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Kwak MH, Yun JS, Kim JN, Lee YR, Kim CK, Kang KA. Validation of the modified CT criteria for identifying non-adenomas. Abdom Radiol (NY) 2024; 49:1603-1614. [PMID: 38411694 DOI: 10.1007/s00261-024-04206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/30/2023] [Accepted: 01/12/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Although adrenal computed tomography (CT) percentage washout is a potentially powerful imaging technique for differentiating adrenal adenomas from non-adenomas, its application to non-adenomas can be problematic. Recently, modified criteria for diagnosing pheochromocytomas using adrenal CT were developed based on data from 199 patients with surgically proven pheochromocytomas and adenomas. However, these criteria have not been thoroughly validated. The purpose of this study was to validate the performance of the modified criteria for diagnosing non-adenomas including pheochromocytomas. METHODS The conventional and modified criteria were applied to 266 patients from two cohorts who had surgically proven lipid-poor adenomas (155/266, 58.3%) and non-adenomas (111/266, 41.7%) and underwent adrenal CT. Two radiologists calculated the attenuation on each dynamic phase and percentage washout of adrenal masses. The final assessments based on the conventional and modified criteria were categorized into adenomas or non-adenomas. The diagnostic performance of each criterion for diagnosing non-adenomas was evaluated using the area under the receiver operating characteristic curve (AUC). False negatives and positives were also compared. RESULTS The AUC for the diagnosis of non-adenomas was 0.806 for conventional criteria and 0.858 for modified criteria (p = 0.047). The false-negative rate of conventional criteria for the diagnosis of non-adenomas was 29.7%. Use of modified criteria could have reduced the false-negative rate by to 7.2%. The false-positive rate increased from 9% to 21.3% when using the modified criteria. CONCLUSION The utilization of modified criteria has the potential to identify additional non-adenomas that would otherwise be misdiagnosed as adenomas using conventional criteria alone.
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Affiliation(s)
- Min Hwan Kwak
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Ji-Sup Yun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Na Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Rae Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Kyo Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
| | - Kyung A Kang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
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Sun B, Wang L, Li X, Zhang J, Zhang J, Tian J, Mossa-Basha M, Xu J, Zhou Y, Zhao H, Zhu C. Delayed Enhancement of Intracranial Atherosclerotic Plaque Can Better Differentiate Culprit Lesions: A Multiphase Contrast-Enhanced Vessel Wall MRI Study. AJNR Am J Neuroradiol 2024; 45:262-270. [PMID: 38388686 DOI: 10.3174/ajnr.a8132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/05/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND PURPOSE Intracranial plaque enhancement (IPE) identified by contrast-enhanced vessel wall MR imaging (VW-MR imaging) is an emerging marker of plaque instability related to stroke risk, but there was no standardized timing for postcontrast acquisition. We aim to explore the optimal postcontrast timing by using multiphase contrast-enhanced VW-MR imaging and to test its performance in differentiating culprit and nonculprit lesions. MATERIALS AND METHODS Patients with acute ischemic stroke due to intracranial plaque were prospectively recruited to undergo VW-MR imaging with 1 precontrast phase and 4 consecutive postcontrast phases (9 minutes and 13 seconds for each phase). The signal intensity (SI) values of the CSF and intracranial plaque were measured on 1 precontrast and 4 postcontrast phases to determine the intracranial plaque enhancement index (PEI). The dynamic changes of the PEI were compared between culprit and nonculprit plaques on the postcontrast acquisitions. RESULTS Thirty patients with acute stroke (aged 59 ± 10 years, 18 [60%] men) with 113 intracranial plaques were included. The average PEI of all intracranial plaques significantly increased (up to 14%) over the 4 phases. There was significantly increased PEI over the 4 phases for culprit plaques (an average increase of 23%), but this was not observed for nonculprit plaques. For differentiating culprit and nonculprit plaques, we observed that the performance of IPE in the second postcontrast phase (cutoff = 0.83, AUC = 0.829 [0.746-0.893]) exhibited superior accuracy when compared with PEI in the first postcontrast phase (cutoff = 0.48; AUC = 0.768 [0.680-0.843]) (P = .022). CONCLUSIONS A 9-minute delay of postcontrast acquisition can maximize plaque enhancement and better differentiate between culprit and nonculprit plaques. In addition, culprit and nonculprit plaques have different enhancement temporal patterns, which should be evaluated in future studies.
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Affiliation(s)
- Beibei Sun
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Radiology (M.M., C.Z.), University of Washington, Seattle, Washington
| | - Lingling Wang
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Li
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Zhang
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianjian Zhang
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Tian
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mahmud Mossa-Basha
- Department of Radiology (M.M., C.Z.), University of Washington, Seattle, Washington
| | - Jianrong Xu
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhou
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huilin Zhao
- From the Department of Radiology, Ren Ji Hospital (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai China
- College of Health Science and Technology (B.S., L.W., X.L., Jin Zhang, Jianjian Zhang, J.T., J.X., Y.Z., H.Z.), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengcheng Zhu
- Department of Radiology (M.M., C.Z.), University of Washington, Seattle, Washington
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Hussain A, Thota Kammili S, Uy E, Piercy J, Ganti S, Gullapalli D. Biochemically Silent Pheochromocytoma in an Asymptomatic Patient With a Unilateral Lipid-Poor Adrenal Adenoma. Cureus 2023; 15:e47120. [PMID: 38021916 PMCID: PMC10648053 DOI: 10.7759/cureus.47120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
In this case, a Caucasian woman was incidentally found to have a left adrenal gland incidentaloma a decade ago. Initial tests indicated a non-functional lipid-poor adenoma, but ongoing surveillance revealed irregularities in biochemical testing for pheochromocytoma. The patient was concurrently taking an SNRI, known to elevate biochemical markers artificially. Given the adenoma's growth and mild biochemical abnormalities, laparoscopic surgery was performed, and the tumor was found to be a 2.4 cm × 1.8 cm pheochromocytoma. Following the procedure, hormone levels normalized, and the patient experienced relief from symptoms. This case underscores the rarity of pheochromocytomas, emphasizing the importance of accurate diagnosis and effective management. Imaging techniques, notably computed tomography (CT) and magnetic resonance imaging (MRI), played a crucial role in localization, particularly through contrast-enhanced methods. Key characteristics like Hounsfield density, enhancement patterns, and washout behavior aided in distinguishing diverse adrenal masses. For cases where imaging had limitations, complementary techniques such as 23I-metaiodobenzylguanidine (MIBG) scintigraphy, specialized MR sequences, and GA-DOTATATE scans provided supplementary diagnostic insights, collectively contributing to a comprehensive clinical understanding. Despite advancements, challenges persist in differentiating specific adrenal tumors, highlighting the need for continued research and refined imaging methodologies.
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Affiliation(s)
- Akbar Hussain
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
| | | | - Edilfavia Uy
- Diabetes and Endocrinology, Appalachian Regional Healthcare, Whitesburg, USA
| | - Jonathan Piercy
- Internal Medicine, Appalachian Regional Healthcare, Whitesburg, USA
| | - Shyam Ganti
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
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Teixeira AP, Haddad Jr. W, Barreto LO, Secaf A, Mermejo LM, Lucchesi FR, Tucci Jr. S, Elias Junior J, Molina CAF, Muglia VF. Histogram analysis in the differentiation between adrenal adenomas and pheochromocytomas: the value of a single measurement. Radiol Bras 2023; 56:59-66. [PMID: 37168042 PMCID: PMC10165976 DOI: 10.1590/0100-3984.2022.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/12/2022] [Indexed: 05/13/2023] Open
Abstract
Objective To assess the diagnostic accuracy of histogram analysis on unenhanced computed tomography (CT) for differentiating between adrenal adenomas and pheochromocytomas (PCCs). Materials and Methods We retrospectively identified patients with proven PCCs who had undergone CT examinations between January 2009 and July 2019 at one of two institutions. For each PCC, we selected one or two adenomas diagnosed within two weeks of the date of diagnosis of the PCC. For each lesion, two readers scored the size, determined the mean attenuation, and generated a voxel histogram. The 10th percentile (P10) was obtained from the conventional histogram analysis, as well as being calculated with the following formula: P10 = mean attenuation - (1.282 × standard deviation). The mean attenuation threshold, histogram analysis (observed) P10, and calculated P10 (calcP10) were compared in terms of their diagnostic accuracy. Results We included 52 adenomas and 29 PCCs. The sensitivity, specificity, and accuracy of the mean attenuation threshold were 75.0%, 100.0%, and 82.5%, respectively, for reader 1, whereas they were 71.5%, 100.0%, and 81.5%, respectively, for reader 2. The sensitivity, specificity, and accuracy of the observed P10 and calcP10 were equal for both readers: 90.4%, 96.5%, and 92.6%, respectively, for reader 1; and 92.3%, 93.1%, and 92.6%, respectively, for reader 2. The increase in sensitivity was significant for both readers (p = 0.009 and p = 0.005, respectively). Conclusion For differentiating between adenomas and PCCs, the histogram analysis (observed P10 and calcP10) appears to outperform the mean attenuation threshold as a diagnostic criterion.
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Affiliation(s)
- Ana P. Teixeira
- Faculdade de Medicina de Ribeirão Preto da Universidade de São
Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - William Haddad Jr.
- Faculdade de Medicina de Ribeirão Preto da Universidade de São
Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Luan Oliveira Barreto
- Faculdade de Medicina de Ribeirão Preto da Universidade de São
Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | | | - Livia M. Mermejo
- Faculdade de Medicina de Ribeirão Preto da Universidade de São
Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | | | - Silvio Tucci Jr.
- Faculdade de Medicina de Ribeirão Preto da Universidade de São
Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Jorge Elias Junior
- Faculdade de Medicina de Ribeirão Preto da Universidade de São
Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Carlos A. F. Molina
- Faculdade de Medicina de Ribeirão Preto da Universidade de São
Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Valdair F. Muglia
- Faculdade de Medicina de Ribeirão Preto da Universidade de São
Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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Abstract
Adrenal cortical carcinoma (ACC) is a rare and aggressive malignancy that poses challenging issues regarding the diagnostic workup. Indeed, no presurgical technique or clinical parameters can reliably distinguish between adrenal cortical adenomas, which are more frequent and have a favorable outcome, and ACC, and the final diagnosis largely relies on histopathologic analysis of the surgical specimen. However, even the pathologic assessment of malignancy in an adrenal cortical lesion is not straightforward and requires a combined evaluation of multiple histopathologic features. Starting from the Weiss score, which was developed in 1984, several histopathologic scoring systems have been designed to tackle the difficulties of ACC diagnosis. Dealing with specific histopathologic variants (eg, Liss-Weiss-Bisceglia scoring system for oncocytic ACC) or patient characteristics (eg, Wieneke index in the pediatric setting), these scores remarkably improved the diagnostic workup of ACC and its subtypes. Nevertheless, cases with misleading features or discordant correlations between pathologic findings and clinical behavior still occur. Owing to multicentric collaborative studies integrating morphologic features with ancillary immunohistochemical markers and molecular analysis, ACC has eventually emerged as a multifaceted, heterogenous malignancy, and, while innovative and promising approaches are currently being tested, the future clinical management of patients with ACC will mainly rely on personalized medicine and target-therapy protocols. At the dawn of the new Fifth World Health Organization classification of endocrine tumors, this review will tackle ACC from the pathologist's perspective, thus focusing on the main available diagnostic, prognostic, and predictive tissue-tethered features and biomarkers and providing relevant clinical and molecular correlates.
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Graveling AJ, Abraham P. Adrenal nodules for the non-specialist: What to look out for and when to refer. J R Coll Physicians Edinb 2022; 52:350-356. [PMID: 36451593 DOI: 10.1177/14782715221138467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Almost all medical specialities utilise cross-sectional imaging of the abdomen to evaluate many different medical conditions. This ever-increasing use of cross-sectional imaging has led to a dramatic increase in the detection rate of adrenal nodules. Following appropriate biochemical and radiological evaluation, the vast majority of these are shown to be benign adrenal adenomas. A small minority are diagnosed with a functional or malignant lesion that may result in significant morbidity and mortality requiring specialist management.
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Muacevic A, Adler JR, Gokden N, Menon LP. Incidental, Solitary, and Unilateral Adrenal Metastasis as the Initial Manifestation of Lung Adenocarcinoma. Cureus 2022; 14:e32628. [PMID: 36660511 PMCID: PMC9845493 DOI: 10.7759/cureus.32628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
An adrenal incidentaloma is an adrenal mass ≥ 1 cm in size discovered on imaging performed for indications other than suspected adrenal disease. It has variable etiologies, which can be benign or malignant, including primary or metastatic disease. We present a rare case of metastatic lung adenocarcinoma with isolated unilateral adrenal metastases, presenting as an adrenal incidentaloma in an asymptomatic patient with no known history of malignancy. A 76-year-old man with a past medical history of chronic obstructive pulmonary disease (COPD) and heavy tobacco use was admitted for the evaluation and treatment of pneumonia. He was found to have an incidental 4.6 cm unilateral adrenal mass on his CT chest. He underwent a workup for the mass, including further imaging studies that were indeterminate and a hormonal workup that concluded that the mass was nonfunctional. Due to the patient's comorbidities, it was determined that he was not a surgical candidate. A multidisciplinary team recommended a biopsy, which revealed metastatic lung adenocarcinoma. The primary lung cancer was located using positron emission tomography with 2-deoxy-2-(fluorine-18) fluoro-D-glucose combined with computed tomography (F-FDG-PET/CT). The patient was evaluated by an oncology service and started on chemotherapy. In this case report, we discuss the approach for evaluating adrenal incidentalomas as well as the role the biopsy has in this process based on a literature review. In addition, we draw a comparison between our case and similar cases in the literature while highlighting the differences that make this case unique.
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Was It an Adrenocortical Adenoma or an Adrenocortical Carcinoma? Limitation of the Weiss Scoring System in Determining the Malignant Potential of Adrenocortical Tumor: Report on Two Cases. Case Rep Endocrinol 2022; 2022:7395050. [PMID: 36160179 PMCID: PMC9492358 DOI: 10.1155/2022/7395050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Adrenocortical carcinoma (ACC) is a rare endocrine malignancy. An accurate diagnosis of ACC is of paramount importance as it greatly impacts the management and prognosis of a patient. However, the differentiation between early stage, low-grade ACC and adrenocortical adenoma (ACA) may not always be straightforward. The recommended classification system, namely, the Weiss scoring system, is not without flaws. We herein report two cases of ACC which were initially diagnosed as ACA according to the Weiss scoring system but developed distant metastases in subsequent years. Case Presentation. Case 1: A 60-year-old Chinese woman presented with a recent onset of worsening of blood pressure control and clinical features of Cushing's syndrome. Investigations confirmed ACTH-independent endogenous hypercortisolism, and a CT abdomen showed a 6 cm right adrenal mass. Twenty-four-hour urine steroid profiling revealed co-secretion of adrenal androgens and atypical steroid metabolites. Laparoscopic right adrenalectomy was performed, and pathology of the tumor was classified as an ACA by the Weiss scoring system. Four years later, the patient presented with an abrupt onset of severe hypercortisolism and was found to have a metastatic recurrence in the liver and peritoneum. The patient received a combination of mitotane, systemic chemotherapy, and palliative debulking surgery and succumbed 8.5 years after the initial presentation due to respiratory failure with extensive pulmonary metastases. Case 2: A 68-year-old Chinese woman presented with acute bilateral pulmonary embolism and was found to have a 3 cm left adrenal mass. Hormonal workup confirmed ACTH-independent endogenous hypercortisolism, and laparoscopic left adrenalectomy revealed an ACA according to the Weiss scoring system. Five years later, she presented with recurrent hypercortisolism due to hepatic and peritoneal metastases. The patient had progressive disease despite mitotane therapy and succumbed 7 years after initial presentation. Conclusions Although the Weiss scoring system is recommended as the reference pathological classification system to diagnose adrenocortical carcinoma, there remain tumors of borderline malignant potential which may escape accurate classification. Various alternative classification systems and algorithms exist but none are proven to be perfect. Clinicians should recognize the potential limitation of these histological criteria and scoring systems and incorporate other clinical parameters, such as the pattern of hormonal secretion, urinary steroid profiling, and radiographic features, to improve the prognostication and surveillance strategy of these tumors.
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Schutte T, Stege CAM, Smits MM, Franssen LE, Donker ML, de Leeuw DC. Midostaurin as the Most Likely Cause of Bilateral Adrenal Masses in a Patient with Acute Myeloid Leukemia. Clin Drug Investig 2022; 42:791-797. [PMID: 35948754 PMCID: PMC9364849 DOI: 10.1007/s40261-022-01186-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Tim Schutte
- Department of Medical Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
| | - Claudia A M Stege
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Mark M Smits
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Laurens E Franssen
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Marjolein L Donker
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - David C de Leeuw
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
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Yan F, Zeng J, Chen Y, Cheng Y, Pei Y, Zang L, Chen K, Gu W, Du J, Guo Q, Wang X, Ba J, Lyu Z, Dou J, Yang G, Mu Y. Clinical analysis of the etiological spectrum of bilateral adrenal lesions: A large retrospective, single-center study. Endocrine 2022; 77:372-379. [PMID: 35606576 DOI: 10.1007/s12020-022-03077-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/11/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the clinical characteristics, endocrinological function, and etiology of bilateral adrenal lesions in hospitalized patients. METHODS A retrospective study of 777 patients with bilateral adrenal lesions was conducted at the Chinese People's Liberation Army General Hospital between January 2013 and January 2018. Patients' demographic features, hormonal profiles, imaging findings, and histopathological findings were reviewed from database records. RESULTS Of the 777 patients with bilateral adrenal lesions, 495 were men. The mean age at diagnosis was 52.0 ± 13.0 years. Overall, 511 (65.8%) cases were benign, followed by adrenal metastases (n = 224, 28.8%), pheochromocytoma (n = 26, 3.3%), adrenal lymphoma (n = 9, 1.2%), and adrenal corticocarcinoma (ACC; n = 7, 0.9%). Hormonal evaluation revealed that 34.3% of bilateral adrenal lesions were functional. The primary etiologies of functional lesions were primary aldosteronism (16.6%, 129/777), and primary bilateral macronodular adrenocortical hyperplasia (PBMAH; 8.8%, 68/777). Patients with lymphoma and metastases were significantly older than those with benign nonfunctional lesions (60.4 ± 11.0 years vs. 54.5 ± 10.4 years and 57.9 ± 10.8 years vs. 54.5 ± 10.4 years, respectively; both P < 0.001). Lesions in patients with adrenal lymphoma, ACC, pheochromocytoma, metastases, congenital adrenal hyperplasia, tuberculosis, and Cushing's syndrome were significantly larger than benign nonfunctional lesions (all P < 0.001). CONCLUSION Benign adrenal lesions and metastases from the lungs are the most common causes of bilateral adrenal lesions. Primary aldosteronism and PBMAH are the most prevalent functional lesions. Moreover, patients with lymphoma or metastases are older and their masses are larger.
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Affiliation(s)
- Fangfang Yan
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jinyang Zeng
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yulong Chen
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yu Cheng
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yu Pei
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Li Zang
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Kang Chen
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Weijun Gu
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jin Du
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qinghua Guo
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xianling Wang
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jianming Ba
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhaohui Lyu
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jingtao Dou
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Guoqing Yang
- Department of Endocrinology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan, China.
| | - Yiming Mu
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China.
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Gopinath C, Shekar S, Acharya M, Pattan V, Sundaresh V. Pure Androgen-Secreting Radiologically Suspicious Adrenal Mass: Benign or Malignant? Cureus 2022; 14:e26234. [PMID: 35898370 PMCID: PMC9308385 DOI: 10.7759/cureus.26234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Pure androgen-secreting adrenocortical tumors (PASATs) are rare entities. Their clinical presentations include virilizing features that vary based on age and gender. The pathogenesis of this tumor is still unclear, with around 50% of such tumors being malignant. Imaging characteristics of the tumor on CT/MRI including size, heterogenicity, and contrast wash-out time are used to predict malignancy. Surgical excision is recommended for all functional adrenal tumors. In this report, we discuss a case of a 68-year-old postmenopausal female presenting with hyperandrogenism and was found to have a 7-cm, PASAT that raised suspicion for malignancy on CT scan, but was determined to be benign on surgical pathology.
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Sobocki BK, Perdyan A, Szot O, Rutkowski J. Management of Pheochromocytomas and Paragangliomas: A Case-Based Review of Clinical Aspects and Perspectives. J Clin Med 2022; 11:jcm11092591. [PMID: 35566714 PMCID: PMC9103340 DOI: 10.3390/jcm11092591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/30/2022] [Accepted: 05/01/2022] [Indexed: 12/12/2022] Open
Abstract
Paraganglioma and pheochromocytoma are rare medical conditions. Thus, there are still a small number of studies, clinical trials, and evidence-based data in this field. This makes clinical decisions more difficult. In this study, we present a case report enriched with a short review of available essential clinical data, indicating the need for constant metoxycatecholamine level observation and a proper diagnostic imaging approach, especially in terms of ongoing pandemics. Our research also provides a summary of the molecular background of these diseases, indicating their future role in clinical management. We analyzed the ClinicalTrials.gov dataset in order to show future perspectives. In this paper, the use of the PET-CT before MRI or CT is proposed in specific cases during diagnosis processes contrary to the guidelines. PET-CT may be as effective as standard procedures and may provide a faster diagnosis, which is important in periods with more difficult access to health care, such as during the COVID-19 pandemic.
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Affiliation(s)
- Bartosz Kamil Sobocki
- Student Scientific Circle of Oncology and Radiotherapy, Medical University of Gdansk, 80-214 Gdansk, Poland;
- Correspondence: (B.K.S.); (J.R.)
| | - Adrian Perdyan
- International Research Agenda 3P Medicine Laboratory, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Olga Szot
- Student Scientific Circle of Oncology and Radiotherapy, Medical University of Gdansk, 80-214 Gdansk, Poland;
| | - Jacek Rutkowski
- Department of Oncology and Radiotherapy, Medical University of Gdansk, 80-214 Gdansk, Poland
- Correspondence: (B.K.S.); (J.R.)
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Rusakov VF, Shcherbakov IE, Chinchuk IK, Savelyeva TV, Rebrova DV, Loginova OI, Pridvizhkina TS, Chernikov RA, Krasnov LM, Fedotov JN, Fedorov EA, Sablin IV, Sleptsov IV, Shihmagomedov SS, Zgoda EA. [Diagnostic value of ct in examination of patients with adrenal cancer]. PROBLEMY ENDOKRINOLOGII 2022; 68:13-29. [PMID: 36104962 DOI: 10.14341/probl12846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/17/2022] [Accepted: 04/25/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND In most cases adrenal tumours are detected by accident while performing medical imaging tests for other diseases. These findings are treated as adrenal incidentaloma. Prevalence of incidentalomas detected on CT scans is up to 4%. According to different authors, 4-12% of all adrenal tumours are adrenocortical carcinomas. As for today, the most significant medical imaging technique is CT scan with bolus IV injection of contrast agent and assessment of tumour's density. The analysis of the results of CT imaging in 67 patients with ACC was carried out according to a single protocol. The main signs characteristic of this disease are described. It is very important to evaluate typical signs of ACC on CT scans for risk assessment of ACC before surgical treatment. If malignant tumour is suspected during preoperative examination, it is extremely important to choose the right surgical treatment strategy. AIM To evaluate the significance of CT as the main method of preoperative diagnosis in patients with malignant tumors of the adrenal cortex. Studying CT semiotics of adrenocortical cancer in a large group of patients using a single standard imaging protocol. Find the main radiological symptoms characteristic of adrenocortical cancerMATERIALS AND METHODS: Here are the results of retrospective study of CT scans performed on 67 patients with adrenocortical carcinoma who received treatment in the Department of Endocrine Surgery of Saint-Petersburg State University N.I. Pirogov Clinic of High Medical Technologies during 2012-2020. The diagnostic significance of CT in patients with ACC was assessed. RESULTS The most common features of ACC: tumour heterogeneity (84.3%), tumour's size 3-9 cm (75%), signs of invasion into surrounding structures (10%), pre-contrast density above +30 HU (75%), absolute contrast washout less than 60% (68.8%), relative contrast washout less than 40% (64.6%)CONCLUSION: CT scan with IV contrast was not able to show any definitive pathognomonic signs of ACC. Nevertheless, CT scan should be performed in all patients with suspected (or confirmed using other medical imaging technique) adrenal tumour according to standard protocol. Bolus injection of contrast agent should be performed in all patients with tumour's pre-contrast density above +5 HU.
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Affiliation(s)
- V F Rusakov
- N.I. Pirogov Clinic of High Medical Technologies
| | | | - I K Chinchuk
- N.I. Pirogov Clinic of High Medical Technologies
| | | | - D V Rebrova
- N.I. Pirogov Clinic of High Medical Technologies
| | - O I Loginova
- N.I. Pirogov Clinic of High Medical Technologies
| | | | | | - L M Krasnov
- N.I. Pirogov Clinic of High Medical Technologies
| | - J N Fedotov
- N.I. Pirogov Clinic of High Medical Technologies
| | - E A Fedorov
- N.I. Pirogov Clinic of High Medical Technologies
| | - I V Sablin
- N.I. Pirogov Clinic of High Medical Technologies
| | - I V Sleptsov
- N.I. Pirogov Clinic of High Medical Technologies
| | | | - E A Zgoda
- N.I. Pirogov Clinic of High Medical Technologies
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Kim MK, Kang KA, Park SY. Clinical significance of a 10-mm cutoff size for adrenal lesions: a retrospective study with 547 non-oncologic patients undergoing adrenal computed tomography. Abdom Radiol (NY) 2022; 47:1091-1097. [PMID: 35028681 DOI: 10.1007/s00261-021-03405-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/28/2021] [Accepted: 12/28/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the proportion of clinically significant adrenal lesions in patients with a subcentimeter adrenal lesion, and the sensitivity of a cutoff size of 10 mm on computed tomography (CT). METHODS This retrospective study included consecutive 547 non-oncologic patients who underwent adrenal CT. Clinically significant adrenal lesions were defined as those that were biochemically abnormal (n = 99) or surgically resected according to the clinician's decision (n = 23). Long-axis diameters (LDs) and short-axis diameters (SDs) of the lesions were measured on CT by two independent readers. Likelihood of the focal lesion was analyzed using a five-point scale (1 = very low; 5 = very high). 66 Sensitivities for clinically significant lesions were analyzed according to cutoff size. Proportions of the clinically significant lesions for subcentimeter lesions were analyzed according to the visual score. RESULTS Sensitivities for clinically significant lesions for cutoffs of 10, 15, and 20 mm were 93%, 79%, and 63% for LD and 85%, 61%, and 49% for SD for Reader 1 and 89%, 78%, and 65% for LD and 80%, 65%, and 48% for SD for Reader 2, respectively (p < 0.001 for 10 mm versus the other cutoffs). In subcentimeter lesions with visual scores of 1-3, the proportions of clinically significant lesions were 5.4% for LD or SD for Reader 1 and 6.6% for LD and 7.7% for SD for Reader 2, respectively. CONCLUSION A lesion LD of ≥ 10 mm was a reasonable cutoff for determining adrenal abnormality. Subcentimeter lesions without visually high suspicion had a low risk of clinical significant lesions in our study cohort. Higher cutoffs significantly decreased sensitivity.
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Affiliation(s)
- Myoung Kyoung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kyung A Kang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Tzikos G, Menni A, Cheva A, Pliakos I, Tsakona A, Apostolidis S, Iakovou I, Michalopoulos A, Papavramidis T. Composite Paraganglioma of the Celiac Trunk: A Case Report and a Comprehensive Review of the Literature. Front Surg 2022; 9:824076. [PMID: 35273997 PMCID: PMC8901723 DOI: 10.3389/fsurg.2022.824076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/12/2022] [Indexed: 12/18/2022] Open
Abstract
IntroductionComposite paragangliomas consist of two components, paraganglioma and ganglioneuroma, representing a rare subgroup of paragangliomas. The purpose of the study is to describe a case of composite paraganglioma of the celiac trunk and a brief review of the existing literature.Case PresentationA 64-year-old female patient with a history of epigastric abdominal pain and a 51 mm-diameter tumor found in a Computerized Tomography of the abdomen was admitted to our surgical department for further evaluation and treatment. After a brief preoperative surgical assessment, the patient underwent a mini-laparotomy for the excision of this tumor. After having the results of the pathology report, a comprehensive review of the international literature was carried out by applying the appropriate search terms.ResultsAs it was found intraoperatively, the tumor was located at the cephalad aspect of the common hepatic artery, over the portal vein and the inferior vena cava. A negative-margin resection was achieved and the tumor was sent for pathology analysis. The final pathology report revealed a composite paraganglioma, with α paraganglioma and a ganglioneuroma component. Seventeen cases of extra-adrenal composite paraganglioma have been reported in the international literature so far. This case was the first one found in the area of the celiac trunk.ConclusionsComposite paragangliomas comprise rare and potentially malignant tumors with variable prognosis. Establishing their diagnosis promptly is of vital significance. Due to the first-described location of the composite paraganglioma in our case, the differential diagnosis of tumors in this area should also include composite paragangliomas.
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Affiliation(s)
- Georgios Tzikos
- 1st Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Alexandra Menni
- 1st Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
- *Correspondence: Alexandra Menni
| | - Angeliki Cheva
- Pathology Department, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Pliakos
- 1st Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Anastasia Tsakona
- Pathology Department, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stilianos Apostolidis
- 1st Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Ioannis Iakovou
- 3rd Laboratory of Nuclear Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1st Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Theodosios Papavramidis
- 1st Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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Gargan ML, Lee E, O'Sullivan M, Egan M, Gibney J, Crowther S, Conlon K, Feeney J. Imaging features of atypical adrenocortical adenomas: a radiological-pathological correlation. Br J Radiol 2022; 95:20210642. [PMID: 34735299 PMCID: PMC8722240 DOI: 10.1259/bjr.20210642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Adrenal adenomas are frequently picked up incidentally on cross-sectional imaging and are known to have a classic imaging appearance on CT and MRI. However, not all adrenal adenomas have this typical radiologic appearance. Our aim is to present the radiological features of atypical adrenocortical adenomas with pathological correlation. METHODS All the imaging from the pathologically proven adrenal adenoma cases in our hospital (Tallaght University Hospital, Dublin, Ireland) database (from 2004 to 2019) was reviewed. 8 out of 48 cases (16%) had an atypical radiological appearance and were selected for presentation. RESULTS Eight cases demonstrated atypical radiological features including heterogeneous density, incomplete washout on post-contrast imaging, the presence of macroscopic fat and calcification. Lipomatous metaplasia was present in two of the cases pathologically. CONCLUSION Adrenocortical adenomas are the most common adrenal mass encountered on CT, however, may not always have classic imaging features. Radiologists should be familiar with both the typical and atypical imaging manifestations of these benign adrenal lesions. ADVANCES IN KNOWLEDGE This paper comprehensively describes the atypical features of adrenocortical adenomas with case examples and radiologic-pathologic correlation. Guidelines and an approach to the work-up of adrenal lesions with atypical appearances are also provided.
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Affiliation(s)
| | - Eimear Lee
- Tallaght University Hospital, Dublin, Ireland
| | | | - Marie Egan
- Tallaght University Hospital, Dublin, Ireland
| | | | | | - Kevin Conlon
- Tallaght University Hospital, St. Vincent’s University Hospital, Dublin, Ireland
| | - John Feeney
- Tallaght University Hospital, Dublin, Ireland
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Niu Z, Wang J, Yang Y, He J, Wang S, Xie Z, Shao M, Zhu F. Risk prediction model establishment with tri-phasic CT image features for differential diagnosis of adrenal pheochromocytomas and lipid-poor adenomas: Grouping method. Front Endocrinol (Lausanne) 2022; 13:925577. [PMID: 36568104 PMCID: PMC9772429 DOI: 10.3389/fendo.2022.925577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The purpose of this study was to establish a risk prediction model for differential diagnosis of pheochromocytomas (PCCs) from lipid-poor adenomas (LPAs) using a grouping method based on tri-phasic CT image features. METHODS In this retrospective study, we enrolled patients that were assigned to a training set (136 PCCs and 183 LPAs) from two medical centers, along with an external independent validation set (30 PCCs and 54 LPAs) from another center. According to the attenuation values in unenhanced CT (CTu), the lesions were divided into three groups: group 1, 10 HU < CTu ≤ 25 HU; group 2, 25 HU < CTu ≤ 40 HU; and group 3, CTu > 40 HU. Quantitative and qualitative CT imaging features were calculated and evaluated. Univariate, ROC, and binary logistic regression analyses were applied to compare these features. RESULTS Cystic degeneration, CTu, and the peak value of enhancement in the arterial and venous phase (DEpeak) were independent risk factors for differential diagnosis of adrenal PCCs from LPAs. In all subjects (groups 1, 2, and 3), the model formula for the differentiation of PCCs was as follows: Y = -7.709 + 3.617*(cystic degeneration) + 0.175*(CTu ≥ 35.55 HU) + 0.068*(DEpeak ≥ 51.35 HU). ROC curves were drawn with an AUC of 0.95 (95% CI: 0.927-0.973) in the training set and 0.91 (95% CI: 0.860-0.929) in the external validation set. CONCLUSION A reliable and practical prediction model for differential diagnosis of adrenal PCCs and LPAs was established using a grouping method.
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Affiliation(s)
- Zhongfeng Niu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jian Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yang Yang
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Jie He
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Subo Wang
- Department of Radiology, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang, China
| | - Zongyu Xie
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Meihua Shao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Fangmei Zhu
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
- *Correspondence: Fangmei Zhu,
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18
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Gündoğdu E, Oğuzman M, Emekli E, Kebapçı M. Are the washout values currently accepted for lesion characterization in dedicated adrenal CT adequate for diagnosis? DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY (ANKARA, TURKEY) 2021; 27:694-702. [PMID: 34792022 DOI: 10.5152/dir.2021.20508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to investigate the accuracy of density characteristics and washout values of lesions detected on computed tomography (CT) at the cutoff values obtained from the literature by taking the pathological results of adrenalectomy specimens as reference and to determine the cutoff values of parameters evaluated on CT for the differentiation of adenoma and nonadenoma lesions in the study group. METHODS Hospital records and standard CT imaging data (noncontrast early phase [65 s] and late phase [15 min] ) of 84 patients with 87 lesions who underwent adrenalectomy between January 2012 and December 2018 were retrospectively reevaluated by two radiologists in consensus. The patients were categorized as having adenoma and nonadenoma lesions according to the pathology results. The sensitivity, specificity and diagnostic accuracy of CT parameters (density values and washout percentages) were evaluated. Differences in the CT parameters (size, noncontrast and early-late enhancement density and absolute and relative washout values) were investigated. The optimal cutoff values of CT parameters were determined by ROC analysis. RESULTS Noncontrast CT had a specificity of 87.75% and 95.9%, sensitivity of 60% and 48.6%, diagnostic accuracy of 77.7% and 89.47% for adenomas, at the cutoff values of ≤10 HU and ≤0 HU, respectively. For absolute washout value ≥ 60%, the sensitivity, specificity and accuracy were 64.7%, 52.38% and 56.75%, respectively; while these rates were 76.47%, 56.52% and 62.16%, respectively, for relative washout value ≥40%. Adenomas and nonadenomas showed significant difference in terms of size (p < 0.0001), unenhanced attenuation (p < 0.0001), relative washout (p = 0.020) and delay enhancement (p < 0.001). But there were no differences in terms of absolute washout (p = 0.230) and early enhancement (p = 0.264). The cutoff values for the differentiation of adenomas and nonadenomas were as follows: size ≤44 mm, noncontrast density <20 HU, early-phase density ≥45 HU, delayed-phase density ≤44 HU, absolute washout 74.83% and relative washout 57.76%. CONCLUSION The current washout criteria used in the differentiation of adenoma and nonadenoma lesions in dynamic CT imaging can give false negative and positive results. According to the existing criteria, the most reliable parameter in adenoma-nonadenoma differentiation is ≤ 0 HU noncontrast CT density value.
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Affiliation(s)
- Elif Gündoğdu
- Department of Radiology, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Mehmet Oğuzman
- Department of Radiology, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Emre Emekli
- Department of Radiology, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Mahmut Kebapçı
- Department of Radiology, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
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Abstract
Incidental findings are common in the evaluation of surgical patients. Understanding the appropriate assessment and management of these frequent occurrences is important for the provision of comprehensive quality care. This review details the epidemiology, considerations, and recommendations for management of common incidental manifestations in surgical patients, including Meckel diverticulum, adrenal incidentaloma, thyroid nodule, solitary pulmonary nodule, small bowel intussusception, gallstones, and incidental appendectomy.
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Affiliation(s)
- Keely Reidelberger
- University of Nebraska Medical Center College of Medicine, 986880 Nebraska Medical Center, Omaha, NE 68198-6880, USA
| | - Abbey Fingeret
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, 986880 Nebraska Medical Center, Omaha, NE 68198-6880, USA.
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Nagayama Y, Inoue T, Kato Y, Tanoue S, Kidoh M, Oda S, Nakaura T, Hirai T. Relative Enhancement Ratio of Portal Venous Phase to Unenhanced CT in the Diagnosis of Lipid-poor Adrenal Adenomas. Radiology 2021; 301:360-368. [PMID: 34463552 DOI: 10.1148/radiol.2021210231] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The development of an accurate, practical, noninvasive, and widely available diagnostic approach to characterize lipid-poor adrenal lesions (greater than 10 HU at unenhanced CT) remains an ongoing demand. Purpose To investigate whether combined assessment of unenhanced and portal venous phase CT allows for the differentiation of lipid-poor adrenal adenomas from nonadenomas. Materials and Methods Patients with lipid-poor adrenal lesions who underwent unenhanced and portal venous phase CT with a single-energy scanner between January 2016 and March 2020 were identified retrospectively. For each lesion, the unenhanced and contrast-enhanced attenuation were measured; the absolute enhancement (contrast-enhanced minus unenhanced attenuation [HU]) and relative enhancement ratio ([absolute enhancement divided by unenhanced attenuation] × 100%) were calculated. The sensitivity achieved at 95% specificity to distinguish adenomas from nonadenomas was determined with receiver operating characteristic curve analysis and compared among parameters with use of the McNemar test. Results A total of 220 patients (mean age ± standard deviation, 66 years ± 12; 134 men) with 131 lipid-poor adenomas and 89 nonadenomas were analyzed. The sensitivity (achieved at 95% specificity) of the relative enhancement ratio (86% [113 of 131 adenomas; 95% CI: 79, 92] at a threshold of >210%) was higher than that of unenhanced attenuation (50% [66 of 131 adenomas; 95% CI: 42, 59] at a threshold of ≤21 HU), contrast-enhanced attenuation (3% [four of 131 adenomas; 95% CI: 1, 8] at a threshold of >120 HU), and absolute enhancement (24% [32 of 131 adenomas; 95% CI: 17, 33] at a threshold of >74 HU; all P < .001). The sensitivities of the relative enhancement ratio were 100% (58 of 58 adenomas; 95% CI: 94, 100), 83% (52 of 63 adenomas; 95% CI: 71, 91), and 30% (three of 10 adenomas; 95% CI: 7, 65) for adenomas measuring unenhanced attenuation of more than 10 HU up to 20 HU, 21-30 HU, and more than 30 HU, respectively. Conclusion A relative enhancement ratio threshold of greater than 210%, measured at unenhanced and portal venous phase CT, accurately differentiated lipid-poor adenomas from nonadenomas, particularly for lesions with unenhanced attenuation of 10-30 HU. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Yasunori Nagayama
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Taihei Inoue
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yuki Kato
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Shota Tanoue
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Masafumi Kidoh
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Seitaro Oda
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Takeshi Nakaura
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Toshinori Hirai
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto 860-8556, Japan
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Naffouje SA, Sabesan A, Hallanger-Johnson J, Kirtane K, Gonzalez RJ, Mullinax J. Adrenal biopsy, as a diagnostic method, is associated with decreased overall survival in patients with T1/T2 adrenocortical carcinoma: A propensity score-matched analysis. J Surg Oncol 2021; 124:1261-1271. [PMID: 34424540 DOI: 10.1002/jso.26639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/01/2021] [Accepted: 07/25/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The standard diagnosis for adrenocortical carcinoma (ACC) is clinical diagnosis (CD) based on radiographic and biochemical studies. Biopsy diagnosis (BD) is seldom required for the suspicion of secondary malignancy. We aim to study the impact of BD in the context of underlying T1/T2 ACC on overall survival (OS) compared with CD. METHODS National Cancer Database (NCDB) for endocrine malignancies was utilized. Only patients with non-metastatic ACC, whose method of diagnosis and local disease extension were reported, and received a surgical adrenalectomy with curative intent were included. Patients were divided by disease stage into T1/T2, T3, and T4 groups. A propensity score match was applied to those with T1/T2 disease who received CD versus BD and the Kaplan-Meier method was used to compare OS. RESULTS In total, 4000 patients with ACC were reported in the database, 1410 met selection criteria. Eight hundred and thirty patients had T1/T2, 365 had T3, and 162 had T4 ACC. Of patients with T1/T2 ACC, 742 (89.4%) received CD versus 88 (11.6%) with BD. A propensity score was calculated per a multivariable regression model with 79 patients matched from each group. Exact matching was applied for margin status and adjuvant therapies. Kaplan-Meier analysis showed a significant difference in median OS between CD versus BD patients in the matched data set (103.89 ± 15.65 vs. 54.93 ± 8.22 months; p = 0.001). In all comers, patients with T1/T2 ACC and BD had comparable median OS to that of patients with T3 ACC (52.21 ± 9.69 vs. 36.01 ± 3.33 months; p = 0.446). CONCLUSION BD in T1/T2 ACC could be associated with disease upstaging and worse OS outcomes.
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Affiliation(s)
- Samer A Naffouje
- Department of Surgical Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Arvind Sabesan
- Department of Surgical Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Kedar Kirtane
- Head and Neck Oncology Program, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Ricardo J Gonzalez
- Sarcoma Oncology Program, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - John Mullinax
- Sarcoma Oncology Program, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
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Garay-Lechuga D, Pérez-Soto RH, Hernández-Acevedo JD, Butrón-Hernández D, Sierra-Salazar M, Pantoja-Millán JP, Herrera MF, Velázquez-Fernández D. Computed tomography (CT) scan identified necrosis, but is it a reliable single parameter for discerning between malignant and benign adrenocortical tumors? Surgery 2021; 171:104-110. [PMID: 34183180 DOI: 10.1016/j.surg.2021.04.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/20/2021] [Accepted: 04/05/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Adrenocortical carcinoma is a rare malignant tumor with a poor prognosis. Discernment of adrenocortical carcinoma in an adrenal mass through imaging studies is paramount for early surgical treatment. Recently, necrosis has been proposed as a single morphological parameter for adrenocortical carcinoma diagnosis. The aim of this study was to analyze the measures of diagnostic efficiency of necrosis and the different computed tomography-scan features related to adrenocortical carcinoma diagnosis. METHODS We conducted a case-control study of patients surgically treated for an adrenal mass with histopathological report consistent with adrenocortical carcinoma (cases) and adrenocortical adenoma (control patients) between 1987 and 2019. Radiological features on computed tomography scan were collected. Bivariate and multivariate statistical analyses were performed for the different imaging features. The measures of diagnostic efficiency for each feature were calculated. Concordance analysis between image-detected and histopathological-identified necrosis was performed. RESULTS Eighteen adrenocortical carcinoma and 41 adrenocortical adenomas were included. Differences between adrenocortical carcinoma and adrenocortical adenoma were found regarding heterogeneity (odds ratio 4.53, 95% confidence interval 2.3-8.9; P < .0001), tumor size ≥4 cm (odds ratio 3.5, 95% confidence interval 2.05-6.14; P < .0001), and attenuation index ≥10 Hounsfield units (odds ratio 1.9, 95% confidence interval 1.3-2.6; P = .001). Necrosis was the most important imaging feature significantly associated with adrenocortical carcinoma (odds ratio 35, 95% confidence interval 5.1-241.6; P < .0001), present in all adrenocortical carcinoma cases. After measures of diagnostic efficiency calculation, necrosis had the highest diagnostic accuracy (98%). Cohen's kappa for concordance between image-detected and histopathological-identified necrosis was 90.4% (P < .0001). CONCLUSION Computed tomography scan-detected necrosis is a reliable radiological feature to discern adrenocortical carcinoma from adrenocortical adenomas.
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Affiliation(s)
- Daniel Garay-Lechuga
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico.
| | - Rafael Humberto Pérez-Soto
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico. https://twitter.com/@rafaperezdr
| | - Juan David Hernández-Acevedo
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico. https://twitter.com/@reconditojp
| | - David Butrón-Hernández
- Department of Radiology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Mauricio Sierra-Salazar
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico. https://twitter.com/@DrMSierra
| | - Juan Pablo Pantoja-Millán
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Miguel F Herrera
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - David Velázquez-Fernández
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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Agrawal N, Awasthi A, Mahata R, Chakraborty PP. Continuous and progressive 'wash-in' without 'wash-out' of contrast in adrenal mass: a useful feature of ganglioneuroma. BMJ Case Rep 2021; 14:14/5/e241661. [PMID: 34011673 DOI: 10.1136/bcr-2021-241661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Computed tomography (CT) scan is a useful and widely performed diagnostic modality to evaluate adrenal masses. Nature of the mass determines the degree of attenuation both in unenhanced and in different phases of contrast enhancement. Benign neurogenic tumours like ganglioneuroma mimicks pheochromocytoma and adrenocortical carcinoma in non-contrast CT scan. The 'adrenal protocol' routinely calculates the wash-out pattern at delayed venous phase (DVP) (15 min) following contrast administration to differentiate majority of benign masses from the malignant ones. Ganglioneuromas typically exhibit continuous wash-in of contrast where enhancement gradually increases to attain its peak in DVP. Such wash-in pattern is different from the wash-out pattern observed in pheochromocytomas or adrenocortical adenomas or carcinomas. Presence of this wash-in pattern provides a useful clue to the clinician for underlying ganglioneuroma in hormonally inactive adrenal masses with suspicious morphological appearances. This wash-in pattern also effectively rules out any malignant potential of ganglioneuroma, and thus helps in preoperative decision-making.
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Affiliation(s)
- Neeti Agrawal
- Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | - Avivar Awasthi
- Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
| | - Rahin Mahata
- Endocrinology and Metabolism, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
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Kang S, Oh YL, Park SY. Distinguishing pheochromocytoma from adrenal adenoma by using modified computed tomography criteria. Abdom Radiol (NY) 2021; 46:1082-1090. [PMID: 32951125 DOI: 10.1007/s00261-020-02764-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/22/2020] [Accepted: 09/08/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the performance of modified criteria to distinguish pheochromocytoma from adrenal adenoma by using adrenal protocol computed tomography (CT). METHODS We retrospectively included consecutive 199 patients who underwent adrenal CT and surgically proven pheochromocytoma (n = 66) or adenoma (n = 133). Two independent radiologists analyzed two CT criteria for pheochromocytoma. Conventional criteria were as follows: (a) lesion attenuation on unenhanced CT > 10 Hounsfield unit (HU); (b) absolute percentage washout < 60%; and (c) relative percentage washout < 40%. Modified criteria were as follows: (a) conventional criteria or (b) one of the following findings: (i) lesion attenuation on unenhanced CT ≥ 40 HU, (ii) 1-min enhanced CT ≥ 160 HU, (iii) 15-min enhanced CT ≥ 70 HU, , or (iv) intralesional cystic degeneration seen on both 1-min and 15-min enhanced CT. We analyzed area under the curve (AUC) and inter-reader agreement. RESULTS Proportion of pheochromocytoma was 33.2% (66/199). AUC of modified criteria was consistently higher than that of conventional criteria for distinguishing pheochromocytoma from adenoma (reader 1, 0.864 versus 0.746 for raw data set and 0.865 versus 0.746 for internal validation set; reader 2, 0.872 versus 0.758 for raw data set and 0.872 versus 0.757 for internal validation set) (p < 0.05 for all comparisons). Inter-reader agreement was excellent in interpreting any criteria (weighted kappa > 0.800). CONCLUSION Our modified criteria seem to improve diagnostic performance of adrenal CT in distinguishing pheochromocytoma from adrenal adenoma.
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Eker F, Gungunes A, Durmaz S, Kisa U, Celik ZR. Nonfunctional adrenal incidentalomas may be related to bisphenol-A. Endocrine 2021; 71:459-466. [PMID: 32965630 PMCID: PMC7509496 DOI: 10.1007/s12020-020-02502-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Bisphenol-A (BPA) is an endocrine-disrupting chemical that may affect the hormones and their receptors. The aim of this study is to determine whether BPA has an effect on the development of nonfunctional adrenal incidentaloma (NFAI). METHODS Fifty patients who were admitted to endocrinology outpatient clinics and diagnosed as NFAI were included in the study. Fifty healthy people without adrenal mass and adrenal pathology in the upper abdominal computerized tomography or magnetic resonance imaging were also included as control group. Age, gender and body mass index of the study groups were similar. The serum samples for BPA were stored at -80 °C in refrigerator until working in the lab. Serum BPA levels were measured using ELISA technique. RESULTS Mean serum BPA level was 7.06 ± 3.96 ng/ml in NFAI patients and 4.79 ± 3.01 ng/ml in control group. Serum BPA level was significantly higher in NFAI group than control group (p = 0.001). Serum BPA levels were also found to be significantly higher in women with NFAI than in men with NFAI (p = 0.019). CONCLUSIONS The mechanisms of NFAI development have not been clarified yet. Increased BPA exposure with developed industrialization may play a role in NFAI formation. For the reduction of BPA exposure, the use of plastic prepacked products, plastic containers, and safety measures are essential for public health.
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Affiliation(s)
- Fatih Eker
- Department of Internal Medicine, Çanakkale Yenice State Hospital, Çanakkale, Turkey
| | - Askin Gungunes
- Department of Endocrinology and Metabolic Diseases, Kirikkale University, School of Medicine, Kirikkale, Turkey.
| | - Senay Durmaz
- Department of Endocrinology and Metabolic Diseases, Kirikkale University, School of Medicine, Kirikkale, Turkey
| | - Ucler Kisa
- Department of Biochemistry, Kirikkale University, School of Medicine, Kirikkale, Turkey
| | - Zeynep Rumeysa Celik
- Department of Biochemistry, Kirikkale University, School of Medicine, Kirikkale, Turkey
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Reginelli A, Vacca G, Belfiore M, Sangiovanni A, Nardone V, Vanzulli A, Grassi R, Cappabianca S. Pitfalls and differential diagnosis on adrenal lesions: current concepts in CT/MR imaging: a narrative review. Gland Surg 2021; 9:2331-2342. [PMID: 33447584 DOI: 10.21037/gs-20-559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The purpose of this pictorial essay is to review the imaging findings of adrenal lesions. Adrenal lesions could be divided into functioning or non-functioning masses, primary or metastatic, and benign or malignant. Imaging techniques have undergone significant advances in recent years. The most significant objective of adrenal imaging is represented by the detection and, when possible, characterization of adrenal lesions in order to direct patient management correctly. The detection and management of adrenal lesions is based on cross-sectional imaging obtained with non-contrast CT (tumour density), contrast-enhanced CT including delayed washout (either absolute percentage washout or relative percentage one) and finally with MR chemical shift analysis (loss of signal intensity between in-phase and out-of-phase images including both qualitative and quantitative estimates of signal loss). The small incidental adrenal nodules are benign, in most of cases; some tumors such as lipid-rich adenoma and myelolipoma have characteristic features that can be diagnosed accurately in CT. On contrary, if the presenting contrast-enhanced CT shows an adrenal mass with uncertain or malignant morphologic features, particularly in patients with a known history of malignancy, further evaluations should be considered. The most significative implications for radiologists are represented by how to assess risk of malignancy on imaging and what follow-up to indicate if an adrenal incidentaloma is not surgically removed.
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Affiliation(s)
- Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Giovanna Vacca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mariapaola Belfiore
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Angelo Sangiovanni
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Valerio Nardone
- Unit of Radiation Oncology, Ospedale del Mare, Naples, Italy
| | - Angelo Vanzulli
- Department of Radiology, University "La Statale" of Milan, Milan, Italy
| | - Roberto Grassi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
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Baral N, Bansal R, Basyal B, Lee W, Kulkarni K, Kantorovich V, Sharma M. Nonseminomatous Germ-Cell Tumor Presenting as Bilateral Adrenal Masses. AACE Clin Case Rep 2020; 7:43-46. [PMID: 33851019 PMCID: PMC7924156 DOI: 10.1016/j.aace.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective Many tumors can metastasize to the adrenal glands, making the diagnosis of adrenal masses challenging. Awareness that rare primary tumors can metastasize to the adrenals and consideration of biopsy for their diagnosis, sometimes at extra-adrenal sites, is essential to prevent unnecessary adrenalectomies and facilitate the right treatment. We report a rare case of bilateral adrenal masses due to metastasis from a nonseminomatous germ-cell tumor of a retroperitoneal lymph node origin. Methods The diagnosis of the adrenal masses from the nonseminomatous germ-cell tumor of a retroperitoneal lymph node origin was based on a retroperitoneal lymph node core biopsy. An initial core biopsy of the adrenal gland revealed necrotic tissue and inflammatory cells without evidence of malignancy. Due to nondiagnostic findings, the core biopsy was repeated, which showed degenerating cells with a high mitotic index and immunohistochemical staining positive for vimentin, suggesting the possibility of a high-grade sarcoma. A retroperitoneal lymph node biopsy was performed. The patient was started on chemotherapy. Results A 34-year-old man presented with acute left upper-abdominal pain of 2 weeks and tenderness on the left upper quadrant of the abdomen, and he was found to have bilateral adrenal masses. Laboratory results showed the following: adrenocorticotropic hormone 41 pg/mL (7-69 pg/mL), metanephrine <0.1 nmol/L (0-0.49 nmol/L), normetanephrine 0.99 nmol/L (0-0.89 nmol/L), and morning cortisol 3.1 μg/dL after a 1-mg dexamethasone-suppression test. His dehydroepiandrosterone sulfate level was 62 μg/dL (120-520 μg/dL), and 17OH progesterone level was 36 ng/dL (<138 ng/dL); androstenedione and serum estradiol levels were normal. Laboratory tests for tumor markers revealed the following: testosterone 21 ng/dL (241-827 ng/dL), prostate-specific antigen 0.57 ng/mL (0-4 ng/mL), alpha-fetoprotein 1.9 IU/mL (0.6-6 IU/ml), and beta-human chorionic gonadotropin 134 mIU/mL (0-1 mIU/mL). Conclusion We report a rare case of rapidly progressing adrenal masses in a young man, found to have metastasized from nonseminomatous germ-cell tumors. Histopathologic confirmation of the metastatic tumor was done, which prevented unnecessary adrenalectomy. The patient received appropriate chemotherapy.
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Affiliation(s)
- Neelam Baral
- Department of Endocrinology, Georgetown University, Washington, District of Columbia
| | - Rashika Bansal
- Department of Endocrinology, National Institutes of Health, Bethesda, Maryland
- Address correspondence and reprint requests to Dr Rashika Bansal, Adult Endocrine Fellow, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bldg 10 CRC, Rm 7C-432A, 10 Center Drive, Bethesda, MD 20892.
| | - Binaya Basyal
- Department of Cardiology, Georgetown University, Washington, District of Columbia
| | - Wen Lee
- Department of Pathology, Medstar Georgetown University, Washington, District of Columbia
| | - Kanchan Kulkarni
- Department of Nuclear Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
| | | | - Meeta Sharma
- Department of Endocrinology, Medstar Washington Hospital Center, Washington, District of Columbia
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Savoie PH, Murez T, Fléchon A, Rocher L, Ferretti L, Morel-Journel N, Camparo P, Méjean A. [French ccAFU guidelines - update 2020-2022: malignancy assessment of an adrenal incidentaloma]. Prog Urol 2020; 30:S331-S352. [PMID: 33349429 DOI: 10.1016/s1166-7087(20)30756-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION - The objective of this publication is to recall the initial oncological management of adrenal incidentalomas. MATERIAL & METHODS - The multidisciplinary working group updated french urological guidelines established by the CCAFU in 2018, based on an exhaustive literature review carried out on PubMed. RESULTS - Although the majority of the adrenal masses are benign and non-functional, it is important to investigate them, as a percentage of these can cause serious endocrine diseases or be cancers. Malignant adrenal tumors are mainly represented by Adrenocortical Carcinomas (ACC), malignant pheochromocytomas (MPC) and adrenal metastases (AM). The malignancy assessment of an adrenal incident includes a complete history, a physical examination, a biochemical / hormonal assessment to look for subclinical hormonal secretion. Diagnostic hypotheses are sometimes available at this stage, but it is the morphological and functional imaging and the histological analysis which will make it possible to close the malignancy assessment and make the oncological diagnosis. CONCLUSIONS - AC and MPC are mainly sporadic but a hereditary origin is always possible. ACC is suspected preoperatively but the diagnosis of certainty is histological. The diagnosis of MPC is more delicate and is based on clinic, biology and imagery. The diagnosis of certainty of AM requires a percutaneous biopsy. At the end, the files must be discussed within the COMETE - adrenal cancer network (Appendix 1).
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Affiliation(s)
- P-H Savoie
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800 Toulon Cedex 09, France.
| | - T Murez
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; service d'urologie et de transplantation rénale, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier Cedex 5, France
| | - A Fléchon
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - L Rocher
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, AP-HP, 157 rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - L Ferretti
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle 203, route de Toulouse, 33401 Talence, France
| | - N Morel-Journel
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite
| | - P Camparo
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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Sherlock M, Scarsbrook A, Abbas A, Fraser S, Limumpornpetch P, Dineen R, Stewart PM. Adrenal Incidentaloma. Endocr Rev 2020; 41:bnaa008. [PMID: 32266384 PMCID: PMC7431180 DOI: 10.1210/endrev/bnaa008] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 04/06/2020] [Indexed: 12/14/2022]
Abstract
An adrenal incidentaloma is now established as a common endocrine diagnosis that requires a multidisciplinary approach for effective management. The majority of patients can be reassured and discharged, but a personalized approach based upon image analysis, endocrine workup, and clinical symptoms and signs are required in every case. Adrenocortical carcinoma remains a real concern but is restricted to <2% of all cases. Functional adrenal incidentaloma lesions are commoner (but still probably <10% of total) and the greatest challenge remains the diagnosis and optimum management of autonomous cortisol secretion. Modern-day surgery has improved outcomes and novel radiological and urinary biomarkers will improve early detection and patient stratification in future years to come.
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Affiliation(s)
- Mark Sherlock
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Andrew Scarsbrook
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - Afroze Abbas
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - Sheila Fraser
- Department of Endocrine Surgery, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - Padiporn Limumpornpetch
- Faculty of Medicine & Health, University of Leeds, Worsley Building, Clarendon Way, Leeds, UK
| | - Rosemary Dineen
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul M Stewart
- Faculty of Medicine & Health, University of Leeds, Worsley Building, Clarendon Way, Leeds, UK
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Akbulut S, Erten O, Kahramangil B, Gokceimam M, Kim YS, Li P, Remer EM, Berber E. A Critical Analysis of Computed Tomography Washout in Lipid-Poor Adrenal Incidentalomas. Ann Surg Oncol 2020; 28:2756-2762. [PMID: 33210268 DOI: 10.1245/s10434-020-09329-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/22/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Contrast-enhanced computed tomography (CT) with washout has emerged as an option to distinguish lipid-poor adenomas from non-adenomas. OBJECTIVE The aim of this study was to assess the utility of CT washout in characterizing indeterminate lipid-poor adrenal incidentalomas. METHODS From an Institutional Review Board-approved database, patients with adrenal incidentalomas who had adrenal protocol CT scans with a 15-min washout between 2003 and 2019 were identified. Non-contrast CT attenuation and washout patterns of different tumor types were compared. RESULTS Overall, 156 patients with 175 adrenal lesions were included. Average tumor size was 3.0 cm, non-contrast CT density was 24.7 Hounsfield units (HU), and absolute washout was 52.6%. In 102 lesions (58.3%), CT washout was ≥ 60%; 94 (92.2%) of these were benign adrenocortical adenomas, 7 (6.9%) were pheochromocytomas, and 1 (0.9%) was an adrenal hematoma. Furthermore, in 73 tumors (41.7%), CT washout was < 60%; diagnosis was benign adrenocortical adenoma in 45 (61.6%) lesions, pheochromocytoma in 8 (11%) lesions, metastasis in 9 (12.3%) lesions, adrenocortical cancer in 6 (8.2%) lesions, and 'others' in 5 (6.9%) lesions. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of > 60% absolute CT washout for detecting an adrenal adenoma was 67.6%, 77.8%, 92.2%, 38.4%, and 69.7%, respectively. CONCLUSION CT washout should be incorporated into the management algorithm of indeterminate adrenal incidentalomas with a high non-contrast CT attenuation to 'rule-in' benign tumors. For small tumors with mild elevation of plasma metanephrines, it should be kept in mind that adenomas and pheochromocytomas may have similar imaging and washout characteristics.
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Affiliation(s)
- Serkan Akbulut
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
| | - Ozgun Erten
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
| | - Bora Kahramangil
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
| | - Mehmet Gokceimam
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
| | - Yoo Seok Kim
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
| | - Pengpeng Li
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA
| | - Erick M Remer
- Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA.
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Abstract
Primary aldosteronism remains a leading cause of secondary hypertension, and its diagnosis and management continue to pose a challenge for clinicians. In this article, we review the diagnosis of primary aldosteronism along with its cardiovascular manifestations. Treatment is described depending on the diagnostic outcome, focusing on medical management with mineralocorticoid receptor antagonists and unilateral adrenalectomy. Although screening and diagnosing hyperaldosteronism follows well-known algorithms, in practice, physicians may find difficulty establishing the best course of action due to complexity in testing and confirming laterality of aldosterone production by the adrenals. Recognizing and treating primary aldosteronism requires a multidisciplinary approach with primary care physicians, cardiologists, endocrinologists, and radiologists working collaboratively.
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Asymptomatic and Biochemically Silent Pheochromocytoma with Characteristic Findings on Imaging. Case Rep Endocrinol 2020; 2020:8847261. [PMID: 33062351 PMCID: PMC7533747 DOI: 10.1155/2020/8847261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/12/2020] [Indexed: 01/09/2023] Open
Abstract
Pheochromocytomas are tumors that originate from the chromaffin tissue of the adrenal medulla and commonly produce catecholamines. The diagnosis is typically established by the measurement of catecholamines or their metabolites in urine or plasma, and tumors are localized with the use of radiographic and scintigraphic studies. Pheochromocytomas can occur in asymptomatic patients, and the preferred treatment is surgical removal of the tumor. We report a 48-year-old male with a left adrenal incidentaloma, which progressively increased in size from 1.1 cm to 2.6 cm over a 4-year period, as measured by an adrenal computed tomography (CT) scan. Throughout his entire course of treatment, he was asymptomatic with normal blood pressure readings. His biochemical screening was unremarkable for the first three years of tumor surveillance. Follow-up imaging, including CT and MRI, showed findings suspicious for pheochromocytoma, and the diagnosis was ultimately made with the combination of imaging and laboratory studies. He underwent laparoscopic resection of the adrenal mass with confirmation of pheochromocytoma on histology. This case illustrates how CT and MRI findings can alert providers to the presence of a pheochromocytoma, even in an asymptomatic, biochemically negative patient.
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Olson MC, Vietti Violi N, Taouli B, Venkatesh SK. Abbreviated Magnetic Resonance Imaging Protocols in the Abdomen and Pelvis. Magn Reson Imaging Clin N Am 2020; 28:381-394. [PMID: 32624156 DOI: 10.1016/j.mric.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In recent decades, the clinical applications for which magnetic resonance (MR) imaging is routinely used have expanded exponentially. MR imaging protocols have become increasingly complex, adversely affecting image acquisition and interpretation times. The MR imaging workflow has become a prime target for process improvement initiatives. There has been growing interest in the cultivation of abbreviated MR imaging protocols that evaluate specific clinical questions while reducing cost and increasing access. The overarching goal is to streamline the MR imaging workflow and reduce the time needed to obtain and report examinations by eliminating duplicative or unnecessary sequences without sacrificing diagnostic accuracy.
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Affiliation(s)
- Michael C Olson
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Naïk Vietti Violi
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA; Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne 1011, Switzerland
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sudhakar Kundapur Venkatesh
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Abstract
OBJECTIVE The aim of this study was to analyze the incidence of and risk factors for adrenocortical carcinoma (ACC) in adrenal incidentaloma (AI). SUMMARY OF BACKGROUND DATA AI guidelines are based on data obtained with old-generation imaging and predominantly use tumor size to stratify risk for ACC. There is a need to analyze the incidence and risk factors from a contemporary series. METHODS This is a retrospective review of 2219 AIs that were either surgically removed or nonoperatively monitored for ≥12 months between 2000 and 2017. Multivariate logistic regression was performed to define risk factors. ROC curves constructed to determine optimal size and attenuation cut-offs for ACC. RESULTS 16.8% of AIs underwent upfront surgery and rest initial nonoperative management. Of conservatively managed patients, an additional 7.7% subsequently required adrenalectomy. Overall, ACC incidence in AI was 1.7%. ACC rates by size were 0.1%, 2.4%, and 19.5% for AIs of <4, 4 to 6, and >6 cm, respectively. The optimal size cut-off for ACC in AI was 4.6 cm. ACC risks by Hounsfield density were 0%, 0.5%, and 6.3% for lesions of <10, 10 to 20, and >20 HU, with an optimal cut-off of 20 HU to diagnose ACC. 15.5% of all AIs and 19.2% of ACCs were hormonally active. Male sex, large tumor size, high Hounsfield density, and >0.6 cm/year growth were independent risk factors for ACC. CONCLUSION This contemporary analysis demonstrates that ACC risk per size in AI is less than previously reported. Given these findings, modern management of AIs should not be based just on size, but a combination of thorough hormonal evaluation and imaging characteristics.
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Gruber LM, Strajina V, Bancos I, Murad MH, Dy BM, Young WF, Farley DR, Lyden ML, Thompson GB, McKenzie TJ. Not all adrenal incidentalomas require biochemical testing to exclude pheochromocytoma: Mayo clinic experience and a meta-analysis. Gland Surg 2020; 9:362-371. [PMID: 32420260 DOI: 10.21037/gs.2020.03.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Excluding a pheochromocytoma is important when a patient presents with an incidentally discovered adrenal mass. However, biochemical testing for pheochromocytoma can be cumbersome, time consuming, or falsely positive. Our objective was to determine if unenhanced computed tomography (CT) imaging alone can be used to rule out pheochromocytoma. Methods We performed a retrospective study of all patients with a pathologically confirmed pheochromocytoma and unenhanced CT imaging who were treated at the Mayo Clinic between 1998 and 2016. Additionally, we performed a systematic review and meta-analysis of original studies published after 2005 with patients who had adrenal masses, more than 10 patients with pheochromocytomas, and reported attenuation on unenhanced CT imaging in Hounsfield units (HU). Results In the Mayo cohort, we identified 186 patients and 199 pheochromocytomas with unenhanced CT imaging. The mean unenhanced CT attenuation was 35±9 HU (range, 15-62), and only 15 tumors had attenuation ≤20 HU. The systematic review identified 26 studies (1,217 tumors), and 23 studies provided a mean unenhanced CT attenuation. The overall mean unenhanced CT attenuation across the studies was 35.6 HU (95% CI, 22.0-49.1 HU). A cutoff of >10 HU had a 100% sensitivity (95% CI, 1.00-1.00) for pheochromocytoma with low heterogeneity between the 21 qualified studies (I2=0%). Sensitivity for pheochromocytoma was 100% and 99% for an unenhanced CT attenuation cutoff of >15 and >20 HU. Conclusions Biochemical testing may not be required to exclude pheochromocytoma if an incidental adrenal mass has low attenuation (<10 HU) on unenhanced CT images.
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Affiliation(s)
- Lucinda M Gruber
- Division of Endocrinology, Metabolism, Nutrition & Diabetes, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Veljko Strajina
- Department of Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Irina Bancos
- Division of Endocrinology, Metabolism, Nutrition & Diabetes, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - M Hassan Murad
- Evidence Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Benzon M Dy
- Department of Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - William F Young
- Division of Endocrinology, Metabolism, Nutrition & Diabetes, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - David R Farley
- Department of Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Melanie L Lyden
- Department of Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Geoffrey B Thompson
- Department of Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Travis J McKenzie
- Department of Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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Meyrignac O, Arcis É, Delchier MC, Mokrane FZ, Darcourt J, Rousseau H, Bouhanick B. Impact of cone beam - CT on adrenal vein sampling in primary aldosteronism. Eur J Radiol 2020; 124:108792. [DOI: 10.1016/j.ejrad.2019.108792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/20/2019] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
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Abstract
Pheochromocytomas are rare neuroendocrine tumors. Extra-adrenal lesions arising from the autonomic neural ganglia are termed paraganglioma. Clinical symptoms are common between the adrenal and extra-adrenal forms and are determined by excess secretion of catecholamines. Hypertension is a critical and often dramatic feature of pheochromocytoma/paraganglioma, and its most prevalent reported symptom. However, given the rare occurrence of this cancer, in patients undergoing screening for hypertension, the prevalence ranges from 0.1% to 0.6%. Still, patients frequently come to the attention of endocrinologist when pheochromocytoma/paraganglioma is suspected as a secondary cause of hypertension. This article summarizes current clinical approaches in patients with pheochromocytoma/paraganglioma.
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Affiliation(s)
- Sergei G Tevosian
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, 1600 Southwest Archer Road, Suite H-2, Gainesville, FL 32608, USA
| | - Hans K Ghayee
- Department of Medicine, Division of Endocrinology, University of Florida, Malcom Randall VA Medical Center, Gainesville, FL 32610, USA.
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Savoie PH, Murez T, Fléchon A, Sèbe P, Rocher L, Camparo P, Morel-Journel N, Ferretti L, Méjean A. [French ccAFU guidelines - Update 2018-2020: Adrenal cancer]. Prog Urol 2019; 28 Suppl 1:R177-R195. [PMID: 31610872 DOI: 10.1016/j.purol.2019.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To update French oncology guidelines concerning adrenal cancer. METHODS Comprehensive Medline search between 2016 and 2018 upon diagnosis, treatment and follow-up of adrenal cancer to update 2013 guidelines. Level of evidence was evaluated according to AGREE-II. RESULTS Adrenal cancers are mainly represented by adrenocortical carcinomas (AC), malignant pheochromocytomas (MPC) and adrenal metastases (AM). Medical background of these tumors is either the exploration of hormonal or tumor symptoms, or an adrenal incidentaloma. Etiological explorations are based on hormonal biochemical assessment, morphological and functional imaging and histological analysis. AC and MPC are mostly sporadic but hereditary origin is still possible. The suspicion of AC is driven mainly by radiological signs of malignancy, signs of local invasion or distant metastasis, and type of hormonal secretion but the accurate diagnosis is histological. The diagnosis of MPC is clinical, biological and radiological. The diagnosis of MS involves a percutaneous biopsy. Medical files for primitive adrenal cancer should be discussed within the COMETE - Adrenal Cancer Network (Appendix 1). Oncological adjuvant treatments are specific for the histological type. In the AC, their indication depends on the risk of recurrence and is based on mitotane, external radiotherapy or chemotherapy. In the MPC, it is based on internal radiotherapy and chemotherapy. Metastatic forms treatment is exceptionally surgical. Debulking is uncommon. For metastatic unresectable AC, treatment is based on mitotane monotherapy or triple chemotherapy. For metastatic unresectable MPC, treatment is based on exclusive metabolic radiotherapy or triple chemotherapy. Recurrences are frequent and sometimes delayed, which justifies a close and long follow-up. CONCLUSION The curative treatment of Adrenal cancers is surgical provided. This treatment is rarely sufficient alone, the prognosis is then pejorative.
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Affiliation(s)
- P-H Savoie
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France.
| | - T Murez
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
| | - A Fléchon
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
| | - P Sèbe
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, groupe hospitalier Diaconesses Croix Saint Simon, 125, rue d'Avron, 75020 Paris, France.
| | - L Rocher
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, HU Paris Sud, site Kremlin-Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France.
| | - P Camparo
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre de pathologie, 51, rue de Jeanne-D'Arc, 80000 Amiens, France.
| | - N Morel-Journel
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, centre hospitalier Lyon Sud (Pierre Bénite), HCL groupement hospitalier du Sud, 69495 Pierre Bénite cedex, France.
| | - L Ferretti
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, MSP de Bordeaux-Bagatelle, 203, route de Toulouse, BP 50048, 33401 Talence cedex, France.
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France.
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Buitenwerf E, Berends AMA, van Asselt ADI, Korteweg T, Greuter MJW, Veeger NJM, Links TP, Dullaart RPF, Kerstens MN. Diagnostic Accuracy of Computed Tomography to Exclude Pheochromocytoma: A Systematic Review, Meta-analysis, and Cost Analysis. Mayo Clin Proc 2019; 94:2040-2052. [PMID: 31515105 DOI: 10.1016/j.mayocp.2019.03.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/26/2019] [Accepted: 03/07/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To assess the diagnostic accuracy of unenhanced computed tomography (CT) attenuation values to exclude a pheochromocytoma in the diagnostic work-up of patients with an adrenal incidentaloma and to model the associated difference in diagnostic costs. METHODS The MEDLINE and Embase databases were searched from indexing to September 27, 2018, and studies reporting the proportion of pheochromocytomas on either side of the 10-Hounsfield unit (HU) threshold on unenhanced CT were included. The pooled proportion of pheochromocytomas with an attenuation value greater than 10 HU was determined, as were the modeled financial costs of the current and alternative diagnostic approaches. RESULTS Of 2957 studies identified, 31 were included (N=1167 pheochromocytomas). Overall risk of bias was low. Heterogeneity was not observed between studies (Q=11.5, P=.99, I2=0%). The pooled proportion of patients with attenuation values greater than 10 HU was 0.990 (95% CI, 0.984-0.995). The modeled financial costs using the new diagnostic approach were €55 (∼$63) lower per patient. CONCLUSION Pheochromocytomas can be reliably ruled out in the case of an adrenal lesion with an unenhanced CT attenuation value of 10 HU or less. Therefore, determination of metanephrine levels can be restricted to adrenal tumors with an unenhanced CT attenuation value greater than 10 HU. Implementing this novel diagnostic strategy is cost-saving.
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Affiliation(s)
- Edward Buitenwerf
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, the Netherlands.
| | - Annika M A Berends
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Antoinette D I van Asselt
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Tijmen Korteweg
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marcel J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nic J M Veeger
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Thera P Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Robin P F Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Michiel N Kerstens
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, the Netherlands
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Ctvrtlik F, Tudos Z, Szasz P, Sedlackova Z, Hartmann I, Schovanek J, Frysak Z, Macova I, Zelinka T, Hora M, Kocova E, Pacovsky J, Krsek M, Lehotska V, Mojtova E, Molnar J, Vanek V, Pacak K, Baxa J. Characteristic CT features of pheochromocytomas - probability model calculation tool based on a multicentric study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 163:212-219. [PMID: 31544898 DOI: 10.5507/bp.2019.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/09/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The aim of the study was to evaluate the CT features of adrenal tumors in an effort to identify features specific to pheochromocytomas and second, to define a feasible probability calculation model. METHODS This multicentric retrospective study included patients from the period 2003 to 2017 with an appropriate CT examination and a histological diagnosis of an adrenal adenoma, pheochromocytoma, adrenocortical carcinoma, or metastasis. In total, 346 patients were suitable for the CT image analysis, which included evaluation of the largest diameter, the shape of the lesion, the presence of central necrosis and its margins, and the presence of an enhancing peripheral rim ("ring sign"). RESULTS Pheochromocytomas have a significantly more spherical shape (P<0.001), whereas an elliptical shape significantly reduces the probability of a pheochromocytoma (odds ratio = 0.015), as does another shape (odds ratio = 0.006). A "ring sign" is also more frequent in pheochromocytomas compared to other adrenal tumors (P=0.001, odds ratio = 6.49). A sharp necrosis also increases the probability of a pheochromocytoma more than unsharp necrosis (odds ratio 231.6 vs. 20.2). The probability calculation model created on the basis of the results confirms a high sensitivity and specificity (80% and 95%). CONCLUSION This study confirms the value of anatomical features in the assessment of adrenal masses with the ability to significantly improve the identification of pheochromocytomas. Advanced assessment of the tumor shape was defined and a original comprehensive calculating tool of the pheochromocytoma probability was created on the basis of the results presented here and could be used in clinical routine.
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Affiliation(s)
- Filip Ctvrtlik
- Department of Radiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Zbynek Tudos
- Department of Radiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Paulina Szasz
- Department of Radiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Zuzana Sedlackova
- Department of Radiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Igor Hartmann
- Department of Urology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Jan Schovanek
- Department of Internal Medicine III - Nephrology, Rheumatology, and Endocrinology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Zdenek Frysak
- Department of Internal Medicine III - Nephrology, Rheumatology, and Endocrinology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Iva Macova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Zelinka
- Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Milan Hora
- Department of Urology, Faculty Hospital Pilsen and Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Eva Kocova
- Department of Radiology, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
| | - Jaroslav Pacovsky
- Department of Urology, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
| | - Michal Krsek
- Second Department of Internal Medicine, Third Faculty of Medicine, Charles University and Royal Vinohrady Teaching Hospital, Prague, Czech Republic
| | - Viera Lehotska
- Second Radiology Department, Faculty of Medicine, Comenius University in Bratislava and St. Elizabeth Cancer Institute, Bratislava, Slovakia
| | - Emilia Mojtova
- Department of Endocrinology, Slovak Medical University and St. Elizabeth Cancer Institute, Bratislava, Slovakia
| | - Josef Molnar
- Department of Algebra and Geometry, Faculty of Science, Palacky University Olomouc, Czech Republic
| | - Vladimir Vanek
- Department of Algebra and Geometry, Faculty of Science, Palacky University Olomouc, Czech Republic
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jan Baxa
- Department of Imaging Methods, University Hospital Pilsen and Faculty of Medicine in Pilsen, Charles University, Czech Republic
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Abstract
OBJECTIVES The aim of this study was to present up to date information concerning the diagnosis and treatment of primary aldosteronism (PA). PA is the most common cause of endocrine hypertension. It has been reported up to 24% of selective referred hypertensive patients. METHODS We did a search in Pub-Med and Google Scholar using the terms: PA, hyperaldosteronism, idiopathic adrenal hyperplasia, diagnosis of PA, mineralocorticoid receptor antagonists, adrenalectomy, and surgery. We also did cross-referencing search with the above terms. We had divided our study into five sections: Introduction, Diagnosis, Genetics, Treatment, and Conclusions. We present our results in a question and answer fashion in order to make reading more interesting. RESULTS PA should be searched in all high-risk populations. The gold standard for diagnosis PA is the plasma aldosterone/plasma renin ratio (ARR). If this test is positive, then we proceed with one of the four confirmatory tests. If positive, then we proceed with a localizing technique like adrenal vein sampling (AVS) and CT scan. If the lesion is unilateral, after proper preoperative preparation, we proceed, in adrenalectomy. If the lesion is bilateral or the patient refuses or is not fit for surgery, we treat them with mineralocorticoid receptor antagonists, usually spironolactone. CONCLUSIONS Primary aldosteronism is the most common and a treatable case of secondary hypertension. Only patients with unilateral adrenal diseases are eligible for surgery, while patients with bilateral and non-surgically correctable PA are usually treated by mineralocorticoid receptor antagonist (MRA). Thus, the distinction between unilateral and bilateral aldosterone hypersecretion is crucial.
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Dietrich CF, Correas JM, Dong Y, Nolsoe C, Westerway SC, Jenssen C. WFUMB position paper on the management incidental findings: adrenal incidentaloma. Ultrasonography 2019; 39:11-21. [PMID: 31786909 PMCID: PMC6920619 DOI: 10.14366/usg.19029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/09/2019] [Indexed: 12/26/2022] Open
Abstract
Focal lesions of the adrenal glands are incidentally detected in approximately 5% of cases by modern imaging techniques. Fewer than 5% of these adrenal incidentalomas are malignant and approximately 10% have endocrine activity. Reliable differentiation of malignant versus benign and hormonally active versus nonfunctional adrenal incidentalomas significantly influences therapeutic management and the outcome of affected individuals. Therefore, each adrenal incidentaloma should undergo a standardized diagnostic work-up to exclude malignancy and endocrine activity. This position statement of the World Federation of Ultrasound in Medicine and Biology (WFUMB) summarizes the available evidence on the management of adrenal incidentaloma and describes efficient management strategies with particular reference to the role of ultrasound techniques.
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Affiliation(s)
- Christoph F Dietrich
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany.,Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Yi Dong
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany.,Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Christian Nolsoe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Copenhagen, Denmark
| | | | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen and Brandenburg Institute for Clinical Ultrasound, Neuruppin, Germany
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Goroshi M, Jadhav SS, Sarathi V, Lila AR, Patil VA, Shah R, Hira P, Sharma R, Goroshi S, Fernandes G, Rojekar A, Dalvi A, Bakshi G, Prakash G, Shah NS, Bandgar TR. Radiological differentiation of phaeochromocytoma from other malignant adrenal masses: importance of wash-in characteristics on multiphase CECT. Endocr Connect 2019; 8:898-905. [PMID: 31252396 PMCID: PMC6599213 DOI: 10.1530/ec-19-0198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 06/05/2019] [Indexed: 12/14/2022]
Abstract
RATIONALE AND INTRODUCTION To evaluate the computerised tomography (CT) characteristics of phaeochromocytoma (PCC) that differentiate them from other non-benign adrenal masses such as adrenocortical carcinoma (ACC), primary adrenal lymphoma (PAL) and adrenal metastases (AM). METHODS This retrospective study was conducted at a tertiary health care institute from Western India. Patients presented between January 2013 and August 2016 with histological diagnosis of PCC or other non-benign adrenal mass having adequate reviewable imaging data comprising all four CECT phases were included. RESULTS The study cohort consisted of 72 adrenal masses from 66 patients (33 PCC, 22 ACC, 4 PAL, 13 AM). Unlike other masses, majority of PCC (25/33) showed peak enhancement in early arterial phase (EAP). PCC had significantly higher attenuation in EAP and early venous phase (EVP), and higher calculated percentage arterial enhancement (PAE) and percentage venous enhancement (PVE) than other adrenal masses (P < 0.001). For diagnosis of PCC with 100% specificity, PAE value ≥100% and EAP attenuation ≥100 HU had 78.8 and 63.6% sensitivity respectively. ACC were significantly larger in size as compared to PCC and metastasis. The adreniform shape was exclusively found in PAL (two out of four) and AM (4 out of 13). None of the enhancement, wash-in or washout characteristics were discriminatory among ACC, PAL and AM. CONCLUSION Peak enhancement in EAP, PAE value ≥100% and EAP attenuation ≥100 HU differentiate PCC from other malignant adrenal masses with high specificity.
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Affiliation(s)
| | - Swati S Jadhav
- Jawaharlal Nehru Medical College, Belagavi, India
- Correspondence should be addressed to S S Jadhav:
| | - Vijaya Sarathi
- Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | | | | | | | - Priya Hira
- Department of Radiology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India
| | - Rajaram Sharma
- Department of Radiology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India
| | - Shettepppa Goroshi
- Department of Radiology, Sri Nijalingappa Medical College Bagalkot, Navanagar, Karnataka, India
| | - Gwendolyn Fernandes
- Department of Pathology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India
| | - Amey Rojekar
- Department of Pathology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India
| | - Abhay Dalvi
- Departments of General Surgery, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India
| | - Ganesh Bakshi
- Department of Uro-Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gagan Prakash
- Department of Uro-Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Mohamed RE, Abodewan KAEW, Amin MA. Diagnostic value of delayed washout rate of contrast-enhanced multi-detector computed tomography in adrenal incidentalomas. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2013.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Chen J, Liu C, Liu C, Fu Q, Pei D, Ren L, Yan H. Anesthetic management of gigantic pheochromocytoma resection with inferior vena cava and right atrium tumor thrombosis: a case report. BMC Anesthesiol 2019; 19:71. [PMID: 31077157 PMCID: PMC6511210 DOI: 10.1186/s12871-019-0742-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/23/2019] [Indexed: 01/21/2023] Open
Abstract
Background This report describes one case of anesthetic management about surgical resection of a malignant phaeochromocytoma with tumor extension into vena cava and right atrium in a patient. Report for anesthetic management is limited in these patients under surgical resection until now. Case presentation In September 2015, a 24-year-old male presented to the department of cardiology with right flank pain and hypertensive urgency in our hospital. Contrast-enhanced CT abdomen and MRI abdomen revealed a mass phaeochromocytoma in right adrenal, which invaded the right inferior vena cava(IVC)wall along with IVC thrombus. Echocardiography shown no abnormal detection. Finally, this patient gave up the surgical resection of phaeochromocytoma and chose the expectant treatment. In April 2018, this patient once again presented to the emergence department in our hospital, he had experienced persistent cough and intermittent wheezing for 5 h. Contrast-enhanced CT and echocardiography shown existing IVC thrombus had extended into the right atrium. After the careful preoperative preparation, adrenalectomy with complete thrombus excision by inferior vena cava exploration and right atriotomy were performed successfully by a multidisciplinary team. After one month post-operation care, this patient healthily left our hospital. Conclusion To the best of our knowledge, the occurrence of pheochromocytoma with IVC and right atrium thrombosis has not been reported in mainland China so far. This clinical case may supply a rare reference experience for surgical treatment and anesthetic management in the group of phaeochromocytoma patient with distance vascular extension.
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Affiliation(s)
- Jingli Chen
- Department of Anaesthesia, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Caihua Liu
- Department of Anaesthesia, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Chang Liu
- Department of Anaesthesia, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Quanyuan Fu
- Department of Anaesthesia, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Dingwei Pei
- Department of Anaesthesia, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Linyun Ren
- Department of Anaesthesia, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Hong Yan
- Department of Anaesthesia, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China.
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Abstract
Given the frequent use of cross-sectional imaging in medicine, adrenal masses are discovered at an increasing rate. Once detected, it is critical to ensure the patient undergoes the appropriate biochemical/hormonal workup to rule out any aberrant activity and ensure imaging features do not raise suspicion for a malignant neoplasm. Patients with hormonal overactivity, concerning size, and/or imaging characteristics must be referred for surgical consideration. For those not requiring adrenalectomy, it is important to determine which patients mandate follow-up to ensure no further growth or development of hormonal production. It is also critical to understand what is the appropriate follow-up.
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Siraj M, Tolofari S, Yow L, Sinclair A, Javed S, Mukherjee R, Bell R, Lynch N, Counsell A, Pollard A, Lewis P, Adeyoju A. ‘Adrenal incidentalomas’; Rationalising assessment in the urology multi-disciplinary team meeting. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818808893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The combination of an aging population and the continual technological advances in modern imaging techniques have contributed to the increased detection of asymptomatic incidental lesions. The definition of an adrenal ‘incidentaloma’ is an asymptomatic lesion (⩾1 cm) detected on imaging following a suspected alternative primary diagnosis. The majority of these adrenal incidentalomas, may be benign and non-functioning, however, a proportion of these lesions may be either malignant or ‘hyperfunctioning’ (hormone-producing). As such, these incidental and asymptomatic lesions can provide the urologist with a diagnostic dilemma. In this article we aim to review the current literature with reference to common clinical scenarios often encountered as part of the urology multi-disciplinary team meeting. The overall aim is to rationalise and standardise an approach to these often challenging scenarios.
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Affiliation(s)
| | | | - Lina Yow
- Glan Clwyd District General Hospital, UK
| | | | - Saqib Javed
- Royal Liverpool and Broadgreen NHS Foundation Trust, UK
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Can Adrenal Adenomas Be Differentiated From Adrenal Metastases at Single-Phase Contrast-Enhanced CT? AJR Am J Roentgenol 2018; 211:1044-1050. [DOI: 10.2214/ajr.17.19276] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Thomas AJ, Habra MA, Bhosale PR, Qayyum AA, Ahmed K, Vicens R, Elsayes KM. Interobserver agreement in distinguishing large adrenal adenomas and adrenocortical carcinomas on computed tomography. Abdom Radiol (NY) 2018; 43:3101-3108. [PMID: 29671009 DOI: 10.1007/s00261-018-1603-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Large adrenal masses pose a diagnostic dilemma. The purpose of this study was twofold: first, to assess the degree of interobserver agreement in evaluating the morphology of pathologically proven adrenal adenomas and adrenocortical carcinomas larger than 4 cm in diameter; and second, to identify morphologic characteristics that correlated with the pathologic diagnosis. MATERIALS AND METHODS For this blinded, retrospective study, we collected cases of 25 adrenal adenomas and 33 adrenocortical carcinomas measuring larger than 4 cm. Two radiologists evaluated morphologic characteristics of the lesions on CT. Interobserver agreement was evaluated using kappa statistics, and the correlation of imaging characteristics with the diagnosis was evaluated using a logistic regression model. RESULTS We found the highest interobserver agreement in the assessment of precontrast attenuation (Κ = 0.81) as well as substantial agreement in determining the shape and the presence of calcifications (Κ = 0.69 and 0.74, respectively). Readers agreed less often regarding the presence of fat (Κ = 0.48), as well as regarding the presence of necrosis, heterogeneity, and the overall impression (Κ = 0.15, 0.24, and 0.26, respectively). CT characteristics correlated with benignity included round shape (p = 0.02), an overall radiologic impression of a benign lesion (p < 0.0001), the presence of fat (p = 0.01), and a precontrast attenuation of less than 10 Hounsfield units (p < 0.0001). The latter two of these characteristics were highly specific for benign pathology (93% and 100%, respectively). CONCLUSION Our study suggests that CT has the ability to consistently identify characteristics significantly correlated with benign vs. malignant adrenal tumors.
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Affiliation(s)
- Aaron J Thomas
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Mouhammed A Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priya R Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aliya A Qayyum
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kareem Ahmed
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rafael Vicens
- Department of Radiology, Hospital Auxilio Mutuo, San Juan, PR, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Savoie PH, Murez T, Fléchon A, Sèbe P, Rocher L, Camparo P, Morel-Journel N, Ferretti L, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU — Actualisation 2018—2020 : tumeur de la surrénale French ccAFU guidelines — Update 2018—2020: Adrenal cancer. Prog Urol 2018; 28:S175-S193. [PMID: 30473001 DOI: 10.1016/j.purol.2018.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.011.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the doi:10.1016/j.purol.2019.01.011.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- P-H Savoie
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800, Toulon cedex 09, France.
| | - T Murez
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie et transplantation rénale, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295, Montpellier cedex 5, France
| | - A Fléchon
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69008, Lyon, France
| | - P Sèbe
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, groupe hospitalier Diaconesses Croix Saint Simon, 125, rue d'Avron, 75020, Paris, France
| | - L Rocher
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service de radiologie, HU Paris Sud, site Kremlin-Bicêtre, AP-HP, 94270, Le Kremlin-Bicêtre, France
| | - P Camparo
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Centre de pathologie, 51, rue de Jeanne-D'Arc, 80000, Amiens, France
| | - N Morel-Journel
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, centre hospitalier Lyon Sud (Pierre Bénite), HCL groupement hospitalier du Sud, 69495, Pierre Bénite cedex, France
| | - L Ferretti
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, MSP de Bordeaux-Bagatelle, 203, route de Toulouse, BP 50048, 33401, Talence cedex, France
| | - A Méjean
- Service d'urologie, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800, Toulon cedex 09, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015, Paris, France
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