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Calissendorff J, Juhlin CC, Sundin A, Bancos I, Falhammar H. Adrenal cysts: an emerging condition. Nat Rev Endocrinol 2023:10.1038/s41574-023-00835-2. [PMID: 37095252 DOI: 10.1038/s41574-023-00835-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 04/26/2023]
Abstract
Adrenal cysts are rare lesions representing approximately 1-2% of adrenal incidentalomas. The majority of these rare lesions are benign. Rarely, phaeochromocytomas and adrenal malignant masses can present as cystic lesions and can occasionally be difficult to distinguish from benign cysts. Histologically, adrenal cysts are subdivided into pseudocysts, endothelial cysts, epithelial cysts and parasitic cysts. The radiological appearance of an adrenal cyst is generally similar to that of cysts in the kidney. They are thus well demarcated, usually rounded, with a thin wall and homogenous internal structure, low attenuating (<20 Hounsfield Units) on CT, low signalling on T1-weighted MRI sequences and high signalling on T2-weighted MRI sequences, and anechoic or hypoechoic on ultrasonography. Benign adrenal cysts have a slight female predominance and are usually diagnosed between the ages of 40 and 60. Most adrenal cysts are asymptomatic and are detected incidentally, although very large adrenal cysts can lead to mass effect symptoms, with surgery required to alleviate the symptoms. Thus, conservative management is usually recommended for asymptomatic cysts. However, when uncertainty exists regarding the benign nature of the cyst, additional work-up or follow-up is needed. The management of an adrenal cyst should preferably be discussed at an adrenal multidisciplinary team meeting.
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Affiliation(s)
- Jan Calissendorff
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Sundin
- Department of Surgical Sciences, Radiology & Molecular Imaging, Uppsala University, Uppsala, Sweden
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Rani M, Garg R, Agraharabachalli Nanjunde VD, Rajput R. Addison's disease with primary hypothyroidism in a case of visceral leishmaniasis and HIV coinfection. BMJ Case Rep 2021; 14:14/3/e238488. [PMID: 33674291 PMCID: PMC7939011 DOI: 10.1136/bcr-2020-238488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 41-year-old man presented with vomiting and loose stools. He had a history of long-term intermittent fever, generalised skin hyperpigmentation, dragging sensation in the left hypochondrium and unintentional weight loss. He was receiving combination antiretroviral therapy since 2010 for HIV infection. He also received antitubercular therapy for tuberculous spondylitis. During the hospital stay, he was found to have postural hypotension, hypoglycaemia, hyponatraemia, hyperkalaemia, pancytopenia, hypothyroidism, hyperglobulinaemia and hypoalbuminaemia with reversal of serum albumin/globulin ratio. The morning plasma cortisol was lower than normal and could not be appropriately stimulated after the Synacthen test. The bone marrow histopathology was suggestive of visceral leishmaniasis. He was diagnosed as a case of visceral leishmaniasis and HIV coinfection with primary adrenal insufficiency (Addison's disease) and primary hypothyroidism, as a rare and unusual presentation.
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Affiliation(s)
- Monu Rani
- Department of Endocrinology and Medicine, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Rakesh Garg
- Department of Endocrinology and Medicine, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | | | - Rajesh Rajput
- Department of Endocrinology and Medicine, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
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Schwing A, Pomares C, Majoor A, Boyer L, Marty P, Michel G. Leishmania infection: Misdiagnosis as cancer and tumor-promoting potential. Acta Trop 2019; 197:104855. [PMID: 30529443 DOI: 10.1016/j.actatropica.2018.12.010] [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: 10/18/2018] [Revised: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 12/17/2022]
Abstract
Given the prevalence of cancer and leishmaniasis worldwide, the presence of these two pathologies in the same tissue sample may be merely fortuitous. The clinical outcome of both diseases is under the control of innate and adaptive immunity, and in both cases these progressive diseases are characterized by an impaired host Th1 response. As a consequence, the Th2 cytokine microenvironment occurring in progressive leishmaniasis may potentially promote tumor cell proliferation and vice versa. On the other hand, clinical aspects of subclinical cutaneous or visceral leishmaniasis sometimes closely resemble those observed in various neoplasms thus leading to misdiagnosis. In this review, we present recent findings on the association between leishmaniasis and malignant disorders. Our review includes HIV positive, HIV negative subjects and patients whose HIV status has not been established. Leishmaniasis mimicking a malignant disorder was confirmed and extended to unreported neoplastic disorders including squamous cell carcinoma, T-cell and B-cell lymphoma, oral and intranasal tumors and granulomas. Thus, leishmaniasis should be considered in the differential diagnosis and course of various cancers in Leishmania endemic areas or in patients with travel history to these areas. We also listed recent reports showing that Leishmania can promote cancer development in immunocompromised as well as in immunocompetent patients. The potential mechanisms supporting this promoting effect are discussed.
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Almenara Escribano MD, García Gómez MJ, Soto Hurtado EJ. Mediastinal cystic mass as atypical location of visceral leishmaniasis. Med Clin (Barc) 2018; 151:379-380. [PMID: 29398008 DOI: 10.1016/j.medcli.2017.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/04/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
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Association d’un syndrome lymphoprolifératif et d’une leishmaniose viscérale après transplantation rénale. Nephrol Ther 2011; 7:488-93. [DOI: 10.1016/j.nephro.2011.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 01/28/2011] [Accepted: 01/31/2011] [Indexed: 11/20/2022]
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Chandra S, Ruhela D, Deb A, Vishwakarma RA. Glycobiology of theLeishmaniaparasite and emerging targets for antileishmanial drug discovery. Expert Opin Ther Targets 2010; 14:739-57. [DOI: 10.1517/14728222.2010.495125] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kopterides P, Mourtzoukou EG, Skopelitis E, Tsavaris N, Falagas ME. Aspects of the association between leishmaniasis and malignant disorders. Trans R Soc Trop Med Hyg 2007; 101:1181-9. [PMID: 17870139 DOI: 10.1016/j.trstmh.2007.08.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 08/06/2007] [Accepted: 08/06/2007] [Indexed: 11/15/2022] Open
Abstract
Given the prevalence of leishmaniasis and cancer, the co-existence of these two diseases may be merely coincidental. However, a number of epidemiological, experimental and laboratory studies suggest that an association between these two entities does exist. The aim of this review is to summarise the occurrence of leishmaniasis as an opportunistic infection associated with malignant disorders and to present the available literature potentially linking this infection with the development of cancerous lesions. We searched electronic databases and evaluated 37 studies involving 44 patients. Four different types of association between leishmaniasis and cancer were established: leishmaniasis mimicking a malignant disorder, such as lymphoma; leishmaniasis arising as a difficult to diagnose and treat infection among patients receiving chemotherapy for various malignant disorders; simultaneous diagnosis of leishmaniasis and a neoplastic disorder in the same tissue samples of immunocompromised patients; and direct involvement of Leishmania spp. in the pathogenesis/occurrence of malignant lesions, especially of the skin and mucous membranes. The main conclusion of this review is that leishmaniasis can directly or indirectly affect the presentation, diagnosis and course of various malignant disorders and it should be considered in the differential diagnosis of malignancies in geographic areas where it is endemic and/or in patients with travel history to these areas.
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Affiliation(s)
- Petros Kopterides
- Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Department of Pathophysiology, Oncology Unit, Laiko General Hospital, University of Athens, School of Medicine, Athens, Greece
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Perciaccante A, Fiorentini A, Ora J, Paris A, Serra P. A case of pancytopenia and splenomegaly: haematological disease? Intern Emerg Med 2007; 2:238-42. [PMID: 17909697 PMCID: PMC7101627 DOI: 10.1007/s11739-007-0069-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 10/30/2006] [Indexed: 12/05/2022]
Affiliation(s)
- A. Perciaccante
- III Clinica Medica Department of Clinical Medicine, University “La Sapienza”, Viale dell’Universita 37, I-00185 Rome, Italy
| | - A. Fiorentini
- III Clinica Medica Department of Clinical Medicine, University “La Sapienza”, Viale dell’Universita 37, I-00185 Rome, Italy
| | - J. Ora
- III Clinica Medica Department of Clinical Medicine, University “La Sapienza”, Viale dell’Universita 37, I-00185 Rome, Italy
| | - A. Paris
- III Clinica Medica Department of Clinical Medicine, University “La Sapienza”, Viale dell’Universita 37, I-00185 Rome, Italy
| | - P. Serra
- III Clinica Medica Department of Clinical Medicine, University “La Sapienza”, Viale dell’Universita 37, I-00185 Rome, Italy
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Paolo WF, Nosanchuk JD. Adrenal infections. Int J Infect Dis 2006; 10:343-53. [PMID: 16483815 PMCID: PMC7110804 DOI: 10.1016/j.ijid.2005.08.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Revised: 08/01/2005] [Accepted: 08/08/2005] [Indexed: 11/18/2022] Open
Abstract
Adrenal infections are an important but under-recognized clinical entity. The adrenal gland can be infected by a myriad of pathogens including fungi, viruses, parasites, and bacteria. Infection can directly or indirectly cause tissue damage and alteration in endocrine function. Direct damage occurs via microbial replication and local production of toxic compounds, such as endotoxins. Indirect damage results from alterations in the regulation of a host's immunologic and endocrine mediators in response to damage by a microbe at a distant site. Variations in pathogen tropism, adrenal anatomy, and host immune integrity contribute to the progression of active disease and discernable adrenal dysfunction. Early recognition and intervention in the case of adrenal infection can significantly improve outcome, demonstrating the need for increased clinical suspicion in the appropriate clinical setting.
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Schmid H, Mussack T, Wörnle M, Pietrzyk MC, Banas B. Clinical Management of Large Adrenal Cystic Lesions. Int Urol Nephrol 2005; 37:767-71. [PMID: 16362596 DOI: 10.1007/s11255-005-4662-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The widespread use of ultrasonography and computed tomography has resulted in an increased diagnosis of large sized adrenal cysts with diameters of more than 5 cm. Most of these adrenal cystic lesions are clinically silent and are therefore often diagnosed incidentally. Since up to 7% of adrenal cysts are malignant, a careful hormonal, morpho-functional and instrumental evaluation is mandatory. In particular, functioning adrenal carcinomas or pheochromocytomas have to be ruled out. Fine needle aspiration cytology as well as examination of a punch biopsy specimen of the cystic wall are of limited value, as there is considerable overlap in cytologic and histologic features of benign and malignant adrenal cystic lesions. Immediate surgical excision is indicated in the presence of symptoms, suspicion of malignancy, increase in the size or detection of a functioning adrenal cyst. En bloc adrenalectomy, preferably by a laparoscopic approach, has become the treatment of choice.
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Affiliation(s)
- Holger Schmid
- Medizinische Poliklinik, Universität München, Pettenkoferstrasse 8a, D-80336, Munich, Germany.
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Lal TG, Kaulback KR, Bombonati A, Palazzo JP, Jeffrey RB, Weigel RJ. Surgical Management of Adrenal Cysts. Am Surg 2003. [DOI: 10.1177/000313480306900917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Adrenal cysts are rare and are often found incidentally during abdominal imaging for another reason. We describe two cases of adrenal cysts, one of which was found to be a cystic pheochromocytoma. Most cystic pheochromocytomas are not diagnosed by urinary screening studies, and the first indication of a pheochromocytoma may be hemodynamic instability during resection. We review the literature on adrenal cysts and make recommendations for the management of cystic adrenal masses.
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Affiliation(s)
- Tanmay G. Lal
- From the Departments of Surgery and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kris R. Kaulback
- From the Departments of Surgery and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alessandro Bombonati
- Departments of Pathology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Juan P. Palazzo
- Departments of Pathology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Ronald J. Weigel
- From the Departments of Surgery and Thomas Jefferson University, Philadelphia, Pennsylvania
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