Ectopic Adrenocortical Tissue: An Incidental Finding During Inguinal Surgery in Children

Abstract

Adrenal rests are usually unrecognized during operation, and the incidence of ectopic adrenal cortical tissue in pediatric patients during inguinal surgery procedures is unknown. We performed 3028 groin surgical explorations in 2680 patients aged 1 month to 17 years. Ectopic adrenal tissue was found in 69 inguinal operations (2.2%): 37 during 1.524 orchiopexy (2.4%), 23 during 1.115 herniectomy (2.0%), and 9 during 389 hydrocoela operation (2.3%). Statistically there were no significant differences among those three groups. No adrenal rests were detected in females. Although a few reported cases with hormonal activity of ectopic adrenocortical tissue (EACT), the recommendation is to remove them if found.

Evaluation of children with inguinoscrotal ectopic adrenal tissues

“…Ketata et al (14) found ectopic adrenal tissue in 1.66% (n = 31) out of 1862 patients who had inguinoscrotal surgery and adrenal medulla was not detected in any of the patients, while all had adrenal cortex. The general opinion is that the observation rate of medullar cells decreases toward zero the more distal the location of ectopic adrenal tissue is (12)(13)(14). However, we found that 1 of our 6 patients had adrenal cortex and adrenal medulla together.…”

“…Similarly, by reviewing a large series, specific disorders or anomalies were not reported as any significant accompanying disease with ectopic adrenal tissues (12)(13)(14). Nevertheless, we did not detect any biochemical, hormonal (ACTH, testosterone, progesterone, and TSH), or hematologic abnormalities suggestive for ectopic adrenal tissue in our patients.…”

“…However, adrenal medulla cells can be found in ectopic adrenal tissues with a more proximal localization. Medulla cells are observed as cellular structures of the capsule of connective tissue, usually with small blood vessels that surround these nodules (13). In the literature, only adrenal cortex was found in ectopic adrenal tissues detected in genital regions, and adrenal medulla cells were not observed (12).…”

Ectopic adrenal tissue of spermatic cord in a 3- year- old boy, an incidental finding during orchidopexy: A case report

“…Ectopic adrenal tissue usually appears as an incidental finding during surgery. According to literature, despite its benign behavior, recommendation to remove ectopic adrenal tissue when discovered remains [8,7,13], since they are associated with hyperplasia and neoplastic change [1,5]. However, a routine search for them is not mandatory.…”

Adrenal Gland

“…Many studies have reported ectopic cortical adrenal gland tissues in the inguinal region (spermatic cord, hernia sac, testis, epididymis, and ovary) with an overall incidence of 1.66-5.14% (Marchetti 1904;Nelson 1939;Gutowski and Gray 1979;Michowitz et al 1979;Mares et al 1980;Miersch et al 1989;Okur et al 1995;Ventura et al 1998;Lorenzo Romero et al 2000;Pérez García et al 2001;Oguzkurt et al 2002;Sullivan et al 2005;Mendez et al 2006;Vaos et al 2006;Iyengar and Pittman 2007;Ozel et al 2007;Ketata et al 2008;Dobanovacki et al 2013). The incidence of ectopic (intratesticular) adrenal gland tissue is quite high (42%) among patients with congenital adrenal gland hyperplasia (Avila et al 1999).…”