A Giant Adrenal Pseudocyst Mimicking an Adrenal Cancer: Case Report and Review of the Literature

Abstract

Adrenal pseudocysts are rare lesions that develop within the adrenal glands, generally from vessel ectasia or from degenerative adenomas or hematomas. They are usually non-functional and asymptomatic. The reported potential malignant transformation of an adrenal cyst is ca. 7% and indicates radical excision of these masses. We report the case of a 69-year-old man with hypertension, chronic obstructive pulmonary disease, and obesity in whom microscopic hematuria was detected during a routine examination performed by his family doctor. To investigate the cause of this microscopic hematuria, the patient underwent computed tomography of the abdomen, which showed a well-defined 12-cm lesion of the left adrenal gland with calcification and necrotic components that was compressing the left kidney, pancreas, and spleen. Suspecting adrenal carcinoma, after preoperative staging, a left subcostal laparotomy was performed, with resection of the left adrenal gland, a splenectomy, and resection of the pancreatic tail. The histology showed an adrenal pseudocyst with a fibrous capsule containing amorphous eosinophilic material with calcification and cholesterol crystals. The patient's postoperative course was uneventful, and he was discharged 12 days after surgery.

Adrenal pseudocyst mimicking a malignant tumor of the adrenal gland, about a case

“…It is noted that 7% of all pseudocysts are malignant or potentially malignant and this risk increases with size, especially when it exceeds 6 cm. 3,5 Most pseudocysts are asymptomatic, but in the case of a large pseudocyst the symptoms are due to the compression of the adjacent organs. 2,5 Thus, the three most frequent clinical manifestations are: abdominal pain, gastrointestinal symptoms (nausea and vomiting) and palpable mass.…”

“…1 The cystic lesions of the adrenal gland are scarce with an estimated incidence of 0.064 to 0.18%. [1][2][3][4] They can shift from malignant cystic tumors to pseudoscystics that represent 38 to 80% of all the adrenal cystic. 3,5 Moreover, there are only 130 pseudocysts that have been reported in literature so far.…”

“…[1][2][3][4] They can shift from malignant cystic tumors to pseudoscystics that represent 38 to 80% of all the adrenal cystic. 3,5 Moreover, there are only 130 pseudocysts that have been reported in literature so far. 1 We report a patient's case followed up for "adrenal incidentalomas", operated because of the tumor's size and the radiological suspicion of the malignancy.…”

“…1,4,5 When surgery is proposed, laparoscopy is preferred to laparotomy regardless of the size of the tumor. 3 Surgery may not be necessary if the lesions are labeled as small benign cystic lesions (<4cm), and the patient can benefit from simple monitoring, which will be done by CT every 3months for a period of 18months. Beyond this, no radiological monitoring is discussed.…”

“…Beyond this, no radiological monitoring is discussed. 1,3,5 Percutaneous puncture is reserved for small or recurrent cysts, as it exposes the risk of recurrence. 1,2 In summary, Adrenal pseudocysts are a rare finding.…”