Determinants for malignancy in surgically treated adrenal lesions

Wright, L.; Nordenström, Erik; Almquist, Martin

doi:10.1007/s00423-011-0849-9

Cited by 4 publications

(5 citation statements)

References 28 publications

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“…The size of the adrenal lesion, suspicious radiological findings, and history of malignancy are known factors associated with malignancy [31][32][33]. The most important oncological recommendation for surgical treatment of an incidentaloma is a suspicious radiological tumour image that does not correspond to adrenal adenoma.…”

Section: Discussionmentioning

confidence: 99%

Adrenal “nonadenoma” — clinical characteristics and risk of malignancy

Samsel

Papierska

Nowak

et al. 2021

Endokrynologia Polska

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Introduction:There is an increasing number of adrenal tumours discovered incidentally during imaging examinations performed for many different indications. Based on imaging results, it is possible to differentiate benign from malignant adrenal masses, although there is still a number of equivocal imaging findings. Our study presents 77 cases of adrenal tumours in which imaging was inconclusive and the final diagnosis was stated only after surgery and histopathological examination. Material and methods:Retrospective data analysis: 77 cases of indeterminate adrenal tumours with a presumptive diagnosis of "nonadenoma" in patients operated within a 16-year period (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019). None of the patients had a history of malignancy, and all tumours were hormonally inactive. On contrast-enhanced CT, the native density of all tumours was higher than 10 Hounsfield Units (HU), and the absolute percentage washout (APW) and relative percentage washout (RPW) were lower than 60% and 40%, respectively. Results:The most common findings were adrenal adenoma (25.9%), macronodular adrenal hyperplasia (16.9%), ganglioneuroma (15.6%), and haemorrhage with posthaemorrhagic changes (13%). In total, there were 12 various histopathological diagnoses in this group. There were only 2 (2.6%) malignant (adrenal cancer and leiomyosarcoma) and 3 (3.9%) potentially malignant (pheochromocytoma) lesions in this group. Conclusions:It is often impossible to make a correct diagnosis in a clinical setting until it is histologically verified. "Nonadenoma" adrenal tumours constitute a heterogeneous group including very rare pathologies. The risk of malignancy in indeterminate adrenal tumours is relatively low.

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Section: Discussionmentioning

confidence: 99%

Adrenal “nonadenoma” — clinical characteristics and risk of malignancy

Samsel

Papierska

Nowak

et al. 2021

Endokrynologia Polska

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“…Quite often, in cases of pheochromocytoma, even this examination is not able to finally determine whether a malignant process actually occurs [4]. The above general rules concerning surgical techniques required in a treatment of adrenal lesions make it difficult to decide on the question of performing operations that are assumed to be non-radical.…”

Section: Szkolenie Podyplomowementioning

confidence: 99%

“…The controversy concerns the assessment and the ruling out of malignant processes, as well as the scope of the removal of normal adrenal tissue in order to safely separate it from the tumour, keeping the removal process radical. This is connected to the pre-surgical assessment of the localisation of the lesion, as well as the differentiation of its nature: whether the tumour is single or multiple, whether it is a case of adenoma, or just a hyperplasia [4,5,6,10].…”

Section: Selection Of Patients Qualifying For Non-radical Resectionmentioning

confidence: 99%

“…Pewną ocenę złośliwości zmiany i jej zaawansowanie można poznać po operacji w badaniu patomorfologicznym. Nierzadko w przypadkach guzów chromochłonnych nawet to nie jest w stanie wykluczyć lub potwierdzić procesu nowotworowego [4].…”

Section: Szkolenie Podyplomoweunclassified

“…Kontrowersje dotyczą oceny i wykluczenia procesu rozrostowego, a jednocześnie szerokości wycięcia normalnej tkanki gruczołu od guza dla zachowania radykalności wycię-cia zmiany. Wiąże się to zarówno z przedoperacyjną oceną lokalizacji, jak i zróżnicowaniem charakteru zmiany: guz pojedynczy czy mnogi, gruczolak czy rozrost [4][5][6]10].…”

Section: Szkolenie Podyplomoweunclassified

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Nieradykalne (oszczędzające) operacje guzów nadnerczy

Otto

Dzwonkowski²

2015

Endokrynologia Polska

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Currently, laparoscopic adrenalectomy is seen as more than just the preferred method, in fact as a routine procedure, always bearing in mind, however, the developed restraints on its usage. The size of the tumour, recurrent disease, and the existing invasive process all remain factors which determine the indications for operation. The situation is similar in cases of qualifying for sparing (non-radical) operations on adrenal glands. The basic challenge in terms of qualification, choice of technique and the range of operation of adrenal lesions remains: obtaining a reliable preoperative diagnosis, the localisation of lesions including their ectopic location, the evaluation of the imaging phenotype, as well as a proper pre-surgical preparation. Maintaining one third of properly vascularised adrenal mass allows one to avoid a substitutive therapy, with the possible necessity of its application in stressful situations. The first partial adrenalectomy has been conducted on a patient with a bilateral pheochromocytoma, in order to retain the glucocorticoid adrenal functions. The recommendations for its administration remain: hereditary pheochromocytoma of at least 2cm diameter, unilateral adenoma of at least 5cm diameter in Cushing's syndrome without any concomitant lesions in the oposite adrenal gland, and unilateral adenoma in Conn's syndrome. It seems that non-radical resection should always be considered for patients at risk of bilateral adrenalectomy in cases of concomitant lesions in both adrenals. StreszczenieObecnie adrenalektomia laparoskopowa traktowana jest już nie tylko jako metoda preferowana, lecz jako postępowanie rutynowe, jednak przy zachowaniu wypracowanych ograniczeń do jej zastosowania. Wielkość guza, zmiany nawrotowe, istniejący proces inwazyjny pozostają czynnikami warunkującymi wskazania do jej wykonania. Podobnie jest w kwalifikacji do operacji oszczędzających (nieradykalnych) na nadnerczach. Podstawową kwestią w kwalifikacji, doborze wyboru techniki i zakresu operacji zmian nadnerczowych pozostaje: pewność przedoperacyjnego rozpoznania, lokalizacja zmian łącznie z ekotopowym ich położeniem, ocena obrazowego fenotypu jak również właściwe przygotowanie przedoperacyjne. Zachowanie 1/3 dobrze unaczynionej masy nadnerczy pozwala na uniknięcie terapii substytucyjnej z możliwą koniecznością jej zastosowania w sytuacjach stresowych. Pierwszą częściową adrenalektomię wykonano u chorego z obustronnym guzem chromochłonnym dla utrzymania czynności glikokortykostroidowej nadnerczy. Wskazaniami do jej wykonania pozostają: guz chromochłonny uwarunkowany dziedzicznie o średnicy 2 cm, jednostronny gruczolak o średnicy ≥ 5 cm w zespole Cushinga bez współistniejących zmian w drugim nadnerczu, jednostronny gruczolak w zespole Conna. Wydaje się, że nieradykalna resekcja powinna być zawsze rozważana u chorych zagrożonych obustronną adrenalektomią w przypadkach współistnienia zmian w obu nadnerczach.

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