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Calissendorff J, Juhlin CC, Sundin A, Bancos I, Falhammar H. Adrenal cysts: an emerging condition. Nat Rev Endocrinol 2023:10.1038/s41574-023-00835-2. [PMID: 37095252 DOI: 10.1038/s41574-023-00835-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 04/26/2023]
Abstract
Adrenal cysts are rare lesions representing approximately 1-2% of adrenal incidentalomas. The majority of these rare lesions are benign. Rarely, phaeochromocytomas and adrenal malignant masses can present as cystic lesions and can occasionally be difficult to distinguish from benign cysts. Histologically, adrenal cysts are subdivided into pseudocysts, endothelial cysts, epithelial cysts and parasitic cysts. The radiological appearance of an adrenal cyst is generally similar to that of cysts in the kidney. They are thus well demarcated, usually rounded, with a thin wall and homogenous internal structure, low attenuating (<20 Hounsfield Units) on CT, low signalling on T1-weighted MRI sequences and high signalling on T2-weighted MRI sequences, and anechoic or hypoechoic on ultrasonography. Benign adrenal cysts have a slight female predominance and are usually diagnosed between the ages of 40 and 60. Most adrenal cysts are asymptomatic and are detected incidentally, although very large adrenal cysts can lead to mass effect symptoms, with surgery required to alleviate the symptoms. Thus, conservative management is usually recommended for asymptomatic cysts. However, when uncertainty exists regarding the benign nature of the cyst, additional work-up or follow-up is needed. The management of an adrenal cyst should preferably be discussed at an adrenal multidisciplinary team meeting.
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Affiliation(s)
- Jan Calissendorff
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Sundin
- Department of Surgical Sciences, Radiology & Molecular Imaging, Uppsala University, Uppsala, Sweden
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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2
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Khan T, Sabu B, Ranganayaki V, Rafeekha P, Thomas R. Management of giant adrenal pseudocyst in pregnancy - A unique approach and review of literature. Obstet Med 2023; 16:52-55. [PMID: 37139502 PMCID: PMC10150310 DOI: 10.1177/1753495x221089210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/24/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
Pseudocysts of the adrenal gland are rare and in the majority of cases are non- functioning. They become symptomatic only when they are complicated by hormonal excess, rupture, haemorrhage or infection. Described here is a 26-year-old woman who developed an acute abdomen at 28 weeks of gestation due to a left adrenal haemorrhagic pseudocyst. A conservative approach was adopted, which was followed by elective term caesarean delivery with surgical intervention at the same time. The described case is unique in terms of strategizing timing and mode of management and thus minimizing the risk of prematurity and maternal morbidity associated with interval surgery.
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Affiliation(s)
- Tazeen Khan
- Department of High-Risk pregnancy and
Perinatology, KIMS Health, Trivandrum, Kerala, India
| | - Brinda Sabu
- Department of High-Risk pregnancy and
Perinatology, KIMS Health, Trivandrum, Kerala, India
| | | | - P Rafeekha
- Department of Obstetrics and Gynaecology, KIMS Health, Trivandrum, Kerala, India
| | - Renu Thomas
- Department of Urology, KIMS Health, Trivandrum, Kerala, India
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3
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Ates E, Kol A, Gokce GS, Yıldız AE, Erol H. A giant adrenal hemorrhagic pseudocyst mimicking a parapelvic renal cyst: A case report and review of the literature. ACTA ACUST UNITED AC 2020; 92. [PMID: 33016061 DOI: 10.4081/aiua.2020.3.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/24/2020] [Indexed: 11/22/2022]
Abstract
Adrenal pseudocysts are rare, nonfunctional, asymptomatic cystic masses that originate from the adrenal gland and are usually located in the suprarenal area. They are usually incidentally discovered during imaging, but diagnosis can be challenging because they are similar to benign and malignant cystic lesions of the adrenal gland and adjacent organs. We describe a giant, adrenal hemorrhagic pseudocyst that was atypically located, extending from the middle to the lower poles of the kidney, admixed with a renal cortical cyst.
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Affiliation(s)
- Erhan Ates
- Department of Urology, Aydin Adnan Menderes University School of Medicine, Aydin.
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4
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Infected adrenal pseudocyst mimicking a duodenal duplication cyst. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2019.101362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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5
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Mandato VD, Mastrofilippo V, Kuhn E, Silvotti M, Barbieri I, Aguzzoli L, La Sala GB. Adrenal Cyst in Pregnancy: A Surgical Emergency. Urology 2018; 121:22-28. [PMID: 29958968 DOI: 10.1016/j.urology.2018.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 05/31/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Vincenzo Dario Mandato
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Unità Sanitaria Locale, Reggio Emilia, Italy.
| | - Valentina Mastrofilippo
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Unità Sanitaria Locale, Reggio Emilia, Italy
| | - Elisabetta Kuhn
- Unit of Pathology, Azienda Unità Sanitaria Locale, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Unità Sanitaria Locale, Reggio Emilia, Italy
| | - Monica Silvotti
- Unit of Radiology, Azienda Unità Sanitaria Locale, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Unità Sanitaria Locale, Reggio Emilia, Italy
| | - Italo Barbieri
- General and Emergency Surgery, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Unità Sanitaria Locale, Reggio Emilia, Italy
| | - Giovanni Battista La Sala
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Unità Sanitaria Locale, Reggio Emilia, Italy; y
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6
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Surgical Management of a Giant Adrenal Pseudocyst: A Case Report and Review of the Literature in the Last Decade. Case Rep Surg 2018; 2018:8473231. [PMID: 29568658 PMCID: PMC5820576 DOI: 10.1155/2018/8473231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/27/2017] [Indexed: 11/18/2022] Open
Abstract
Adrenal pseudocysts are rare entities and occurred in the 5th and the 6th decades of life. They are discovered accidentally, while appearing with nonspecific clinical and imaging findings. We report a case of a 28-year-old woman presented in our Emergency Department complaining about upper abdomen pain. Computed tomography revealed a hypodense cystic lesion containing hyperdense material. The size of a mass was 11. 7 × 9.3 × 6.6 cm in diameter close to the pancreas, but the origin was from the left adrenal gland. The mass was excised with surgical laparotomy. Giant adrenal pseudocysts are rare entities. Final diagnosis usually confirmed with the pathology examination. Management of such adrenal lesions depends on the unique characteristics, the surgeon's experience, and local resources.
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Samal S, Ramya K, Mohapatro A, Gupta S, Nayak P. Conservative Management of Adrenal Cyst in Pregnancy: A Novel Approach. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sunita Samal
- Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College & Research Institute, Pilliyarkuppam, Puducherry, India
| | - Krishnamurhty Ramya
- Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College & Research Institute, Pilliyarkuppam, Puducherry, India
| | - Akshaya Mohapatro
- Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College & Research Institute, Pilliyarkuppam, Puducherry, India
| | - Shweta Gupta
- Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College & Research Institute, Pilliyarkuppam, Puducherry, India
| | - Prasant Nayak
- Department of Urology, Mahatma Gandhi Medical College & Research Institute, Pilliyarkuppam, Puducherry, India
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Patnaik S, Htut A, Wang P, Eisenberg D, Miick R, Feyssa E. All Those Liver Masses are not Necessarily from the Liver: A Case of a Giant Adrenal Pseudocyst Mimicking a Hepatic Cyst. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:333-7. [PMID: 26035028 PMCID: PMC4463998 DOI: 10.12659/ajcr.893798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Most abdominal cysts, including adrenal pseudocysts, are benign and asymptomatic. Rapid enlargement, hemorrhage, infection, rupture with leakage of cyst contents, or pressure on adjacent organs can cause symptoms. Although usually diagnosed incidentally on imaging, determining the origin of a cyst can sometimes be challenging. In these situations, surgical excision and pathological analysis is crucial to diagnosis and management. We report here a case of a giant symptomatic adrenal pseudocyst that closely mimicked a hepatic cyst at presentation. CASE REPORT A 50-year-old man, with a history of an incidentally detected hepatic cyst, presented with severe abdominal pain, fevers, leukocytosis, and mildly abnormal liver function tests. CT scan revealed a large well defined cystic space-occupying lesion within the liver, with findings suggesting cyst rupture and possible infection. Early laparotomy was performed, and the origin was determined intraoperatively to be right adrenal, which was later confirmed by pathology. CONCLUSIONS Contrast-enhanced CT scan is the criterion standard for evaluation for abdominal cystic masses. Precise diagnosis of a giant abdominal cyst can be challenging. Surgery is both diagnostic and curative in such situations. We also discuss the specific situations in which surgery should be considered in cases of adrenal cystic masses.
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Affiliation(s)
- Soumya Patnaik
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Alvin Htut
- Department of Medicine, Division of Gastroenterology, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Peter Wang
- Department of Radiology, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Daniel Eisenberg
- Department of Radiology, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Ronald Miick
- Department of Medicine, Division of Hepatology, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Eyob Feyssa
- Department of Medicine, Division of Hepatology, Albert Einstein Medical Center, Philadelphia, PA, USA
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Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases. World J Surg 2012; 36:75-82. [PMID: 22057755 DOI: 10.1007/s00268-011-1338-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Spontaneous adrenal hemorrhage associated with a mass is uncommon and treatment strategies are not standardized. Current treatment modalities range from supportive management and blood transfusion to embolization or immediate operative extirpation. Our objectives were to describe six cases from a single institution and to perform a literature review of the etiology of the condition and recommended management of patients with hemorrhagic adrenal masses. METHODS Records from six patients diagnosed with adrenal hemorrhage and an associated mass at a single institution were reviewed. Clinical records and outcomes were analyzed. A comprehensive review of 133 reported cases in the literature was performed. RESULTS Six patients presented with spontaneous adrenal hemorrhage that appeared to be associated with a mass, with tumor sizes ranging from 3.7 to 15 cm. Three patients underwent adrenalectomy for pheochromocytoma or adrenocortical cancer. Three patients did not undergo adrenalectomy: one had a metastasis from lung cancer, one underwent embolization, and one had resolution of the mass on interval imaging. A comprehensive review of the literature identified 133 cases, with pheochromocytoma the most commonly reported lesion (48%). CONCLUSIONS Spontaneous adrenal hemorrhage is rare. When it does occur, a high level of suspicion for malignant disease or pheochromocytoma should be maintained. The possibility of a hematoma masquerading as a neoplasm should also be considered. In cases of ongoing hemorrhage, embolization may be a lifesaving temporizing measure. Acute surgical intervention should be considered in selected patients, and surgery may not be required in all patients. A cautious approach with a comprehensive biochemical and imaging work-up is advised prior to operation.
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Ujam AB, Peters CJ, Tadrous PJ, Webster JJ, Steer K, Martinez-Isla A. Adrenal pseudocyst: Diagnosis and laparoscopic management - A case report. Int J Surg Case Rep 2011; 2:306-8. [PMID: 22096761 DOI: 10.1016/j.ijscr.2011.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 09/28/2011] [Accepted: 10/05/2011] [Indexed: 12/13/2022] Open
Abstract
Cysts of the adrenal gland are rare and are usually discovered incidentally. Large adrenal cysts can however present with severe abdominal pain and can be complicated by haemorrhage, rupture or infection. Adrenal pseudocysts appear to result from haemorrhage within a normal adrenal gland and can expand to accommodate massive amounts of fluid.We report the case of a 39-year-old woman who presented with worsening right upper quadrant pain. An ultrasound scan of the abdomen confirmed a large 29 cm × 20 cm × 17 cm cyst that appeared to originate in the upper pole of the right kidney causing displacement of the liver and right kidney.Following complete aspiration the cyst re-accumulated and an MRI scan demonstrated a thickened and irregular cyst wall with haemorrhagic fluid. Laparoscopic right adrenalectomy was performed and the histopathological diagnosis was confirmed as an adrenal pseudocyst.
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Affiliation(s)
- Atheer B Ujam
- Department of Surgery, St Marks-Northwick Park Hospital, London, UK
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11
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Karaman K, Teke Z, Dalgic T, Ulas M, Seven MC, Zulfikaroglu E, Sakaogullari Z, Bostanci EB. Giant hemorrhagic adrenal pseudocyst in a primiparous pregnancy: report of a case. Surg Today 2010; 41:153-8. [PMID: 21191710 DOI: 10.1007/s00595-009-4207-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 09/01/2009] [Indexed: 12/15/2022]
Abstract
Adrenal cysts are rare and are usually discovered incidentally during diagnostic imaging, surgery, or autopsy. Most cystic lesions of the adrenal gland are nonfunctioning and become symptomatic when complicated by rupture, hemorrhage, or infection. A 40-year-old woman presented with a history of gradual-onset pain in her left flank region at 20 weeks' gestation. Ultrasound showed a 20-cm cystic mass in her left abdominal cavity. Pertinent laboratory tests were within normal limits. The patient underwent exploratory laparotomy, which revealed a 20 × 15-cm left adrenal cyst; thus, we performed left adrenalectomy with complete excision of the cyst. Histological examination confirmed a hemorrhagic adrenal pseudocyst. The patient had an uneventful postoperative course, and subsequent routine obstetric ultrasound examinations showed normal fetal activity and development until the pregnancy terminated with a stillbirth caused by pre-eclampsia at 34 weeks' gestation. To the best of our knowledge, this is only the 12th reported case of adrenal pseudocyst discovered during pregnancy. We analyze the clinicopathologic findings and discuss the possible association of pregnancy, with special reference to etiopathogenesis, presentation, diagnosis, and treatment.
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Affiliation(s)
- Kerem Karaman
- Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey
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12
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Poiana C, Carsote M, Chirita C, Terzea D, Paun S, Beuran M. Giant adrenal cyst: case study. J Med Life 2010; 3:308-13. [PMID: 20945822 PMCID: PMC3018989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
One of the rarest situations regarding an adrenal incidentaloma is an adrenal cyst. We present the case of a 61Z–year old male patient diagnosed with peritonitis. During surgery, a right adrenal tumor of 2 cm is discovered. The patient was referred to endocrinology. 6 months later the diameter of the tumor is 7 times bigger than the initial stage. It has no secretory phenotype, except for the small increase of serum aldosterone and the 24–h 17–ketosteroids. Open right adrenalectomy is performed and a cyst of 15 cm is removed. The evolution after surgery is good. The pathological exam reveals an adrenal cyst with calcifications and osteoid metaplasia. The immunohistochemistry showed a positive reaction for CD34 and ACT in the vessels and VIM in the stroma. The adrenal cysts are not frequent and represent a challenge regarding the preoperative diagnostic and surgical procedure of resection. The pathological exam highlights the major aspects.
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Affiliation(s)
- Catalina Poiana
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
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13
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Surgery for a pancreatic pseudocyst uncovers an adrenal mass instead. JAAPA 2010; 23:33-7. [PMID: 20214246 DOI: 10.1097/01720610-201002000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kim BS, Joo SH, Choi SI, Song JY. Laparoscopic resection of an adrenal pseudocyst mimicking a retroperitoneal mucinous cystic neoplasm. World J Gastroenterol 2009; 15:2923-6. [PMID: 19533819 PMCID: PMC2699015 DOI: 10.3748/wjg.15.2923] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Adrenal pseudocysts are rare cystic masses that arise within the adrenal gland and are usually non-functional and asymptomatic. Adrenal pseudocysts consist of a fibrous wall without a cellular lining. We report a patient with a 9 cm, left-sided suprarenal cystic mass who presented with abdominal discomfort of 2 years’ duration. A 38-year-old woman was referred to our service for evaluation of abdominal discomfort and gastrointestinal symptoms. Routine laboratory tests were within normal limits. An abdominal computed tomography scan showed a 9 cm × 8 cm × 8 cm well-defined cystic lesion displacing the left kidney. Magnetic resonance imaging showed a cystic lesion with low signal intensity on the T1-weighted image and high signal intensity on the T2-weighted image. A laparoscopic left adrenalectomy was performed to diagnose the lesion. The final pathology showed an adrenal pseudocyst without a cellular lining. The patient had no postoperative complications and she was discharged four days after surgery.
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