Cystic adrenal lesions: focus on pediatric population (a review)

Abstract

Background and aimThe cysts may potentially affect any organ; adrenals cysts are rare. This is a review of the literature regarding adrenal cysts, focusing on children and young adults.General dataThree major types have been described: pure cysts (endothelial, epithelial, and hemorrhagic or pseudocyst), parasitic (as hydatid) cysts and cystic part of a tumour (most frequent are neuroblastoma, ganglioneuroma, pheocromocytoma, and teratoma). The complications are: bleeding, local pressure effects; infection; rupture (including post-traumatic); arterial hypertension due to renal vessels compression. Adrenal hemorrhage represents a particular condition associating precipitating factors such as: coagulation defects as Factor IX or X deficiency, von Willebrand disease, thrombocytopenia; antiphospholipid syndrome; previous therapy with clopidogrel or corticosteroids; the rupture of a prior tumour. At birth, the most suggestive features are abdominal palpable mass, anemia, and persistent jaundice. Adrenal insufficiency may be found especially in premature delivery. The hemorrhage is mostly self-limiting. Antenatal ultrasound diagnosis of a cyst does not always predict the exact pathology result. The most important differential diagnosis of adrenal hemorrhage/hemorrhagic cyst is cystic neuroblastoma which is highly suggestive in the presence of distant metastases and abnormal catecholamine profile. The major clue to differentiate the two conditions is the fact that the tumor is stable or increases over time while the adrenal hemorrhage is expected to remit within one to two weeks.ConclusionPediatric adrenal cysts vary from simple cysts with a benign behavior to neoplasia- related lesions displaying severe prognosis as seen in cystic neuroblastoma. A multidisciplinary team is required for their management which is conservative as close follow-up or it makes necessary different surgical procedures in cases with large masses or if a malignancy suspicion is presented. Recently, laparoscopic approach is regarded as a safe procedure by some authors but generally, open surgery is more frequent used compare to adults; in most cases the preservation of normal gland is advisable.

Haemorrhagic suprarenal pseudocysts: a systematic review of a rare condition from family physicians’ perspective during the COVID-19 global pandemic

“…Intracystic haemorrhage is one of the complications of adrenal pseudocysts, which our patient had 4 . Haemorrhagic complication of adrenal cysts is usually associated with factors like coagulopathies, Von Willebrand's disease, thrombocytopenia, antiphospholipid syndrome, previous therapy with clopidogrel or steroids and rupture of a prior tumor 18 , none of which our patient had. The diagnosis of adrenal cysts or pseudocysts is largely by imaging (Ultrasound Scan, CT Scan and MRI Scan) as confirmed in a review of 6 patients over 3 years 5 , while the use of laparoscopy, as enumerated by another study, is important not only in diagnosis but also in management of symptomatic cases 7 .…”

Pseudoquiste adrenal derecho

“…A diferencia de los quistes verdaderos los pseudoquistes adrenales no tienen un revestimiento celular, se componen de tejido fibrótico, algunas veces con calcificaciones. 8,9 La mayoría son no funcionales y benignos. El estado funcional de los mismos puede causar síntomas de insuficiencia suprarrenal.…”

“…7 Acorde a la clasificación de Levison se dividen en cuatro categorías: quistes endoteliales (45%), quistes epiteliales (9%), pseudoquistes (39%) y quistes parasitarios (7%). 6,[8][9][10][11] Pueden medir desde milímetros hasta 50 cm de diámetro. 12 Son unilaterales, pero se pueden presentar de forma bilateral (8-15%).…”

Flush after unilateral adrenalectomy

“…Modern days brought a real progress in the field of adrenal surgery which is no longer open but laparoscopic, including in large tumors even with cystic consistence (3,10). In children, the cortex sparing surgery is preferred in many cases where malignancy is not suspected but the typical approach is open in majority of cases (11,12).…”