Diagnosis of Undetermined Masses in Adrenal Gland Topography Mimicking Adrenal Tumors – Experience of a Tertiary Health Center

Presentation Number: SUN 406
Date of Presentation: April 2nd, 2017

Vânia Balderrama Brondani*1, Fabio Y. Tanno2, Ricardo Miguel Costa de Freitas3, Sandro S Fenelon4, Maria Adelaide Albergaria Pereira5, Madson Q. Almeida6, Berenice Bilharinho Mendonça7, Maria Candida B V Fragoso8 and Jose Luiz Chambo9
1Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, BRAZIL, 2Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 3Instituto do Cancer do Estado de Sao Paulo, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil, 4Institute of Cancer of sao Paulo -ICESP, SAO PAULO, Brazil, 5Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SAO PAULO, Brazil, 6University of Sao Paulo, Sao Paulo, Brazil, 7Hospital das Clinicas University of Sao Paulo, Sao Paulo, Brazil, 8Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, 9Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

Abstract

Introduction: Masses in adrenal topography have been diagnosis frequently due to more available access to radiological imaging. Clinical, laboratory and imaging work-up is mandatory to establish the diagnosis and to indicate the correct treatment. Our Hospital is a tertiary center and national reference to adrenal disorders. Objective: Our aimed is to analyze retrospectively the definitive diagnosis of non-functional masses in adrenal gland topography identified by CT or MRI from 2006 to 2016. Methods: Twenty-four patients (18 females and 6 males), with mean chronological age of 48 years (range 18-82 years) performed the abdominal CT or MRI due to abdominal pain (62%), urinary infection (16%), nephrolithiasis (8%) and in 14% without clear reason. All of them were submitted to extensive laboratorial workup to determine adrenal functionality according to ENSAT statement2. Results: None of the patients had any clinical signs of adrenal hyperfunction neither hormonal alteration. The radiological imaging (CT or RM) showed masses at adrenal topography, 58% of them at the left side, with a median diameter size of 8.4 cm (ranging from 2.3 to15 cm); 45% of the masses were >10 cm, 8% were <4 cm. Among the 19 abdomen CTs available the pre-contrast average Hounsfield units (HU) in the masses were 28.3 HU (range - 3 HU to 50 HU): 16 masses had 32.5 HU (range 12-50 HU) and in 3 had <10 HU (range -3 to 9 HU). Histopathological diagnosis of the masses smaller than 4 centimeters were: ganglioneuroma (3.5 cm) and acute splenitis (2.3 cm). Intermediary masses (4-10cm) were: ganglioneuroma (n=3), schawannoma(n=2), myelolipoma(n=1), haematoma(n=1), hemorrhage(n=1), epithelioid cancer(n=1), lymphangioma(n=1), leiomyosarcoma(n=1). Masses larger than 10 cm were: ganglioneuroma (n=2) sarcoma (2), haemorrhagic hemangioma(n=2), leiomyosarcoma(n=1), neuroendocrine carcinoma(n=1), renal carcinoma(n=1), neuroblastoma(n=1) and hepatic cell carcinoma (n=1). Discussion: Adrenal incidentalomas are found in up to 10% of patients undergoing abdominal imaging. Differential diagnosis includes both benign and malignant lesions. According to the recent guidelines on adrenal incidentaloma, the recommendation to perform adrenalectomy is if the radiological findings are suspicious of malignancy or signals of local invasion2. Our retrospective analysis of non-functional masses in adrenal gland topography mimicking adrenal tumors showed that the most prevalent lesions were ganglioneuroma (25%), leiomyosarcoma (8%), sarcoma (8%), haemorrhagic hemangioma (8%) and schwannoma (8%).

Conclusion: In our cohort, ganglioneuromas, leiomyosarcoma, sarcoma, haemorrhagic hemangioma and schwannoma were the most frequent lesions in adrenal gland topography mimicking non functional adrenal tumors.

 

Nothing to Disclose: VBB, FYT, RMCDF, SSF, MAAP, MQA, BBM, MCBVF, JLC