Cystic lymphangiomatous lesions of the adrenal gland: A clinicopathological study of 37 cases including previously unreported cysts with papillary endothelial proliferation

Koperski, Łukasz; Pihowicz, Paweł; Anysz-Grodzicka, Agnieszka; Górnicka, Barbara

doi:10.1016/j.prp.2019.03.014

Cited by 9 publications

(6 citation statements)

References 22 publications

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“…So we summarize our 8-year experience of adrenal lesions with calcification and discuss the rational indications for surgical treatment for the sake of avoiding unnecessary surgical intervention. The pathological types of adrenal lesions with calcification vary with reports from authors in different periods [3][4][5][6][7] . In 2008, Bhargav et al 5 from Indian reported that calcified adrenal lesions were more likely to be seen in pheochromocytoma, adrenal cyst and myelolipoma.…”

Section: Discussionmentioning

confidence: 97%

“…It is reported that adrenal calcification can be secondarily attributed to internal hemorrhage and necrosis of an adrenal tumor, or primarily to calcareous diseases of the adrenal gland such as hemangioma and cyst 1,2 . Adrenal calcification can also be secondary to tuberculosis, or malignant metastasis from other systems [3][4][5][6] . There are controversies over whether surgery is necessary for such diseases at present.…”

Section: Discussionmentioning

confidence: 99%

“…Calcification in most pseudocysts was located peripherally on CT imaging. The main difference between adrenal cyst and pseudocyst is reflected in the microscopic finding that the cyst wall of the latter is made up of inflammatory granulation tissue or fibrous tissue with no coverage of epithelial cells on the cyst wall surface 3,6 .…”

Section: Discussionmentioning

confidence: 99%

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An 8-year clinical experience with diagnosis and treatment of adrenal lesions with calcification

Dai

Xie

Yang

et al. 2022

Sci Rep

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Adrenal lesions with calcification are uncommon and surgical indication remains controversial. We evaluate rational indications for surgical intervention of adrenal lesions with calcification. From 2013 to 2021, 75 adrenal lesions with calcification managed with surgery had necessary studies for evaluation of rational surgical indication. Clinical benefit was defined as relief of symptoms or/and removal of the malignant tumors. Influencing factors for clinical benefit were evaluated by logistic regression. During the past 8-year period, 5057 patients received adrenal surgery in our center and 75 (1.5%) patients were accompanied with calcification, including 34 males and 41 females with a median age of 54 years (IQR = 41–63 years). The median maximum diameter of calcified adrenal lesions on preoperative CT imaging was 4.2 cm (IQR = 3.0–5.9 cm). Clinical benefit was achieved in 22 cases, including 4 cases of malignant tumors and 18 cases of relieved clinical symptoms. Correlation analysis indicated that maximum diameter of the lesion was significantly correlated with clinical benefit (p = 0.025). The maximum diameter in benefit group vs. non-benefit group was 5.5 cm (IQR = 3.7–7.4 cm) vs. 3.7 cm (IQR = 2.8–5.4 cm). AUC of the maximum diameter ROC curve of adrenal lesions was 0.662. The diameter, sensitivity and specificity corresponding to the maximum Youden index value were 4.5 cm, 0.682 and 0.623, respectively. Clinical benefit was not significantly correlated with calcification distribution (peripheral or internally scattered) (P = 0.106), calcification area ≥ 50% (P = 0.617) and internal enhancement of the lesion (P = 0.720). Adrenal lesions with calcification are mostly benign. Clinical benefit is significantly correlated with the maximum diameter of the lesion and 4.5 cm may be considered as the cutoff point of surgical intervention.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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An 8-year clinical experience with diagnosis and treatment of adrenal lesions with calcification

Dai

Xie

Yang

et al. 2022

Sci Rep

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“…Some theories have also described their origin from pre‐existing vascular hamartoma, hence can be seen in young age also 20 . A recent study done by Koperski et al 21 mentioned cystic lymphangiomatous malformations in three broad categories as multicystic, unicystic, and lymphangiomatous cysts with papillary endothelial proliferation. Pseudocysts are most common among all adrenal cysts across different studies with an incidence of 39% 6 .…”

Section: Discussionmentioning

confidence: 99%

Cystic adrenal lesions: A report of five cases

et al. 2020

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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.

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“…Benign adrenal cysts are usually discovered incidentally (in 88% of cases), but a significant number (up to 40% of cases) of malignant adrenal neoplasms with cystic transformation are also incidentalomas [6,9,13]. Adrenal cysts used to be the most prevalent in the fourth to seventh decade of life [6,9,14], but the more frequent use of imaging diagnostics has led to the shift in the age range to younger patients (fourth to fifth decade of life) [3,6,14,15]. Our patient was very young (18 years old) at the time of diagnosis of the large adrenal cyst (8 cm), which makes her one of the youngest cases with this kind of pathology.…”

Section: Case Descriptionmentioning

confidence: 99%

Adrenal Cysts: To Operate or Not to Operate?

Bozic Antic,

Djurisic,

Nikolic

2024

JCM

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Adrenal cysts are uncommon and usually asymptomatic, and therefore are usually incidentally discovered adrenal lesions. They have a broad pathohistological spectrum that includes pseudocysts and endothelial (vascular), parasitic, and epithelial (mesothelial) cysts. Although most adrenal cysts are benign and hormonally non-functional lesions, some can have ambiguous imaging appearances and mimic malignant adrenal neoplasms. On the other hand, the actual malignant neoplasms could undergo cystic transformation. Additionally, immune cell infiltrations, thrombosis, or haemorrhage seen in sepsis can frequently cause adrenal cyst development, raising a question about the possible connection between severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and adrenal cystic lesions. Due to the disease’s rarity, the likelihood of malignancy, and the lack of specific guidelines, the management of adrenal cysts is always challenging especially in a young person. This review discusses the important diagnostic and the current treatment possibilities for adrenal cystic lesions. Aiming to emphasize clinical dilemmas and help clinicians navigate the challenges when encountering a patient with an adrenal cyst in everyday practice, we based our review on a practical question–answer framework centred around the case of a young woman with an incidentally discovered large adrenal cyst.

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Cystic lymphangiomatous lesions of the adrenal gland: A clinicopathological study of 37 cases including previously unreported cysts with papillary endothelial proliferation

Cited by 9 publications

References 22 publications

An 8-year clinical experience with diagnosis and treatment of adrenal lesions with calcification

An 8-year clinical experience with diagnosis and treatment of adrenal lesions with calcification

Cystic adrenal lesions: A report of five cases

Adrenal Cysts: To Operate or Not to Operate?

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