic material was present in all cases when compared with an overall EUS-guided FNA diagnostic rate of 88%. Material for cell block was present in 21 cases, and IHC was used in 3 cases. Final diagnoses were as follows: cortical tissue consistent with cortical adenoma (19), metastatic adenocarcinoma (3), pheochromocytoma (1), and adrenal cortical carcinoma (1). EUS-guided FNA of the adrenal gland is primarily used in the staging of other malignancies when lesions of the left adrenal are recognized sonographically. Diagnostic tissue is easily obtained, including material for cell block IHC, which allows definitive diagnosis in cases that present difficult differential diagnoses.

D2-40 is a sensitive and specific marker in differentiating primary adrenal cortical tumours from both metastatic clear cell renal cell carcinoma and phaeochromocytoma

“…Although we have shown the utility of D2-40 in surgical material, the fact that D2-40 has been used successfully in cytological preparations is promising, as FNA assessment of the solitary adrenal lesion is well-established,14 15 and the cytopathologist is faced with the same diagnostic difficulties as are posed to the surgical pathologist. Thus D2-40 may also prove useful in the assessment of FNA material from the adrenal gland.…”

EUS-FNA for the detection of left adrenal metastasis in patients with lung cancer

“…Transesophageal ultrasound guided fine needle aspiration (EUS-FNA) is a safe and minimally invasive alternative for surgical mediastinal staging that is incorporated in international guidelines [20,21]. Reports about EUS-FNA for the assessment of left adrenal metastases in patients with lung cancer are limited, mostly single centre case series and rarely take PET findings into account [19,[22][23][24][25][26][27]. The aim of this multicentre study was to investigate the sensitivity of EUS-FNA in patients with (suspected) lung cancer with a suspect left adrenal gland metastasis based on CT and/or 18 FDG-PET imaging.…”

“…The left adrenal gland can be visualised and real-time sampled from the stomach using endoscopic ultrasound [19]. Transesophageal ultrasound guided fine needle aspiration (EUS-FNA) is a safe and minimally invasive alternative for surgical mediastinal staging that is incorporated in international guidelines [20,21].…”

Immunohistochemical Distinction of Primary Adrenal Cortical Lesions From Metastatic Clear Cell Renal Cell Carcinoma

“…14, 37, 48 The increasing use of image-guided biopsies 15, 17, 38, 46 that yield very scant tissue samples often complicates the diagnosis at a metastatic location. In addition, CC-RCC has considerable morphologic overlap with other non-renal neoplasms and normal tissues, 31, 39 especially primary lesions of the adrenal cortex such as adenoma, carcinoma, hyperplasia, and even adrenal-renal fusion.…”