Association between Tumor Size and Malignancy Risk in Hormonally Inactive Adrenal Incidentalomas

Abstract

Introduction Adrenal incidentalomas (AI) are adrenal masses that are discovered during radiological examinations conducted for other reasons. In this study, we focused on the pathological and radiological properties of nonfunctional AI(NFAI) and the association with malignancy risk in our clinical series. Methods A total of 186 patients underwent adrenalectomy between 2010 and 2017; of these, 76 (40.8%) patients with non-functional AI were included in the current study. The radiological and pathologic characteristics of these AIs were retrospectively analyzed to determine the malignancy rate. Results There were 22 (28.9%) male and 54 (71.1%) female patients with nonfunctional AI included in this study. The median age was 55 (range: 24-85) years. Of the patients included, 37 (48.6%) had AI on the left and 39 (51.3%) had AI on the right adrenal gland. Sixty-one (80.2%) cases were treated laparoscopically, four (5.3%) required conversion to open surgery due to intraoperative difficulties such as bleeding and adhesions, and 11 (14.4%) were managed with open adrenalectomy. The rate of malignancy in the tumors with diameters of <4 cm, 4-6 cm, and >6 cm was found to be 0%, 2.9%, and 13.6%, respectively. Conclusions Determining the ideal cutoff value for surgical indication in an NFAI is challenging. Besides the malignancy risk, the rate of silent pheochromacytomas must be taken into account in the surgical decision.

Adrenocortical Carcinoma: Updates of Clinical and Pathological Features after Renewed World Health Organisation Classification and Pathology Staging

“…Adrenal incidentalomas are common endocrine diagnoses which are adrenal masses that are discovered during radiological examination conducted for other reasons [ 190 ]. Often, they should be monitored in terms of radiological characteristics, clinical features, and functional levels.…”

“…On the other hand, ACC accounts for less than 2% of adrenal incidentalomas [ 5 , 193 ]. The rate of malignancy depends on size of the tumour [ 190 ]. A study on 139 operations for adrenal tumour more than 50 mm in diameter showed that the most common tumour (around 25%) were ACC [ 194 ].…”

Demographic and Clinicopthologic Properties of Patients Operated for Adrenal Masses

“…ADX was recommend in the case of AMs more than 3 cm in diameter in young patients, whereas more than 5 cm in older patients [14]. The rate of malignancy of the AMs with diameters of less than 4 cm, 4-6 cm, and more than 6 cm to be 0%, 2.9%, and 13.6% [15]. In our study, histopathologically benign lesions are much smaller than malign lesions, the average diameters of ACC were 98.8 mm.…”

Robotic-assisted left adrenal cystic mass excision in a pregnant patient

“…Tissue biopsy was required to rule out the remote possibility of adrenal malignancy. Considering that solid adrenal tumours>6 cm in diameter carry a 25% risk of potential malignancy, cystic adrenal masses carry a much lower malignancy potential of roughly 6% 6 7. Initial fine-needle aspiration biopsy was inconclusive and was repeated with core needle biopsy and cyst aspiration.…”