1
|
Iijima H, Noda T, Uchida K, Hakamata Y, Fujisaki A, Imai S, Otsuki Y, Yoneda T. A case of adrenal lymphangioma successfully treated with laparoscopic partial adrenalectomy. IJU Case Rep 2023; 6:341-344. [PMID: 37928276 PMCID: PMC10622198 DOI: 10.1002/iju5.12618] [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: 03/07/2023] [Accepted: 07/26/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Adrenal lymphangioma is a rare benign tumor of lymphatic origin, usually incidentally detected from various imaging studies taken for an unrelated purpose. We present a case of a right adrenal lymphangioma treated successfully with surgical intervention. Case presentation A 36-year-old previously healthy woman was referred to our urology department for a right adrenal mass, discovered during a routine health checkup. The tumor had no endocrinological activity, and the patient opted for surgical resection following a concern for malignancy. A laparoscopic right partial adrenalectomy was performed, and on histological examination, the tumor was diagnosed as right adrenal lymphangioma. Conclusion Adrenal lymphangiomas lack disease specific radiological characteristics that allow for a definitive diagnosis from imaging alone. To rule out tumors of potentially malignant nature, surgical intervention should be considered.
Collapse
Affiliation(s)
- Heisuke Iijima
- Department of Urology Seirei Hamamatsu General Hospital Shizuoka Japan
| | - Taisho Noda
- Department of Urology Seirei Hamamatsu General Hospital Shizuoka Japan
| | - Kosuke Uchida
- Department of Urology Seirei Hamamatsu General Hospital Shizuoka Japan
| | - Yasuhiro Hakamata
- Department of Urology Seirei Hamamatsu General Hospital Shizuoka Japan
| | - Akira Fujisaki
- Department of Urology Seirei Hamamatsu General Hospital Shizuoka Japan
| | - Shin Imai
- Department of Urology Seirei Hamamatsu General Hospital Shizuoka Japan
| | - Yoshiro Otsuki
- Department of Pathology Seirei Hamamatsu General Hospital Shizuoka Japan
| | - Tatsuaki Yoneda
- Department of Urology Seirei Hamamatsu General Hospital Shizuoka Japan
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Yu N, Du J, Zheng G, Zheng Y. Giant Adrenal Cyst: A Case Report. Cureus 2023; 15:e37086. [PMID: 37153235 PMCID: PMC10159221 DOI: 10.7759/cureus.37086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
Giant adrenal cysts are rare lesions, most often discovered incidentally. In this case report, a patient presenting with nonspecific abdominal distension is described. Imaging studies revealed a vast cystic mass closely attached to the left adrenal gland. Neither routine laboratory tests nor endocrine function tests revealed abnormalities. By performing open surgery, the cystic mass was completely removed. According to the pathological results, the wall of the cystic mass has an endothelial structure and some vascular components. Comprehensive analysis indicated that this case was an angiomatous adrenal endothelial cyst which was an extremely uncommon form of an adrenal cyst. Over a one-year follow-up, no evidence of recurrence was observed in the patient postoperatively. Through this case, we wish to raise awareness of this disease.
Collapse
|
4
|
Gubbiotti MA, LiVolsi V, Montone K, Baloch Z. A Cyst-ematic Analysis of the Adrenal Gland: A Compilation of Primary Cystic Lesions From Our Institution and Review of the Literature. Am J Clin Pathol 2022; 157:531-539. [PMID: 34596217 DOI: 10.1093/ajcp/aqab156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/12/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Although primary adrenal lesions and metastases are most commonly encountered, de novo cysts of the adrenal gland can occasionally occur. METHODS We analyzed the pathology archives at the Hospital of the University of Pennsylvania for diagnoses of cystic lesions of the adrenal gland between 1998 and 2020. Patient demographics and clinical information were extracted, and pathology slides and stains, as appropriate, were analyzed. The literature between 1998 and 2020 was also searched for large case series involving cystic adrenal lesions. RESULTS We found 18 cystic lesions of the adrenal gland in our archives, categorized as pseudocysts (7), endothelial cysts (5), mesothelial cysts (2), mature teratoma (1), cystic adrenal cortical adenoma (1), cystic pheochromocytoma (1), and cystic metastasis (1). The mean age at time of diagnosis was 52.3 years, and the mean size of the cysts was 6.0 cm. There was a slight female predilection, and cysts were more likely to be found on the left side. All lesions were incidental findings. The cystic metastasis was clear cell renal cell carcinoma. Our findings were also compared with those found in the literature published within the same timeframe. CONCLUSIONS Adrenal cysts are rare entities. Our findings are concordant with other large studies and provide additional cases to the existing literature. In addition, our literature search expands the possible differential diagnoses for cystic lesions arising in the adrenal gland.
Collapse
Affiliation(s)
| | - Virginia LiVolsi
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kathleen Montone
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Zubair Baloch
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
5
|
Marques-Piubelli ML, Gonzales EWP, Gonçalves VL, Balancin ML, Botelho MLA, Yamauchi FI, de Mello Ando S, Brondani VB, Chambo JL, Fragoso MCBV, Zerbini MCN. Adrenal cysts of lymphatic origin: A clinical and pathological study of six cases and systematic literature review. Ann Diagn Pathol 2022; 57:151888. [DOI: 10.1016/j.anndiagpath.2021.151888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 12/15/2021] [Accepted: 12/26/2021] [Indexed: 11/27/2022]
|
6
|
Infected adrenal pseudocyst mimicking a duodenal duplication cyst. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2019.101362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
7
|
Trujillo Díaz JJ, Ferreras García C, Romero de Diego A, González-Obeso E, Beltrán de Heredia Y Rentería JP. Giant adrenal adenoma with hemorrhagic cystic degeneration. Cir Esp 2019; 97:539-541. [PMID: 30777257 DOI: 10.1016/j.ciresp.2019.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 11/17/2022]
Affiliation(s)
| | - Carlos Ferreras García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Alejandro Romero de Diego
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Elvira González-Obeso
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | | |
Collapse
|
8
|
An Unusual Presentation of Idiopathic Lymphatic Cyst of the Thigh. Case Rep Surg 2019; 2018:1930207. [PMID: 30652044 PMCID: PMC6311866 DOI: 10.1155/2018/1930207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/18/2018] [Indexed: 12/15/2022] Open
Abstract
Lymphatic cyst is a collection of lymphatic fluid with an epithelial lining which can either represent lymphatic malformations or may occur after trauma or operation. Idiopathic lymphatic cyst of the thigh in adulthood is extremely rare. We report a case of a 27-year-old Thai female presented with a rapidly growing mass over her right thigh. The magnetic resonance imaging scan demonstrated a well-defined, thin rim, enhancing simple cyst. The cyst disappeared for a few days after aspiration. Completed surgical resection was performed for definitive diagnosis and treatment. Immunohistochemical studies revealed the cell lining was positive for CD34, CD31, and D2-40 and negative for calretinin. To our best knowledge, idiopathic lymphatic cyst of the thigh in young adult has never been reported and should be kept in mind in the patient who presents with abnormal thigh mass.
Collapse
|
9
|
Olaoye IO, Adesina MD, Afolayan EA. A giant adrenal cyst with an uncertain preoperative diagnosis causing a dilemma in management. Clin Case Rep 2018; 6:1074-1076. [PMID: 29881567 PMCID: PMC5986023 DOI: 10.1002/ccr3.1519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 02/10/2018] [Accepted: 03/08/2018] [Indexed: 11/06/2022] Open
Abstract
Giant Adrenal cysts are rare differentials of retroperitoneal cysts that often present dilemma in diagnosis. A man presented with a huge retroperitoneal cyst and an uncertain preoperative diagnosis. Initial working diagnosis of urinoma and an attempt at drainage had to be abandoned for complete excision before obtaining a histological diagnosis.
Collapse
|
10
|
Sargar KM, Khanna G, Hulett Bowling R. Imaging of Nonmalignant Adrenal Lesions in Children. Radiographics 2018; 37:1648-1664. [PMID: 29019745 DOI: 10.1148/rg.2017170043] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The adrenal glands in children can be affected by a variety of benign lesions. The diagnosis of adrenal lesions can be challenging, but assessment of morphologic changes in correlation with the clinical presentation can lead to an accurate diagnosis. These lesions can be classified by their cause: congenital (eg, discoid adrenal gland, horseshoe adrenal gland, and epithelial cysts), vascular and/or traumatic (eg, adrenal hemorrhage), infectious (eg, granulomatous diseases), enzyme deficiency disorders (eg, congenital adrenal hyperplasia [CAH] and Wolman disease), benign neoplasms (eg, pheochromocytomas, ganglioneuromas, adrenal adenomas, and myelolipomas), and adrenal mass mimics (eg, extralobar sequestration and extramedullary hematopoiesis). Multimodality cross-sectional imaging helps to define the origin, extent, and relationship of these lesions to adjacent structures, as well as to guide treatment management. The anatomic and functional imaging modalities used to evaluate pediatric adrenal lesions include ultrasonography, computed tomography (CT), magnetic resonance imaging, and iodine 123 metaiodobenzylguanidine scintigraphy. Identifying the imaging features of nonmalignant adrenal lesions is helpful to distinguish these lesions from malignant adrenal neoplasms. Identifying characteristic imaging findings (eg, enlarged adrenal glands, with cerebriform surface, and stippled echogenicity in CAH; a T2-hyperintense mass with avid contrast enhancement in pheochromocytoma; low CT attenuation [<10 HU] and signal intensity drop on opposed-phase chemical shift images in adenoma; and enhancing suprarenal mass supplied by a systemic feeding artery in extralobar sequestration) can aid in making the correct diagnosis. In addition, clinical features (eg, ambiguous genitalia in CAH and hypertension in pheochromocytoma) can also guide the radiologist toward the correct diagnosis. ©RSNA, 2017.
Collapse
Affiliation(s)
- Kiran M Sargar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110
| | - Geetika Khanna
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110
| | - Rebecca Hulett Bowling
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110
| |
Collapse
|