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Histological examination of the cyst showed an adrenal pseudocyst. The cystic wall consisted of dense fibrous tissue without an epithelial lining (arrow). A rim of normal adrenal tissue was found compressed within the cystic capsule (arrow head). (hematoxylin and eosin stain, Scale bar = 1 mm).
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Adrenal pseudocysts are rare cystic masses that arise from the adrenal gland and which are usually non-functional and asymptomatic. Adrenal pseudocysts consist of a fibrous wall without an epithelial or endothelial lining. We report the case of a patient with a giant adrenal pseudocyst presenting with right hypochondralgia and high fever.
A 52-year...
Citations
... Adrenal pseudocysts are usually encountered as an incidental finding on CT, and thus has a wide preoperative differential diagnosis. This includes cystic or solid lesions from surrounding structures such as liver, kidney, spleen, retroperitoneum, etc [8]. They may mimic adrenal tumors, but a small series detected internal hemorrhage in 6 out of 7 adrenal pseudocysts [9,10]. ...
... While their etiology has not been definitively established, these lesions could arise from hemorrhage into the adrenal gland or cystic degeneration of adrenal neoplasms [11]. They are characterized by an absence of true epithelium and are frequently surrounded by a fibrous wall, with or without surrounding residual adrenal tissue [8,11]. Clinically they are commonly indolent, until they reach a significant size and exert a mass effect on surrounding tissues [3,12]. ...
Adrenal cysts are uncommon lesions that are usually benign, with an incidence of 0.06-0.18%. Pseudocysts are the second most common type of adrenal cyst. We present the case of a 57-year-old female whose CT scan of the abdomen incidentally revealed a 7.2 cm right adrenal tumor with peripheral calcifications. Due to its large size and unusual CT findings, resection was indicated.
... Non -neoplastic adrenal cysts are clas si fied into four groups: en dothe lial cysts (45%), pseudo cysts (39%), ep ithelial cysts (9%), and par a sitic cysts (7%) [ 4 ]. Adrenal pseudo cysts arise within ei ther the cor tex or medulla, and are sur rounded by a fi brous wall de void of an ep ithe lial or en dothe lial lin ing [ 3 ]. Most pseudocysts in chil dren de velop as a re sult of adrenal he m or rhage, which is much more com mon in neonates than in older chil dren or adults, and is as so ci ated with pre na tal or peri na tal stress, hy poxia, sep ticemia, hy poten sion, and de hy dra tion [ 1 , 5 ]. ...
... The chal lenge of di ag nos ing adrenal pseudo cysts pre -operatively has been well de scribed in the lit er a ture, mainly be cause of its close prox im ity and ad he sion to ad ja cent or gans [ 3 ]. The dif fer en tial di agno sis in cludes splenic, he patic, re nal, mesen teric, retroperi toneal, and urachal cysts, as well as solid adrenal tu mors [ 3 ]. ...
... The chal lenge of di ag nos ing adrenal pseudo cysts pre -operatively has been well de scribed in the lit er a ture, mainly be cause of its close prox im ity and ad he sion to ad ja cent or gans [ 3 ]. The dif fer en tial di agno sis in cludes splenic, he patic, re nal, mesen teric, retroperi toneal, and urachal cysts, as well as solid adrenal tu mors [ 3 ]. CT has been the gold stan dard for imag ing adrenal masses, but MRI may be the best modal ity for vi su al iz ing in tra cys tic com po nents since pseudo cysts often have more com pli cated com po nents than sim ple cysts [ 3 , 6 ]. ...
A nine year-old boy with a complex medical history, including Phelan-McDermid syndrome, autism spectrum disorder, and focal epilepsy was admitted from Infectious Disease (ID) clinic for persistent fever for over three weeks. Laboratory studies were significant for leukocytosis, elevated inflammatory markers, transaminitis, and anemia. He was initially thought to have an infected duodenal duplication cyst with secondary parapneumonic involvement on imaging. Exploration revealed a densely inflamed suprarenal cyst with a communication to the duodenum. Pathology revealed an infected and hemorrhagic adrenal pseudocyst. We speculate that he had a relatively old or subacute hemorrhagic adrenal pseudocyst that subsequently became infected and perforated into the duodenum and sub-diaphragmatic space. Keywords: Adrenal pseudocyst, Adrenal hemorrhage, Persistent fevers
... The wall of a pseudocyst seems to have occasional calcification on CT. MRI is pathognomonic for visualizing the complicated intracystic components [15]. ...
... Regarding surgical treatment, the open approach is preferable if the patient is symptomatic, the mass is > 6 cm, or there is a possibility of malignancy. Laparoscopic surgery is indicated for small tumors or pseudocysts provided there is no peri-adrenal infiltration and subsequent capsular disruption [15,16]. Conclusions ACC is a rare and aggressive malignancy. ...
Background
There are an estimated 1–2 cases per million per year of adrenocortical carcinoma in the USA. It represents a rare and aggressive malignancy; it is the second most aggressive endocrine malignant disease after anaplastic thyroid carcinoma. Non-secretory adrenal masses are diagnosed late due to a mass effect or metastatic disease or found incidentally (adrenal incidentalomas).
Case presentation
The first case report describes a 39-year-old Greek woman who presented to our department with complaints of repeated symptoms of flatulence and epigastric discomfort over a few months. The second case report is about a 67-year-old Greek woman who presented to our department after being evaluated for fatigue, mass effect, and epigastric discomfort. Both of them were diagnosed as having a nonfunctioning adrenocortical carcinoma and underwent open adrenalectomy.
Conclusions
Approximately 60% of patients with adrenocortical carcinoma present with symptoms and signs of hormonal secretion. Our cases’ adrenocortical carcinomas were not functional. Hormone secretion is not a discriminating feature between benign and malignant adrenocortical masses. The silent clinical nature of nonfunctioning adrenocortical carcinoma results in late diagnosis, while the majority of patients present with locally advanced and/or metastatic disease.
Adrenocortical carcinoma is a rare endocrine tumor with a poor prognosis that can be diagnostically challenging and demands high clinical suspicion. The work-up for adrenal masses must include determination of whether the mass is functioning or nonfunctioning and whether it is benign or malignant.
... Considering the increasful availability of the TDM, they represent 5.7% of adrenal incidentalomas. 1 The cystic lesions of the adrenal gland are scarce with an estimated incidence of 0.064 to 0.18%. [1][2][3][4] They can shift from malignant cystic tumors to pseudoscystics that represent 38 to 80% of all the adrenal cystic. 3,5 Moreover, there are only 130 pseudocysts that have been reported in literature so far. 1 We report a patient's case followed up for "adrenal incidentalomas", operated because of the tumor's size and the radiological suspicion of the malignancy. ...
... The initial lesion leads to the development of a cavity with cicatricial fibrous coating that grows over time. 2,4,8 Another theory suggests that these lesions are true cysts that have lost their cell lining due to inflammation and bleeding in the cyst. 2,4,8 The pseudocysts are mostly unilateral and their size exceptionally exceeds 10 cm. ...
... 2,4,8 Another theory suggests that these lesions are true cysts that have lost their cell lining due to inflammation and bleeding in the cyst. 2,4,8 The pseudocysts are mostly unilateral and their size exceptionally exceeds 10 cm. It is noted that 7% of all pseudocysts are malignant or potentially malignant and this risk increases with size, especially when it exceeds 6 cm. ...
... Based on statistic analysis, it becomes clear that most adrenal pseudocysts are asymptomatic because of their small size and their location in the retroperitoneum; however, when they grow up signi cantly, they may cause compression of neighboring structures or/and increase intraabdominal pressure [9]. e three most frequently reported clinical features are a dull pain in the anatomic area where the adrenal pseudocyst is located, gastrointestinal symptoms, and a palpable mass, while adrenalectomy, laparoscopic or open, is the preferable treatment method (Table 1). ...
... Nuclear medicine imaging, such as 131 I-MIBG scintigraphy, may be used for the di erentiation of an adrenal pseudocyst from a cystic pheochromocytoma, apart from the pertinent biochemical investigations, which should consist of a comprehensive preoperative hormonal and functional evaluation (serum vanyl-mandelic acid, adrenocorticotropic hormone, and cortisol levels) [20]. e di erential diagnosis of an adrenal pseudocyst essentially includes all the upper abdominal space-occupying lesions, such as splenic, hepatic, and renal cysts, as well as mesenteric or retroperitoneal cysts, urachal cysts, and solid adrenal tumours [9,12,13,16]. However, it must be noted that a preoperative diagnosis of a large adrenal pseudocyst can be very di cult indeed, due to the indistinct boundaries with surrounding organs as well as the presence of adhesions to neighboring organs [9], as in our case, where di erential diagnosis of the adrenal or pancreatic origin of the mass could not be established through radiologic examination. ...
... e di erential diagnosis of an adrenal pseudocyst essentially includes all the upper abdominal space-occupying lesions, such as splenic, hepatic, and renal cysts, as well as mesenteric or retroperitoneal cysts, urachal cysts, and solid adrenal tumours [9,12,13,16]. However, it must be noted that a preoperative diagnosis of a large adrenal pseudocyst can be very di cult indeed, due to the indistinct boundaries with surrounding organs as well as the presence of adhesions to neighboring organs [9], as in our case, where di erential diagnosis of the adrenal or pancreatic origin of the mass could not be established through radiologic examination. ...
Adrenal pseudocysts are rare entities and occurred in the 5th and the 6th decades of life. They are discovered accidentally, while appearing with nonspecific clinical and imaging findings. We report a case of a 28-year-old woman presented in our Emergency Department complaining about upper abdomen pain. Computed tomography revealed a hypodense cystic lesion containing hyperdense material. The size of a mass was 11. 7 × 9.3 × 6.6 cm in diameter close to the pancreas, but the origin was from the left adrenal gland. The mass was excised with surgical laparotomy. Giant adrenal pseudocysts are rare entities. Final diagnosis usually confirmed with the pathology examination. Management of such adrenal lesions depends on the unique characteristics, the surgeon’s experience, and local resources.
... Patients presenting with fever and tachycardia secondary to an underlying pseudocyst is a rare finding and often requires surgical intervention. 13 An increasing incidence of adrenal cysts has been suggested by some authors, this is thought to be secondary to increasing use of radiological modalities for diagnostic purposes. 8 Frequent use of ultrasound or CT scans on patients with non-specific symptoms or signs is now commonplace in medicine, and it can now be said that the vast majority of patients diagnosed with adrenal cysts occur as incidental findings on CT scans. ...
A man aged 33 years presented with a 3-day history of left-sided testicular discomfort. Clinical examination revealed a large left-sided varicocele. He was referred for a testicular ultrasound, which demonstrated a moderate left-sided varicocele and an associated large suprarenal mass. An urgent (CT) scan was arranged which confirmed this, with associated compression of adjacent structures, including the left kidney and left renal vessels. The patient was admitted 1 week following the CT scan with features of sepsis. An inpatient adrenal MRI scan suggested the presence of a large left-sided haemorrhagic adrenal cyst. This was removed surgically through a left subcostal incision. Histology confirmed there was no malignancy. The patient was discharged and a follow-up CT scan at 6 months showed complete resolution of the cyst with no further testicular discomfort. This is the first known case of an adrenal cyst presenting with a varicocele.
... Calcification may be present in the wall or septum. (2,9,11) Histopathologicalexaminationofthespecimenconfirmsthe diagnosisofadrenalcysts.Trueadrenalcystsarelinedwith endothelial or epithelial cells, but adrenal pseudocysts are devoidofarecognizablelayerofliningcellsandenclosedbya fibroustissuewall. (7) The management of adrenal pseudocysts depends on some (4,11,12) Basedonourknowledge,thereare a few reports, that showed the feasibility of laparoscopic techniqueforlarge(>6cm)adrenalcystsandmasses. ...
... Adrenal pseudocyst are rare cystic masses that arise from the adrenal gland which are usually non-function and asymptomatic [1]. The symptomatic occasionally may be due to large size, adrenal dysfunction and infection. ...
Abstract: Adrenal pseudocyst is a rare condition and most of them are non functional and asymptomatic. Large pseudocyst may cause pressure effect and have compressive symptom to adjacent organ. Adrenal pseudoyst are devoid of lining epithelium and have a fibrous wall only. Here author reports a case of 36 year old female patient with a giant adrenal pseudocyst having pain in left hypochondrium and low grade fever. CT scan revealed a large cystic mass in left lumber region. Her all laboratory test are within normal limit. It was excised and diagnosis made as adrenal pseudocyst
Keywords: Adrenal, Pseudocyst
... L'imagerie en a donné la topographie et l'analyse anatomopathologique le diagnostic de certitude. L'exérèse de la masse a amélioré la symptomatologie Les kystes et les pseudokystes représentent actuellement 5,7% des incidentalomes surrénaliens [2,3]. Histologiquement, des quatre sous-types de kystes surrénaliens de la classification de Foster [4], les pseudokystes, sont les plus fréquents avec environ 80% des cas, avant les kystes parasitaires, endothéliaux et épithéliaux, [1,2]. ...
... L'exérèse de la masse a amélioré la symptomatologie Les kystes et les pseudokystes représentent actuellement 5,7% des incidentalomes surrénaliens [2,3]. Histologiquement, des quatre sous-types de kystes surrénaliens de la classification de Foster [4], les pseudokystes, sont les plus fréquents avec environ 80% des cas, avant les kystes parasitaires, endothéliaux et épithéliaux, [1,2]. Ils peuvent se rencontrer à tout âge, le plus souvent entre la quatrième et la cinquième décade [1,5]. ...
... Les trois principaux signes cliniques, retrouvés dans notre observation, sont la masse abdominale, et dus à la compression, les douleurs lombaires ou abdominales, et les troubles digestifs [2]. Exceptionnellement, un tableau d'abdomen aigu par rupture, infection ou hémorragie intrakystique peut apparaître [6,7]. ...
Introduction: Les pseudokystes géants de la surrénale sont exceptionnels. A travers une nouvelle observation, nous en décrivons les aspects épidémiologiques diagnostiques et thérapeutiques.
Observation: Un patient de 52 ans, sans antécédents notables, rapportait depuis 15 jours des douleurs à l'hypochondre gauche, des vomissements bilieux, et une altération de l’état général. L'examen clinique révélait une volumineuse masse de l'hypochondre gauche. L’échographie et la tomodensitométrie abdominales montraient une énorme lésion kystique intersplénorénale, refoulant les organes voisins. Le bilan biologique surrénalien était normal et la sérologie hydatique négative. La laparotomie avait confirmé la nature kystique de la masse. L'analyse histopathologique de la paroi du kyste n'a montré ni épithélium; ni endothélium, mais un infiltrat inflammatoire polymorphe.
Conclusion: Le pseudokyste géant surrénalien observé était symptômatique et non fonctionnel. Le diagnostic de certitude en a été histopathologique, après exérèse chirurgicale.
... However, a preoperative confirmatory diagnosis of a large adrenal cyst can be very difficult because of the indistinct boundary with surrounding organs and adhesion to neighboring organs. 3 The differential diagnosis of adrenal cysts includes splenic, hepatic, and renal cysts, as well as mesenteric or retroperitoneal cysts, urachal cysts, and solid adrenal tumors. ...
