PubMed · 8528646
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A Y Su, L E Bilhartz. 1995. Endocrine-related gut dysfunction.. https://pubmed.ncbi.nlm.nih.gov/8528646/
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We report two cases of intraadrenal thyroid gland tissue, both found by abdominal computed tomography (CT) scan and ultrasound echography. Histologically, the lesions were composed of mature thyroid follicles, varying in size, and some with cystic dilatation. Immunohistochemical staining for thyroglobulin confirmed their thyroid follicular nature. In neither case was there any evidence of thyroid gland cancer or teratomatous elements. Clinical examinations, including CT, ultrasound echography, and scintscanning did not show any tumorous lesions in the thyroid gland or elsewhere. The cause of ectopic thyroid in the adrenal gland is not known. It seems difficult to explain these ectopic lesions on the basis of developmental error because their location is distant from the path of embryological descent of the thyroid. The most important practical consideration is that they must be distinguished from metastatic deposits from a clinical point of view.
CT scanning remains the principal imaging technique for delineating adrenal gland lesions. Additional modalities complement CT by providing information about functional status and tissue-specific characteristics of adrenal pathology. They include MR imaging, radionuclide scintigraphy, selective venous sampling, angiography, ultrasound, percutaneous adrenal biopsy, and positive emission tomography.
Adrenal cysts have been traditionally managed by excision to rule out malignancy. We reviewed the 613 cases of adrenal cysts (including 6 new cases of our own) to evaluate whether this is still appropriate. Descriptive statistics and distribution of each pathologic type have been updated, based on 515 cases, and have changed from statistics compiled on 155 cases by G. A. Absehouse et al. Only seven per cent of all adrenal cysts are malignant or potentially malignant. There is only one reported case of a malignancy found in a nonfunctioning adrenal cyst that was initially thought to be benign. In this case, no CT or aspiration was performed. There have been 19 cases of adrenal cysts managed with aspiration. All were nonfunctioning and benign. One had a bloody aspirate. Reaccumulation occurred in 32 per cent of the cases (six cases); six per cent were symptomatic, four per cent were excised. Follow up was available in 15 cases from 4 months to 3.5 years. Management of the patient with a suspected adrenal cyst should include a careful history and physical and biochemical screening to rule out a functioning lesion. A CT scan, and aspiration of the cyst with a cystogram should be performed to confirm a simple cyst of the adrenal. If the suspicion of malignancy is low, and the lesion is nonfunctional, the adrenal cyst may be managed by aspiration alone. If the cyst recurs and is asymptomatic, it may be observed. If a symptomatic cyst recurs, it may be reaspirated or excised.