Adrenal tumour bigger than 5 cm — what could it be? An analysis of 139 cases

Abstract

Introduction: There is an increasing number of adrenal being tumours discovered incidentally during imaging examinations performed for many different indications. Radiological findings suggesting adrenal pathology may be caused by true adrenal tumours or by other retroperitoneal masses. Generally, the larger the tumour, the higher the possibility of adrenal cancer. Material and methods: Analysis of our data -139 operations performed over 11 years (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) in patients with tumours in the adrenal area larger than 5 cm. Results: The most common finding was adrenal cancer (25.2%), benign adenoma (24.5%), pheochromocytoma (12.9%), and metastatic cancer (10.1%). In total, there were 19 various histopathological diagnoses in this group. Conclusion: Although adrenal cancer is the most likely diagnosis in large adrenal tumours, a broad spectrum of various adrenal and retroperitoneal tumours with size more than 5 cm can be found in such patients. (Endokrynol Pol 2017; 68 (4): 411-415)

Clinical analysis of adrenal lesions larger than 5 cm in diameter (an analysis of 251 cases)

“…Adrenal tumors are occasionally found in patients undergoing abdominal radiology, and the prevalence of such findings increased with increasing age [13, 14]. Generally, the larger the tumor, the greater possibility of adrenal cancer [3–6]; therefore, it was even recommended that a tumor size greater than 5 cm should be considered an additional criterion for surgical treatment of adrenal incidental tumors [15]. For this reason, we decided to analyze tumors of this size to provide experience and basis for preoperative differentiation and selection of appropriate treatment approaches of LATs.…”

“…However, large adrenal tumors (LATs) are considered uncommon, with an incidence ranging from 8.6 to 38.6% [1, 2]. The possibility of malignancy increases with the increasing tumor volume [3–6]. For LATs, accurate preoperative assessments of the nature and origin of the tumors are important to the choice of therapy [7–9].…”

“…By definition, LATs range in size from more than 5 to 10 cm in diameter, with a consensus of approximately 5 cm [3, 10]. LATs cover a spectrum of various pathologies, ranging from benign lesions to adrenocortical carcinoma or metastasis.…”

“…LATs cover a spectrum of various pathologies, ranging from benign lesions to adrenocortical carcinoma or metastasis. Among 19 histopathological diagnoses, the most common was found to be adrenal cancer, followed by benign adenomas, pheochromocytomas, and metastasis [3]. The prognosis of different pathological types of LATs was found to differ.…”

“…Accurate diagnosis and functional evaluation of LATs and preoperative differentiation of benign and malignant tumors have great significance for the selection of appropriate treatment approaches. Functional adrenal tumors and local invading lesions require more preoperative preparation [3] and may even affect the choice of surgical approach [7]. Because the possibility of an uncomplete curative resection with the laparoscopic adrenalectomy, open adrenalectomy is indicated in some cases [12].…”