Analysis of etiology distribution and clinical manifestation in bilateral adrenal lesions / 中华内分泌外科杂志

Objective:To investigate the etiologies and clinical characteristics of bilateral adrenal lesions.Methods:The clinical data of 143 patients with bilateral adrenal lesions hospitalized in the First Affiliated Hospital of Chongqing Medical University from Jan. 2013 to Mar. 2018 were collected and analyzed.Results:140 patients were retained for final analysis. 79 were men, and 61 were women. The age was (51.53±13.93) years. Regarding the etiologies, there were primary aldosteronism ( n=44, 31.43%) , Cushing’s syndrome ( n=27, 19.29%) , non-functional lesions ( n=23, 16.43%) , adrenal tuberculosis ( n=17, 12.14%) , pheochromocytoma ( n=11, 7.86%) , congenital adrenal hyperplasia ( n=5, 3.57%) , adrenal metastases ( n=5, 3.57%) , and adrenal lymphoma ( n=4, 2.86) . These patients were classified into the following groups according to the mass size: ≤2 cm, 2-4 cm and ≥4 cm. The highest proportion of primary aldosteronism (62.79%) , Cushing’s syndrome (46.15%) and pheochromocytoma (31.25%) was observed in the ≤2 cm, 2-4 cm and ≥4 cm groups, respectively. The mass sizes of primary aldosteronism, Cushing’s syndrome and pheochromocytoma were compared, with pheochromocytoma the largest, followed by Cushing’s syndrome, non-functional lesion, and primary aldosteronism. Conclusions:For patients with bilateral adrenal lesions in our hospital, primary aldosteronism and Cushing’s syndrome are more common than non-functional lesion. Mass size is of great value in the diagnosis of endocrinological etiology, as well as distinguishing malignant tumors from the benign ones. The imaging phenotype is helpful to determine tumor types.

Estrogen-secreting adrenocortical carcinoma / 영남의대학술지

Adrenocortical carcinoma is a rare type of endocrine malignancy with an annual incidence of approximately 1–2 cases per million. The majority of these tumors secrete cortisol, and a few secrete aldosterone or androgen. Estrogen-secreting adrenocortical carcinomas are extremely rare, irrespective of the secretion status of other adrenocortical hormones. Here, we report the case of a 53-year-old man with a cortisol and estrogen-secreting adrenocortical carcinoma. The patient presented with gynecomastia and abdominal discomfort. Radiological assessment revealed a tumor measuring 21×15.3×12 cm localized to the retroperitoneum. A hormonal evaluation revealed increased levels of estradiol, dehydroepiandrosterone sulfate, and cortisol. The patient underwent a right adrenalectomy, and the pathological examination revealed an adrenocortical carcinoma with a Weiss' score of 6. After surgery, he was treated with adjuvant radiotherapy. Twenty-one months after treatment, the patient remains alive with no evidence of recurrence.

Clinicopathologic characteristics and reticular fiber staining of adrenocortical carcinoma / 临床与实验病理学杂志

Purpose To analyse the clinicopathologic characteristics and reticular fiber staining of adrenocortical carcinoma (ACC).Methods The clinical,imaging,pathological data and reticular fiber staining of 20 cases with adrenocortical adenoma (ACA) and 16 cases with ACC were analyzed retrospectively.Results The median course of disease and maximum diameter of ACA were 21 months and 2.6 cm respectively,but ACC were 5 months and 9.5 cm respectively.9 cases with ACC were diagnosed with distant metastasis.Histologically,ACA cells arranged in nest-like and coarse trabecular forms with acidophilic or clear cytoplasm,unconspicuous nuclear atypia,and rare mitotic figures.The capsules,sinusoids and veins were uninvolved,and hemorrhage,necrosis and thick collagen fibers were infrequent.The Weiss score of all ACA was less than 2 (average =0.85 ± 0.81).ACC cells arranged in nest-like,coarse trabecular,cord-like,and diffuse structure with acidophilic cytoplasm,various nuclear atypia and atypical mitotic figures.The invasion of capsules,sinusoids and veins,hemorrhage and necrosis regions and thick collagen fibers were easily found.The Weiss score of all ACC was more than 3 (average =5.2 ±1.3).Immunohistochemical staining showed that vimentin,Syn,NSE,CK,CR,Melan-A and α-inhibin were expressed similarly between ACA and carcinoma (P ＞ 0.05).Reticular fiber staining revealed that the reticular fiber structures of ACA were unbroken,but ACC were destructed with various degrees of rupture,collapse,sparsity or disappearance (P ＜ 0.01).Conclusion ACC lacks characteristic immune phenotype,but increased diameter,distant metastasis,thick collagen fibers and destructed reticular fibrillar network are helpful in the diagnosis of ACC.

Adrenal cholangiocarcinoma: a case report and literature review / 中华泌尿外科杂志

Objective To discuss the clinical characteristics and pathologic features of adrenal cholangiocarcinoma.Methods We reported one extremely rare adrenal cholangiocarcinoma case and review the relative literature.A 71-year-old male was admitted with right adrenal mass for 2 months.Patient has been suffered from hypertension and controlled by oral drugs for ten years.Enhanced computerized tomography (CT) revealed a mass in right adrenal gland area,with the size of 7.1 cm × 6.8 cm × 4.4 cm and inhomogeneous enhancement in arterial phase.Adrenal functional examination showed no obvious abnormalities of serum catccholamine,supine RAAS,cortisol determination and rhythm and urine VMA detection.Results After medical preparation of phenoxybenzamine for 3 weeks preoperatively,the patient's blood pressure was maintained at 110-125/80-90 mmHg and with stuffy nose and ruddy nail bed.The patient's weight gained of 1kg than before.Retroperitoneal laparoscopic resection of right adrenal tumor was performed in general anesthesia.The tumor that related to the inferior vena cava and liver was successfully removed without any other damage.The operation time was 155 min and estimated blood volume was 50 ml.Perioperative blood pressure of patient was stable and recovery was well.According to clinical characteristic and pathological test and immunohistochemical results,patient was diagnosed with adrenal cholangiocarcinoma.Followed up for 15 months,no tumor recurrence and metastasis based on ultrasound examination and CT,and with normal blood pressure.Conclusions Adrenal cholangiocarcinoma was extremely rare type in the adrenal malignant tumors based on hepato-adrenal fusion histologically.This case constitutes a contribution for the knowledge of adrenal cholangiocarcinoma.The imaging findings were heterogeneous enhancement of soft tissue masses,and there was no obvious abnormality in adrenal functional examination.The retroperitoneal laparoscopic surgery is a treatment choice for this kind of patient.

Mielolipoma suprarrenal incidental / Incidental Detection of Adrenal Myelolipoma

La implementación de nuevas tecnologías y la ampliación de la cobertura a nivel de imágenes, han facilitado encontrar casos incidentales, siendo el más común el adenoma suprarrenal no funcionante. El mielolipoma suprarrenal es una neoplasia benigna, rara, en la mayoría de casos asintomática compuesta por tejido adiposo maduro y elementos hematopoyéticos. Se presenta un caso clínico de una paciente remitida al servicio de radiología por presentar en ecografía previa, una masa en región suprarrenal derecha incidentalmente. La paciente se encontraba asintomática, por lo cual se realiza tomografía axial computarizada abdominal. A la paciente por su ausencia de síntomas se le continúo con seguimiento periódico sin detectar cambios evolutivos (MÉD.UIS. 2014;27(2):105-107) .

The implementation of new technologies and expanding coverage to level of images, have provided incidental finding cases, the most common nonfunctioning adrenal adenoma. Myelolipoma adrenal benign tumors, rarely, in most cases consisting of asymptomatic mature adipose tissue and hematopoietic elements (myeloid and erythroid cells). We present a case of a patient referred to the radiology department for filing in previous ultrasound a right adrenal mass incidentally region. The patient was asymptomatic, which is done by abdominal CT. A patient by the absence of symptoms is continued with regular monitoring undetected evolutionary changes (MÉD.UIS. 2014;27(2):105-107).

Large Bilateral Adrenal Leiomyomas Presenting as Calcified Adrenal Masses: A Rare Case Report

We report the case of a 55-year-old woman with bilateral, large, calcified adrenal tumors who was treated by laparoscopic adrenalectomy. The patient presented with upper abdominal discomfort for the past 5 years. Her imaging showed bilateral enlarged adrenal glands up to 10-cm size with punctate calcifications. Positron emission tomography scan demonstrated moderate fluorodeoxyglucose avidity in the left adrenal mass. Bilateral laparoscopic adrenalectomy was performed through a transperitoneal approach. The postoperative period was uneventful, and the patient was discharged on the third postoperative day. Histology findings were consistent with adrenal leiomyomatosis.

Clinical Effectiveness of Laparoscopic Adrenalectomy

PURPOSE: A laparoscopic approach, rather than conventional laparotomy, is the well-accepted first choice for excision of an adrenal or perinephric retroperitoneal mass. The purpose of this study was to investigate the factors that affect surgical outcomes and analyze the clinical effectiveness of this surgical treatment modality. METHODS: We conducted a retrospective analysis of 62 patients who underwent laparoscopic adrenalectomies from September 2007 to February 2013. These operations were performed by a single surgeon. Demographic characteristics, operative data, tumor characteristics, and surgical outcomes were analyzed. RESULTS: Of 62 patients, 21 were men and 41 were women. The mean operative time was 151.16+/-48.58 minutes and the mean amount of blood loss was 179.51+/-161.66 ml. There were two cases of metastatic adrenal tumors that were resected completely with prolonged survival. There was one case of recurrence during the postoperative period. Preoperatively, it was only a tumor measuring 3.5 cm without evidence of malignancy. Postoperative complications occurred in three patients. However, there was no case of conversion to laparotomy. Previous history of open abdominal operation did not affect post-operative outcomes. CONCLUSION: Laparoscopic approach for adrenal tumors is indicated regardless of its type or past history of abdominal surgery. Unless greater than 10 cm, relatively large tumors can be safely removed using this method. In particular, due to the possibility of malignant potential, aggressive surgical intervention is recommended for tumors measuring between 3 and 5 cm. Use of a laparoscopic approach is associated with low risk of surgical complication and the benefits outweigh the disadvantages.

Retroperitoneal laparoscopic resection of adrenal neurilemmoma / 中华内分泌外科杂志

Objective To study the safety and efficacy of retroperitoneal laparoscopic resection of adrenal neurilemmoma.Methods The data of 7 cases with adrenal neurilemmoma undergoing retroperitoneal laparoscopic resection were analyzed.2 cases were diagnosed by ultrasound scan,3 cases had blood pressure elevation,and 2 cases had pain in waist and abdomen.All cases underwent ultrasound and CT scan.The neurilemmoma was located in left adrenal area in 2 cases and located in right adrenal area in 5 cases.Results All the 7 cases were successfully operated.No conversion or severe blood loss happened.The average tumor size was 5.0 cm,ranging from 3.0 to 7.0 cm.The average operation time was 75 min,ranging from 45 to 120 min.The estimated blood loss was 50 ml,ranging from 20 to 100 ml.The patients were discharged 7-8 day after the operation.During the 2-12 months of follow-up,no recurrence or metastasis was found.Conclusion Retroperitoneal laparoscopic resection offers an effective and better treatment for adrenal neurilemmoma,with the advantages of less blood loss,less trauma,and faster recovery.

Primary non-Hodgkin's lymphoma of the adrenal gland: 2 cases report and review of the literature / 中华内分泌外科杂志

Objective To discuss the clinical features, diagnosis and therapy of primary adrenal lymphoma (PAL) . Methods Two patients (65-year old and 52-year old respectively) who complained vague pain were analyzed. Occupying lesions in adrenal gland were discovered by computed tomography (CT) and diagnosed by needle biopsy and laparoscopic surgery. Results The two patients in our hospital were diagnosed as nonHodgkin's lymphoma. They were treated with chemotherapy and one of them was partial response. Literatures on PAL were reviewed. In the literature, 7 of the 65 patients achieved complete response, 15 partial response, 43 death or unspecified and the survival duration was 3 days to 26 months. Conclusions Most of PAL are bilateral, without specific clinical characters. Neele biopsy is the first choice to make the diagnosis. The therapeutic modalities for PAL include surgery, chemotherapy, surgery followed by chemotherapy as well as radiation therapy. The prognosis of PAL is poor if other organs are involved.

A Case of an Asymptomatic Adrenal Myelolipoma

Adrenal myelolipoma is a rare benign, non-functioning tumor that is frequently discovered incidentally. We report here on a case of a 47-year-old woman with an incidentally found adrenal tumor. She was slightly obese and had been diagnosed with diabetes. Her blood sugar level was well-controlled with oral hypoglycemic agents. All the laboratory test results were within normal limits. The abdomen CT scan revealed a well-demarcated homogenous solid mass that was 9cm in diameter, and it consisted of fat tissues. The differential diagnosis for malignant tumors was necessary, so we performed complete surgical excision. The patient recovered well without any major complications. If the diagnosis of adrenal myelolipoma is definite, then regular follow-up of this type of patient is sufficient. However, as the differential diagnosis with malignant tumors is rather difficult and as spontaneous hemorrhage can persist in the giant myelolipomas that are greater than 10cm in diameter, performing complete surgical excision is inevitable.

El tamaño de los tumores suprarrenales ¿está en relación al tiempo de evolución o expresa una diferencia biológica? / Is adrenal tumor size related to evolution time or does it represent a biological difference?

Background: Adrenal tumor (AT) malignancy has been related to tumor size. Since laparoscopic surgery is being used, smaller adrenal tumors are being excised. Aim: To evaluate eventual clinical and histológica! differences between adrenal tumors smaller than 4 cm. and those larger than 6 cm. Patients and Methods: Retrospective review of pathological reports and clinical records of patients operated for adrenal tumors, dividing them in two groups. Group 1 had 29patients aged 52 ± 13 years with AT < 4 cm operated during the period 2000-2005, and Group 2 was formed by 52 patients aged 46 ±18 years with AT >6 cm operated between 1984-2005- Tumors between 4 and 6 cm were not included in the study to establish clear cut differences between groups. Results: Tumors were functional in 40 and 41 percent of cases in groups 1 and 2 respectively. Fifty percent of functional tumors of group 1 were pheochromocytomas and the rest secreted aldosterone. In group 2, 66 percent of tumors were phechromocytomas and no aldosterone secreting tumors were found. Fifty two and eight percent of tumors in Groups 1 and 2 were adenomas, respectively (p <0.001). Nineteen tumors of group 2 were malignant, compared with one of group 1 (p <0.001). Conclusions: The tumor size of adrenal cortical tumors may represent biological differences, suggesting two different tumor populations. At time of diagnosis adrenal carcinomas are almost always larger than 6 cm.

A case of Gardner's syndrome associated with adrenal adenoma / 대한내과학회지

Gardners syndrome is a single gene disorder with variable manifestations associated with the adenomatous polyposis coli (APC) gene; including gastrointestinal polyposis and osteomas associated with a variety of benign soft tissue tumors and other extraintestinal manifestations. Infrequently associated tumors include papillary carcinoma of the thyroid, biliary neoplasia and adrenal neoplasia, both benign and malignant. It is classified as a variant of classic familial adenomatous polyposis (FAP) and is an autosomal dominant disease. The incidence of incidentaloma in FAP patients is known to be higher than general population. The occurrence of an adrenal carcinoma could affect a patient's prognosis with Gardners syndrome. Increased awareness of this lesion is important in patients with Gardners syndrome who have extended lifespan after prophylactic colectomy. We report a 37 year old case of Gardners syndrome associate with adrenal adenoma.

Transperitoneal Laparoscopic Removal of Adrenal Ganglioneuroma / 대한비뇨기과학회지

Ganglioneuroma is generally considered to be a benign tumor arising from neural crest tissue. An adrenal ganglioneuroma is located within the substance of the adrenal medulla or along the sympathetic chain, thus may secrete catecholamines, and present with endocrine symptoms. However, nonfunctional growths remain silent until they reach a large size, and are usually discovered incidentally. Complete surgical excision of adrenal ganglioneuroma is the treatment of choice, and especially a laparoscopic adrenalectomy can be performed safely, and is an ideal substitute to an open procedure, with the added benefits associated with minimally invasive surgery. Herein, we report a case of an incidentally discovered adrenal ganglioneuroma.

Update of the relationship between the insulin-like growth factor system and primary adrenocortical tumor / 医学研究生学报

THe insulin-like growth factor(IGF) system,a very important polypeptide growth hormone,has been found to have some relation with primary adrenocortical tumorigenesis and modulates its growth.This article reviews the general biological characteristics of IGF and the relations of the IGF system with the normal adrenal cortex and primary adrenocortical tumor.It also and discuss the clinical meaning of its possible presence in the primary adrenocortical tumor.

Laparoscopic adrenalectomy for adrenal tumors via transperitoneal or retroperitoneal approaches:A report of 56 cases / 中国微创外科杂志

Objective To summarize the clinical experience of retroperitoneal and transperitoneal laparoscopic adrenalectomy for adrenal tumors.Methods Laparoscopic adrenalectomy was carried out in 56 cases of adrenal tumors via transperitoneal(10 cases) or retroperitoneal(46 cases) approaches.For transperitoneal laparoscopic adrenalectomy,the operation was performed through 3 abdominal trocars.After the peritoneum and the Gerota's fascia were opened,the adrenal gland or tumor were disconnected near the upper polar of the kidney.Then the tumor was removed by using the LigaSure system and a harmonic scalpel.For retroperitoneal laparoscopic adrenalectomy,a self-made balloon was used to dilate the retroperitoneal space.Then the Gerota's fascia was opened and the tumor was removed by using the LigaSure system and a harmonic scalpel. Results Of the 10 cases of transperitoneal adrenalectomy,conversions to open surgery were required in 3 cases because of extensive abdominal adhesion;of the 46 cases of retroperitoneal adrenalectomy,a conversion to open surgery was needed in 1 case because of massive hemorrhage of the inferior vena cava.Of the remaining 52 cases,the intraoperative blood loss was 20~200 ml(mean,70 ml) and no blood transfusion was needed.The operation time was 40~200 min(mean,110 min).The postoperative hospital stay was 3~8 d (mean,5.4 d).Follow-up for(6~36) months(mean,8 months) in 52 cases showed no tumor recurrence and metastasis.Conclusions Laparoscopic adrenalectomy has advantages of reliable effects,minimal invasion,rapid recovery,and short hospital stay.This procedure can be used as the first choice for the treatment of adrenal tumors.