Adrenal Cystic Lesions: A Clinicopathological Analysis of 25 Cases with Proposed Histogenesis and Review of the Literature

Abstract

Adrenal cystic lesions are uncommon and we analyzed clinical and pathologic features of 25 such cases from a single institute over 23 years. There were 16 pseudocysts, eight endothelial cysts, and one epithelial cyst. Seven of eight endothelial cysts were confirmed to be lymphangiomatous by D2-40 immunostaining. We suggest that pseudocysts and endothelial cysts may have different histogenesis. The proposed mesothelial origin of adrenal epithelial cyst cannot be confirmed in our example. Seven adrenal pseudocysts were associated with tumor, including two pheochromocytomas, one neuroblastoma, one adrenal cortical carcinoma, one adrenal cortical adenoma, one myelolipoma, and one schwannoma. The distinction of true cystic lesion from cystic neoplasm is important and requires thorough sampling of the specimens.

Clinicopathologic Analysis and Surgical Outcome of Adrenal Lesions- A Single Centre Experience

“…endothelial cysts (most common), 45%; epithelial cysts, 9%; pseudocyst/haemorrhagic, 39% and parasitic cysts, 7%. 12,13 The prevalence of cystic adrenal lesions in our series is higher (29.2%) as compared to other reported series. In addition, pseudocyst was the most common adrenal cystic lesion (50%).…”

Adrenal Gland Lymphangiomas

“…The majority of these articles were single case reports. It is noteworthy that 15 cases were reported in two Indian J Surg (December 2015) 77(Suppl 3):S1334-S1342 articles, one by Ellis et al [2] (nine cases) and the other by Chien et al [34] (six cases). Berthet et al [15] mentioned three cases; however, one of the described patients was previously reported by the same authors [40].…”

“…It is remarkable that 15 ALs were diagnosed incidentally, as patients were presented with unrelated or no complaints. Laboratory findings in six ALs cases showed hormones over secretion [10,17,25,26,33,34]. The detected hormones were catecholamines, aldosterone, cortisol, and iodocholesterol.…”

“…To date, ALs have been characterized mostly as incidentalomas (56.52 %) and rarely as adrenal adenomas [2,26,36], pheochromocytomas [2,29,33], or adrenal cysts [2,5,7]. Moreover, five ALs have been characterized as nonadrenal lesions [2,14,15,17,34]. Accurate diagnosis for all ALs was made postoperatively by pathology reports.…”

Regressive changes in phaeochromocytomas and paroxysmal hypertension

“…One of possible result is a formation of posthaemorrhagic psuedocyst, while another is fibrosis and hyalinization, repeatedly spreading outside the adrenals into surrounding tissues, which makes the surgery even more difficult [13]. Despite the occurrence of advanced posthaemorrhagic regressive changes, which were frequently very intense in the studied group, in all the cases phaechromocytoma was proved in pathological examination.…”