Sixty Adrenal Masses of Large Dimensions: Hormonal and Morphologic Evaluation

Bernini, Giampaolo; Miccoli, Paolo; Moretti, A; Vivaldi, M. S.; Iacconi, Pietro; Salvetti, Antonio

doi:10.1016/s0090-4295(98)00026-0

Cited by 18 publications

(6 citation statements)

References 39 publications

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“…In our experience, based on a large series of adrenocortical cancers evaluated with this technique in a single center, all nonfunctioning and 70% of hypersecreting carcinomas did not show radiocholesterol uptake at scintiscan. The results confirm data from the literature, where scintigraphic non-visualization of the tumor has been found capable of identifying primary or secondary adrenal malignancies with high sensitivity and specificity (5,6,14,16,17). This scintigraphic pattern has been related to the low uptake of radiocholesterol per gram of tissue, compared with normal adrenal cortex or benign adrenocortical lesions (14), and has been attributed to an altered cholesterol metabolism or to de novo synthesis of cholesterol by the tumor (18).…”

Section: Discussionsupporting

confidence: 84%

Scintigraphic patterns of adrenocortical carcinoma: morpho-functional correlates

Barzon

Zucchetta

Boscaro

et al. 2001

European Journal of Endocrinology

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Objective: Adrenocortical scintigraphy has demonstrated clinical utility in the morpho-functional characterization of adrenal tumors. The aim of this study was to identify possible relationships between the scintigraphic pattern and endocrine and/or morphological data in a series of adrenocortical carcinomas. Design and Methods: Twenty-one patients with adrenocortical carcinoma (11 nonfunctioning and 10 hormone-secreting) were investigated with 75Se-methyl-nor-cholesterol scintigraphy. Clinical, hormonal, radiological, and pathological data were analyzed. Results: The adrenal mass showed no radiocholesterol uptake in 18 cases (11 nonfunctioning and 7 functioning lesions). Contralateral normal adrenal gland was visualized in all patients with nonfunctioning tumors, whereas classic bilateral nonvisualization was observed in the 7 cases with hyperfunctioning masses. Three patients with cortisol-producing carcinomas showed radiotracer uptake by the mass, without visualization of the contralateral gland. At histology, the tumors were shown to be undifferentiated adrenocortical carcinomas; they had an aggressive clinical behavior. Conclusions: Radiocholesterol scintigraphy has an important role in diagnosing adrenocortical carcinomas, which typically are not visualized. However, 30% of hypersecreting adrenocortical carcinomas show an atypical increased tracer uptake, not predictive of the biochemical and histological features of the tumor.

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Section: Discussionsupporting

confidence: 84%

Scintigraphic patterns of adrenocortical carcinoma: morpho-functional correlates

Barzon

Zucchetta

Boscaro

et al. 2001

European Journal of Endocrinology

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“…Many of these were certainly benign, yet the cost of several follow-up CT scans, together with the radiation exposure, cannot be underestimated. Although some studies have reported on the outcomes of incidental adrenal nodules in an effort to produce guidance for investigation [11][12][13], there still appears to be a tendency to overinvestigate these lesions for the small percentage that are clinically significant. More research into which lesions require further evaluation may help to rationalise resources.…”

Section: Discussionmentioning

confidence: 99%

The economic implications of unsuspected findings from CT urography performed for haematuria

Bromage

Liew²,

Moore³

et al. 2012

BJR

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Objectives: We set out to determine the prevalence of unsuspected findings from CT urography (CTU) performed for haematuria and to evaluate the economic implications associated with the subsequent management of these findings. Methods: We analysed the results of 778 consecutive CTU scans performed in a haematuria clinic between 2008 and 2010. We excluded cases where diagnosis of an abnormality had been made prior to CTU. Costs incurred during the follow-up of unsuspected findings were calculated following guidance set out in the NHS Costing Manual 2009/10. Results: 778 CTU scans were performed for patients attending a haematuria clinic from 2008 to 2010. 455 men and 323 women underwent CTU scan; they had a median age of 62 years. 56% of scans were found to have unexpected extra-urinary findings (587 abnormalities in 439 scans). Common findings included diverticular disease (138, 17.7%), adrenal masses [85, 10.9%; 40 (5.1%) of which were indeterminate], lung abnormalities (67, 8.6%), gall bladders containing calculi (44, 5.7%), adnexal cysts (25, 7.7% of women) and aortic aneurysms (18, 2.3%). These findings led to a total of 136 outpatient appointments, 88 radiological investigations and 11 procedures (4 of which were major). The overall cost incurred was £47 366, or £60 per patient. Conclusion: CTU is associated with a high rate of unsuspected findings. There is an economic implication to performing CT scanning in this setting, in which further unanticipated investigation and treatment cost is approximately £60 per patient.

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“…Imaging studies can help the surgeons to evaluate a malignant lesion; abdominal ultrasounds, computed tomography (CT) and MRI can demonstrate irregular tumor margins, local invasion of the periadrenal tissue, heterogeneity, and hyperdensity, but these predictors of malignancy may also be seen in benign tumors [24]. CT can predict a malign lesion when it has a high attenuation values (>10 Hounsfeld units) [25,26].…”

Section: Discussionmentioning

confidence: 99%

Is laparoscopic adrenalectomy safe and effective for adrenal masses larger than 7 cm?

et al. 2007

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LA for adrenal masses larger than 7 cm is a safe and feasible technique, offering successful outcome in terms of intraoperative and postoperative morbidity, hospital stay and cosmesis for patients; it seems to replicate open surgical oncological principles demonstrating similar outcomes as survival rate and recurrence rate, when adrenal cortical carcinoma were treated. The main contraindication for this approach is the evidence, radiologically and intraoperatively, of local infiltration of periadrenal tissue.

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Sixty Adrenal Masses of Large Dimensions: Hormonal and Morphologic Evaluation

Cited by 18 publications

References 39 publications

Scintigraphic patterns of adrenocortical carcinoma: morpho-functional correlates

Scintigraphic patterns of adrenocortical carcinoma: morpho-functional correlates

The economic implications of unsuspected findings from CT urography performed for haematuria

Is laparoscopic adrenalectomy safe and effective for adrenal masses larger than 7 cm?

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