Objectives: To evaluate the prevalence in our work center of pathology of adrenal glands and to assess the efficacy of the radiology imaging in the detection of especific features and to exclude malignancy lessions.
Material and Methods: We included patients who presented some adrenal lesion with histological study after surgerie between January 2010 and December 2015 in the hospitals of Albacete, Almansa and Villarrobledo. We use the Pathological Anatomy database and retrospectively review the clinical histories and radiological findings. We exclude fine needle puncture procedures and those cases without pathology after histological analysis. We describe the radiological findings in CT and/or MRI of these lesions, emphasizing the malignant and less frequent ones.
Results: We present a total of 83 patients. 59 patients had benign adrenal pathology: 29 adenomas, 12 pheochromocytomas, 7 myelolipomas (1 xanthogranulomatous), 1 endothelial cyst, 1 ganglioneuroma, 2 hemorrhages, 1 congenital adrenal hyperplasia, 3 cortical nodular hyperplasias, 1 tuberculous granulomatous adrenalitis and 2 collision tumors (adenoma and pheochromocytoma, pheochromocytoma and ganglioneuroblastoma). Malignant adrenal pathology was observed in 24 patients: 20 metastases, 3 cortical carcinomas and 1 type B non-Hodgkin lymphoma. The radiological findings were diagnostic of adenoma in 25 of 29 patients. The three cases of feocromocitoma were ONLY considered in the list of the radiological differential diagnosis (one in association to MEN2). 5 mielolipomas and endotelial cyst had a specific feature and were diagnosed by radiology imaging. Two of the three adrenal carcinoma and 90% of metástasis had a high suspicious diagnostic by radiology imaging. Ganglioneuroma, tuberculous granulomatous adrenalitis, hemorrhage, collision tumors and lymphoma had inespecific radiologic findings.
Conclusion: Most adrenal lesions are benign.
The adenomas, followed by the metastases, are the most frequent adrenal lesions.
There are some typical radiological signs that allows the diagnosis of the lesions, as in the case of adenomas cyst or in myelolipomas.
Even the size greater than 4 cm is a criteria that suggests malignancy, in our series many benign lesions such as myelolipomas and hemorrhages were larger than 4 cm.
The metastases were solid tumors in the context of a known neoplasm (carcinoma). The most frequent primary tumor were the lung and kidney.
Pheochromocytomas are inespecific but most are hypervascular and hyperintense in T2.
To consider that the clinical context of the patient can help us to diagnose nonspecific lesions such as pheochromocytoma or tuberculosis infection.
18 - 21 May 2019
European Society of Endocrinology