A Review of Cystic Lesions of the Adrenal Gland: Our Experience over the Last 20 Years
Christopher Sebastiano, Xiangrong Zhao, Fang-Ming Deng, Kasturi Das. New York University Langone Medical Center, New York, NY; National Institute of Cancer, National Institutes of Health; University of Wisconsin, Madison, WI
Background: Cystic lesions of the adrenal gland are uncommon, often presenting with non-specific clinical and radiologic findings, and are thus underrecognized. They are occasionally associated with malignant neoplasms, which can greatly mimic benign lesions and carry detrimental clinical consequences if misdiagnosed. A review is desired on the demographic, clinical, radiologic, gross and microscopic pathologic features, as well as the differential diagnoses of cystic adrenal lesions. Here we present our 20-year experience with these lesions at a large academic medical center.
Design: An extensive database search (1992-2012) for primary cystic adrenal lesions was performed. Macroscopic descriptions, available histologic and immunostain slides, and available radiologic records were reviewed for all included cases.
Results: Among over 4,500 adrenal gland specimens microscopically examined, 31 cases of adrenal lesions with predominant cystic components were identified in 30 patients, summarized in Table 1. The patients ranged in age from 34 to 86 years (median, 55.5) with a male to female ratio of 13:17. Radiologic studies and gross examination correlated well: 20 (64%) of these lesions were almost entirely cystic, 8 (26%) exhibited accompanying solid components, and the remaining 3 (10%) had significant cystic degeneration. In addition, hemorrhage (26 cases, 84%) and encapsulation (24 cases, 77%) appeared to be non-specific radiologic/gross features shared across histologic subtypes. Microscopic review identified 2 cases (6%) as malignant neoplasms (1 adrenocortical carcinoma, 1 epithelioid angiosarcoma); the remaining 29 (94%) were benign lesions. Radiologic impression and histopathologic diagnosis were concordant in 11 of the 15 cases (73%) for which radiologic records were available.
Conclusions: This study represents the second largest case series to date on cystic adrenal lesions, summarizing their most updated clinicopathologic data, and presents a comprehensive review on their differential diagnoses.
|Subtypes of adrenal cysts||Subtotal||Benign||Malignant|
|Pseudocysts (no inner wall lining)||12 (39%)||12||0|
|Epithelial-derived||17 (56%)||16 (pheochromocytomas)||1 (adrenocortical carcinoma)|
|Endothelial-derived||2 (6%)||1||1 (angiosarcoma)|
|Total||31 (100%)||29 (93.6%)||2 (6.4%)|