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PubMedDate not supplied

Extraneous cells of hepatic origin in adrenal fine needle aspiration as a diagnostic pitfall: a case report.

BACKGROUND: The fine needle aspiration (FNA) cytologic evaluations of most adrenal lesions are straightforward. However, there are diagnostic pitfalls to be avoided. CASE: A 34-year-old, pregnant woman was discovered to have an asymptomatic, right upper abdominal mass on ultrasound examination. After delivery, computed tomography-guided FNA showed bland epithelial cells, and a diagnosis of adrenal cortical adenoma was made. However, subsequent resection showed a myelolipoma of the adrenal gland. CONCLUSION: This case illustrated 2 cytodiagnostic pitfalls in adrenal fine needle aspirates. First, the myeloid cells characteristic of a myelolipoma were not present in the FNA smears because a large portion of the lesion was composed of fibroadipose tissue. Second, extraneous, benign cells of hepatic origin were misinterpreted as adrenal cortical adenoma cells.

Adrenal Cortex Neoplasms↗
PubMed2004

The clinically inapparent adrenal mass: update in diagnosis and management.

Clinically inapparent adrenal masses are incidentally detected after imaging studies conducted for reasons other than the evaluation of the adrenal glands. They have frequently been referred to as adrenal incidentalomas. In preparation for a National Institutes of Health State-of-the-Science Conference on this topic, extensive literature research, including Medline, BIOSIS, and Embase between 1966 and July 2002, as well as references of published metaanalyses and selected review articles identified more than 5400 citations. Based on 699 articles that were retrieved for further examination, we provide a comprehensive update of the diagnostic and therapeutic approaches focusing on endocrine and radiological features as well as surgical options. In addition, we present recent developments in the discovery of tumor markers, endocrine testing for subclinical disease including autonomous glucocorticoid hypersecretion and silent pheochromocytoma, novel imaging techniques, and minimally invasive surgery. Based on the statements of the conference, the available literature, and ongoing studies, our aim is to provide practical recommendations for the management of this common entity and to highlight areas for future studies and research.

Adrenal Cortex Neoplasms↗
PubMed1986

[Therapeutic procedure in "incidentaloma" of the adrenal glands].

Incidentally discovered adrenal masses are a therapeutic challenge. As benign lesions, like hyperplasias and adenomas, are much more common than malignant ones, an approach is needed, which incidental discovered mass should be removed. If the tumor is hormonally active or the lesion has a diameter of more than 3 cm, we advice surgery. The smaller mass should have a careful follow-up.

Adenoma↗
PubMed1983

Benign nonfunctional tumors of adrenal gland.

Seven cases of benign nonfunctional adrenal tumors are presented. All except one were found accidentally by computerized tomography (CT) scan during a workup of an abdominal condition. In 1 patient the CT scan was ordered to evaluate hirsutism, but subsequent endocrine studies were found to be normal. Asymptomatic adrenal tumors found by abdominal CT scans are usually benign. Careful selection of individual patients and a possible nonsurgical follow-up are suggested.

Adenoma↗
PubMed1998

Ultrasonography of the adrenal glands in the dog, cat, and ferret.

Ultrasonography has become an important modality for imaging adrenal glands in small animals. Normal adrenal glands and structural abnormalities, such as changes in size, shape, and echogenicity, can be identified. In the case of adrenal tumors, ultrasonography is a valuable tool for identifying neoplastic masses with local and regional involvement, as well as potential abdominal metastases. When correlated with clinical findings and results of hematologic, serum biochemical and endocrine tests, ultrasonographic findings make a substantial contribution to the diagnosis of adrenal diseases in dogs, cats, and ferrets.

Abdominal Neoplasms↗
PubMed1985

Fine needle aspiration cytology in the diagnosis of solid renal and adrenal masses.

In the eight-year period 1977-1984, 83 renal and adrenal mass lesions which were not clearly simple cysts by ultrasonographic examination (US) were investigated by percutaneous fine needle aspiration (FNA) biopsy. Initially, biopsy was often guided by fluoroscopy, later US was by far the most commonly used modality. There were 77 renal and 6 adrenal masses; 69 lesions were malignant and 14 were benign. A positive cytological diagnosis of malignancy was given in 62 cases, a diagnostic sensitivity of 90%. One false positive diagnosis occurred, an angiomyolipoma was misinterpreted as a low grade renal cell tumour. One significant complication was recorded, post biopsy haemorrhage into a large, extensively necrotic renal adenocarcinoma causing severe pain. The place of FNA in the preoperative investigation of solid renal tumours is discussed on the basis of this experience and results reported in the literature.

Adolescent↗
PubMed2006

Role of laparoscopy in the management of adrenal malignancies.

BACKGROUND AND OBJECTIVES: The role of laparoscopic approach for the treatment of malignant adrenal diseases is still controversial. The aim of this study was to verify the results of laparoscopic adrenalectomy (LA) in the management of adrenal malignancies. METHODS: The medical records of all the patients who underwent laparoscopic procedures for adrenal diseases and in whom malignancy was demonstrated at final histology were reviewed. RESULTS: Nine patients were included (three malignant pheochromocytomas, four adrenocortical carcinomas, and two adrenal metastases). At a mean follow-up of 23.0 months, all but two patients were alive. One patient died for metastatic disease and the other one for unrelated causes. One patient operated on for an adrenocortical carcinoma developed a pelvic recurrence. One patient operated on for a malignant pheochromocytoma developed multiple intra-abdominal recurrences. No other case of recurrence was observed. CONCLUSIONS: The results of this study demonstrate that LA can have a role also in case of adrenal malignancies. Conversion to open surgery is mandatory in case of local invasion and when the dissection cannot be as accurate as in conventional operations. A preliminary laparoscopic exploration can be planned in case of suspected malignant lesions to confirm the diagnosis and to evaluate their operability.

Abdominal Neoplasms↗
PubMed1996

Diagnosis and management of adrenal tumors.

Tumors of the adrenal gland are not uncommon. Patients with these tumors usually demonstrate symptoms associated with the biochemical substance or hormone produced by the tumor. Tumors of the adrenal cortex, whether benign or malignant, are often associated with excess production of steroids, whereas tumors of the medulla are generally associated with overproduction of catecholamines. With the ubiquitous use of computed tomographic imaging, many asymptomatic adrenal lesions are discovered, presenting a management problem for the clinician. The algorithm for investigating so-called adrenal "incidentalomas" in the current era of cost containment continues to evolve. This review addresses current trends in the clinical evaluation, biochemical testing, and nuclear and radiologic imaging in the diagnostic work-up of these neoplasms. The mainstay of treatment is still surgical extirpation, the only curative modality. However, advances have occurred in adjuvant therapies, perhaps best typified by the neoadjuvant use of 131I-methyl iodobenzylguanidine in the treatment of neuroblastoma.

Adrenal Cortex Neoplasms↗
PubMed1979

Angiographic findings in adrenal masses.

The angiographic findings in 34 patients with adrenal lesions were reviewed, including 11 adrenal metastases, 9 adrenal pheochromocytomas, 4 adrenal cortical carcinomas, 4 adrenal cortical adenomas, 3 cases of adrenal hyperplasia and 3 cases of adrenal invasion from carcinoma of the upper pole of the kidney. The results indicate differential diagnostic difficulties in distinguishing among these various entities by angiography.

Adenoma↗
PubMed1999

Laparoscopic ultrasound imaging of adrenal tumors during laparoscopic adrenalectomy.

BACKGROUND: The purpose of this study was to determine the usefulness of laparoscopic ultrasound (LUS) during laparoscopic adrenalectomy (LA) and to define the ultrasound imaging characteristics of various adrenal tumors. METHODS: LUS was utilized in 27 patients who underwent LA (including one bilateral adrenalectomy) from May 1994 to October 1998. Tumor size ranged from 1.0 to 5.5 cm (mean 3.3 cm), and a transabdominal lateral approach to LA was used. RESULTS: LUS localized the adrenal gland and tumor in all 28 adrenalectomies and demonstrated the relationship of the tumor to the kidney and adjacent vascular structures (renal artery/vein and inferior vena cava). The adrenal vein was visualized sonographically in only six cases (21 %). Pheochromocytomas were mild to markedly heterogenous, whereas most aldosteronomas and cortical adenomas were homogenous. LUS provided useful information to the surgeon in 11 of 28 cases (39%) by: 1) localizing the adrenal gland and tumor and/or guiding the dissection; 2) demonstrating that tumors > or =4 cm were confined to the adrenal gland; and 3) investigating suspected pathology in other organs. Mean operating time for LUS was 10.9 min (range 5 to 24 min) and calculated hospital charges were $602. CONCLUSIONS: LUS accurately localizes adrenal tumors, helps define their relationship to adjacent structures, and provides confirmation that larger tumors are amenable to laparoscopic resection. LUS is a useful adjunct to laparoscopic adrenalectomy in selected patients.

Adrenal Cortex Neoplasms↗
PubMed1982

Functioning adrenocortical tumour in a dog.

Naturally-occurring hyperadrenocorticism was diagnosed in an 11-year-old female Dachshund with signs of polydipsia, polyuria, pendulous abdomen, weakness, depression and lethargy, and laboratory test abnormalities comprising lymphocytopaenia, eosinopaenia, hypercholesterolaemia and increased plasma alkaline phosphatase concentration. While awaiting hormonal test results, an adrenocorticolytic drug (o,p'-DDD) was administered for 14 days, during which the patient deteriorated. Hormonal assays suggested a functioning adrenocortical tumour, but the poor condition of the patient precluded adrenalectomy. An adrenocortical carcinoma with hepatic metastases was found at necropsy.

Adrenal Cortex Neoplasms↗
PubMed1977

Metabolic regulation and relationship of endogenous protein kinase activity and steroidogenesis in isolated adrenocortical carcinoma cells of the rat.

In the adrenocortical carcinoma cell, in contrast to normal isolated adrenal cells, 10 to 50 muunits of ACTH do not raise the level of adenosine cyclic 3':5'-monophosphate (cyclic AMP), protein kinase activity, and steroidogenesis. This indicates a lesion in the tumor adenylate cyclase system. Two-tenths to 10 mM cyclic AMP and guanosine cyclic 3':5'-monophosphate (cyclic GMP) which stimulate steroidogenesis in a normal cell, activate protein kinase activity in a concentration-response manner without any detectable rise in steroidogenesis in the adrenocortical carcinoma cell. Cycloheximide and actinomycin D do not inhibit the stimulation of the phosphorylation. These results suggest that the tumor cyclic nucleotide-dependent protein kinase activity is unrelated to steroidogenesis and is also not under the transcriptional or translational control steps. Curiously, muM concentrations of cyclic AMP, in contrast to cyclic GMP, stimulate protein kinase activity. In a normal cell, both cyclic AMP and cyclic GMP, in this concentration range, stimulate protein kinase without an increase in steroidogenesis. It is therefore proposed that, in contrast to the normal cell, there is an additional defect in cyclic GMP-dependent protein kinase.

Adenylyl Cyclases↗
PubMed1984

Real-time ultrasound of normal adrenal glands and small tumors.

The adrenals were studied prospectively with real-time ultrasound in a series of 60 healthy individuals and 13 patients with small adrenal masses sized 8-20 mm in diameter. In only one of the 60 healthy subjects was a normal adrenal gland delineated as a distinct hypoechoic structure. In all other instances only the highly echogenic suprarenal fat could be displayed. Visualization of small tumors was successful in 12 of 13 patients. The suprarenal area and small lesions were best demonstrated by a lateral intercostal approach using longitudinal and transverse scanning planes. The best access was through the 9th/10th intercostal space at the junction with the anterior and middle axillary lines on the right and the posterior axillary line on the left.

Adrenal Cortex Neoplasms↗