Urologic Diseases Clinical Trial
Official title:
Complex Cystic Benign Adrenal Incidentalomas Mimicking Non-adenomatous Masses; Rare Pathologies: Clinical Features and Outcomes. Case Series With Short Review of Literature.
Benign complex cystic and vascular adrenal tumors comprise a group of lesions characterized by significant rarity. But, their detection is increasing due to improved radiologic imaging techniques. Nevertheless, they are still conflicting with other lesions. the investigators reviewed their experience with complex cystic benign adrenal tumors in adults, review previous reports to determine the appropriate diagnosis and management of these tumors.
Adrenal masses are incidentally found on computed tomography (CT) of the abdomen (so-called
"incidentaloma") (AIs) approximately 4% of the time and in 8% in autopsy series. It is
important to distinguish benign from malignant. Also, differentiating functioning vs
nonfunctioning tumors. The majority of AIs are nonfunctioning , benign lesions account for
82.5% of cases including adenomas (61%), myelolipomas (10%), adrenal cysts (6%), and
ganglioneuromas (5.5%), cortisol-secreting adenomas (5.3%), pheochromocytomas (5.1%),
adrenocortical carcinomas (4.7%), metastatic lesions (2.5%), and aldosteronomas (1%).
The frequency of adrenal incidentaloma reported in the radiology literature varies according
to imaging modality with computed tomography (CT) scans and magnetic resonance imaging (MRI),
it ranges from 0.3 to 7%, whereas with ultrasound, it is 0.4-2 %. The evaluation and
classification of adrenal vascular tumors and cysts remain a challenging, in spite of, the
frequency of detection over the past years has been facilitated by advances in imaging and
molecular histopathology. This overlap not only because of their scarcity but because these
lesions are often obscured by the extensive hemorrhage. As a result, surgical excision of
these lesions has to trend in the last decades.
Because of that, we retrieved our data to determine the clinical features, histopathological
pathognomonic features and the long term outcomes for these lesions.
The computerized dedicated database of patients who were treated for adrenal tumors between
January 2010 and December 2017 was reviewed. Only patients aged >18 years were included in
the study and their files were fully evaluated. The data collected were the age at the time
of presentation, clinical features, medical history, adrenal metabolic profile, radiological
tumor characteristics, treatment methods, and histopathological characteristics. In all
cases, CT with contrast was performed unless contraindicated and MRI was performed. Also,
basic hormonal assay including 24-hour urinary cortisol and plasma metanephrines were
requested for all cases. Under general anesthesia with fixation of intra-arterial line,
patients were explored laparoscopically or via the lumbar incision. Three days postoperative,
the patient was discharged unless hormonal replacement therapy is required for a longer
period of time. The patients were followed up by metabolic profile and radiologically after 6
and 12 months postoperatively then annually.
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