The indeterminate adrenal mass

Harrison, Barney

doi:10.1007/s00423-011-0845-0

Cited by 12 publications

(14 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…AGT being malignant from 0.1% to 50-75%. Adrenal incidentaloma may be a sole manifestation of a previously undiagnosed cancer in 0.2% of cases (2).…”

mentioning

confidence: 99%

“…In contrast to frequently occurring ACAs, adrenocortical carcinoma (ACC) is a very rare neoplasm, with an incidence of 0.5-2/million/year, accounting for 3% of all endocrine neoplasms and 0.05-0.2% of all cancers (2)(3)(4)(5)9). It is most commonly detected in the 5th decade in women (5:1 vs. men).…”

mentioning

confidence: 99%

“…ACC is often an aggressive neoplasm, associated with a poor prognosis. Due to the lack of early symptoms, it is usually diagnosed at an advanced stage (2,3,5,9).…”

mentioning

confidence: 99%

See 2 more Smart Citations

Minichromosome Maintenance Proteins MCM-3, MCM-5, MCM-7, and Ki-67 as Proliferative Markers in Adrenocortical Tumors

et al. 2019

View full text Add to dashboard Cite

Background/Aim: Morphological features, combined with Ki-67 proliferative index, remain the standard for discriminating benign and malignant adrenocortical tumors. The aim of this study was to evaluate the role of minichromosome maintenance proteins MCM-3, MCM-5, MCM-7, and Ki-67 as proliferative markers in adrenocortical tumors. Materials and Methods: Specimens of 81 adrenocortical adenomas and 3 adrenocortical carcinomas were stained with antibodies against MCM-3, 5, 7 and Ki-67. Results: Malignant tumors were characterized by a greater size (p=0.017), volume (p=0.017), and higher levels of Ki-67 (p=0.005), MCM-3 (p=0.005), MCM-7 (p=0.008), but not MCM-5 (p=0.069). The markers' levels were independent from the tumors' size and volume, the patient's age and hormonal status. ROC curves showed Ki-67 (AUC 0.984), MCM-3 (AUC 0.984), and MCM-7 (AUC 0.950), but not MCM-5 (AUC 0.820) to be reliable markers. Conclusion: Ki-67, MCM-3, and MCM-7, but not MCM-5 are reliable proliferative and diagnostic markers in discerning benign and malignant adrenocortical tumors. Adrenal gland tumors (AGTs) are relatively common and constitute 5-9% of all human tumors. The greater accessibility to diagnostic imaging in recent years, especially ultrasound (US) and computed tomography (CT), has revealed that the rate of AGTs is significantly higher than previously reported. The prevalence of incidentally detected adrenal mass (socalled incidentaloma) is greater with age and ranges from 0.2% (20-29 years old) to 3% (over 50 years of age) and even up to 7% (over 70 years of age) (1, 2). The mean value for the general population is about 2-4% (3, 4). An incidentaloma is typically detected in the right adrenal gland, between the 5th and 7th decade of life (mean age 55 years). AGTs are found on average in 1-8.9% (mean 2.3%) of autopsies, and even in as high as 15% according to some authors (2, 4). Apart from an incidentaloma, adrenal tumors may present symptoms, either of hormonal excess or a mass effect (5). Following the finding of an AGT, steps are taken to determine its origin (cortical/medullar) and character (benign/malignant) (1, 3, 6). Most AGTs are of cortical origin and benign, adrenocortical adenoma (ACA) is the most frequent diagnosis (70-94%) (2, 5). The majority of ACAs do not display hormonal activity. The most common functioning ACA is aldosterone-producing adenoma (APA), followed by cortisol-producing adenoma (CPA) (7). A malignant AGT can be either a primary adrenal lesion or a metastasis (3). Primary malignancies consist of cortical (adrenocortical carcinoma-ACC) and medullar lesions (malignant pheochromocytomaabout 10% (2.5-26%) of all pheochromocytomas) (6). Metastatic AGTs vary in origin, including lung, renal, breast, gastrointestinal (gastric, colorectal), hepatocellular carcinoma and melanoma (1, 3, 5, 8). The presence of an extra-adrenal primary malignancy increases significantly the odds of an 1151 This article is freely accessible online.

show abstract

“…AGT being malignant from 0.1% to 50-75%. Adrenal incidentaloma may be a sole manifestation of a previously undiagnosed cancer in 0.2% of cases (2).…”

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Minichromosome Maintenance Proteins MCM-3, MCM-5, MCM-7, and Ki-67 as Proliferative Markers in Adrenocortical Tumors

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Interestingly, despite increases in the frequency of CT scanning in the population at-large and adrenal incidentalomas becoming an increasingly common indication for adrenalectomy, there has been no decrease in mortality associated with ACC [3,25]. MRI using chemical shift can be useful for differentiating lipid-rich ACA from ACC, but this technique is not useful in lipid-poor ACA [33]. MRI is superior compared with CT at evaluating inferior vena cava invasion (IVC), which complicates resection of a right-sided ACC [24].…”

Section: Evaluation and Work-upmentioning

confidence: 99%

Adrenocortical Carcinoma: Modern Management and Evolving Treatment Strategies

McDuffie

Aufforth

2016

Int. J. Endo. Oncol.

View full text Add to dashboard Cite

Adrenocortical carcinoma (ACC) is a rare cancer with a poor prognosis. Unlike many other cancers, there has been little improvement in patient outcome over the past several decades. However, as scientific advancements are made and our understanding of the molecular genetics involved in ACC improve then progress may be achieved in this devastating disease. This review focuses on recent literature published in the field of ACC from 2010 to 2015 with an emphasis on improving diagnosis, staging and treatment for ACC.

show abstract

“…The indeterminate adrenal mass [1] There is very limited evidence on which to base recommendations for the management of the small number of adult patient with an indeterminate/lipid poor (on CT/MRI) adrenal mass in whom there are no critical, biochemical, or radiological indications for surgery. Further investigation with MRI (chemical shift/contrast enhanced) is advised.…”

Section: Adrenocortical Carcinomasmentioning

confidence: 99%

Positional statement of the European Society of Endocrine Surgeons (ESES) on malignant adrenal tumors

Henry

Peix

Kraimps

2011

Langenbecks Arch Surg

View full text Add to dashboard Cite

) a workshop on malignant or potentially malignant adrenal tumors. In the year prior to the workshop, three working groups reviewed the available literature on pheochromocytomas (PCCs)/paragangliomas (PGLs), adrenocortical carcinomas, and metastases, respectively. In their respective field, these three working groups tried to grade the evidence for recommendations in accordance with accepted international standards. Results of their extensive update were presented during this workshop, and recommendations were discussed in three plenary sessions with input from all the participants. Articles were amended on the basis of the discussion at the workshop. Adrenocortical carcinomasThe indeterminate adrenal mass [1] There is very limited evidence on which to base recommendations for the management of the small number of adult patient with an indeterminate/lipid poor (on CT/MRI) adrenal mass in whom there are no critical, biochemical, or radiological indications for surgery. Further investigation with MRI (chemical shift/contrast enhanced) is advised. Negative uptake on 18 F-FDG PET scan or a positive scan with appropriately low tumor SUV max or tumor/liver SUV max ratio supports nonintervention. At the present time, the added value and role of image-guided FNA are unclear.If adrenalectomy is not to be recommended or performed on the basis of the clinician's opinion and patient choice, appropriate follow-up according to local protocols is essential. A subsequent increase in tumor size is an indication for surgery.Adrenocortical carcinoma: which surgical approach? [2] There are no randomized studies comparing open adrenalectomy with laparoscopic adrenalectomy for ACC. There is no evidence of postoperative benefit for the patients undergoing laparoscopic adrenalectomy compared to open adrenalectomy (level B).Results from comparison of oncological outcomes in ACC between open and laparoscopic approaches are equivocal: increased risk of local recurrence and peritoneal carinomatosis by the laparoscopic route (level D), identical results between the two approaches in terms of survival, and recurrence and peritoneal carcinomatosis (level C). An open approach is recommended in case of local invasion, with a view to achieving an R0 resection (level D).

show abstract

The indeterminate adrenal mass

Abstract: The management of a patient with an indeterminate adrenal mass in the absence of clear clinical, biochemical, and radiological indications for adrenalectomy may be aided by further assessment using chemical-shift/contrast-enhanced MRI and (18)F-FDG PET/CT.

Cited by 12 publications

References 56 publications

Minichromosome Maintenance Proteins MCM-3, MCM-5, MCM-7, and Ki-67 as Proliferative Markers in Adrenocortical Tumors

Minichromosome Maintenance Proteins MCM-3, MCM-5, MCM-7, and Ki-67 as Proliferative Markers in Adrenocortical Tumors

Adrenocortical Carcinoma: Modern Management and Evolving Treatment Strategies

Positional statement of the European Society of Endocrine Surgeons (ESES) on malignant adrenal tumors

Contact Info

Product

Resources

About