Cystic adrenal lesions: A report of five cases

Abstract

Background Cystic adrenal lesions are rare and uncommon manifestation with few cases reported so far. Different types of adrenal cysts have been described with heterogeneous etiology and overlapping clinical findings, ranging from benign to malignant cystic neoplasm. They are usually asymptomatic or may rarely present with abdominal pain or fullness. Optimum management of adrenal cysts still remain controversial, owing to its low incidence. In this study, we report our institutional experience on diagnosis and management of different histological types of cystic adrenal lesions. Cases During 4 years period, 55 patients underwent adrenalectomy with five cases presenting as adrenal cysts. All the five patients were biochemically nonfunctional and underwent adrenalectomy (laparoscopic anterior n = 2, retroperitoneoscopic approach n = 1, and open anterior transperitoneal approach n = 2). The primary indications for surgery were larger size and/or suspicion of malignancy. Histological evaluation revealed two epithelial cysts, one endothelial cyst, one pseudocyst, and a very rare case of adrenocortical carcinoma arising in a pseudocyst. Conclusion Cystic adrenal lesions are rare with varied etiologic and clinical presentation that may sometimes lead to diagnostic and management dilemma. These cases must undergo biochemical and radiological evaluation to rule out underlying malignancy followed by referral for surgical intervention.

Overview of the 2022 WHO Classification of Adrenal Cortical Tumors

“…Several primary and metastatic tumors in the adrenal gland may develop cystic changes, thus entering in the differential diagnosis with adrenal cysts and pseudocysts. These include cystic regressive and hemorrhagic degenerative changes in adrenal cortical adenoma, adrenal cortical carcinoma, pheochromocytoma, hemangioma, lymphangioma, angiosarcoma, vascular malformations, renal cell carcinoma, mature teratomas, ectopic thyroid nodules, and even in metastases [62,63,65,67,[73][74][75]. The morphological distinction is generally straightforward in the presence of a conventional histological component of the individual neoplasms.…”

Giant Adrenal Cyst: A Case Report

“…Functional cysts and malignant or potentially malignant cysts are usually surgically treated. Cysts over 5 cm and symptomatic cysts smaller than 5 cm are also indications for surgery [ 2 , 13 ]. Although it is more recommended to enucleate the cyst laparoscopically while preserving the adrenal gland.…”

A case of adrenal lymphangioma successfully treated with laparoscopic partial adrenalectomy

“…1,2 Some have also reported adrenal lymphangiomas accompanied by abnormal hormonal secretions, presumably due to compression of the adrenal artery or medulla. 5 Ellis et al observed that these tumors are more frequently found in women, and more commonly seen in the right adrenal gland. 1 As it was the case for this patient, on a histological level, lymphangiomas are often seen on H&E staining as polycystic lesions lined with endothelium-like cells.…”

“…Most lymphangiomas are asymptomatic, although incidences where these tumors were discovered after symptoms such as abdominal pain, palpable abdominal mass, hemorrhage, and infections have been reported 1,2 . Some have also reported adrenal lymphangiomas accompanied by abnormal hormonal secretions, presumably due to compression of the adrenal artery or medulla 5 . Ellis et al .…”