An Uncommon Presentation of Adrenal Cyst with Subclinical Cushing’s Syndrome: A Diagnosis Dilemma

Adrenal cysts are a rare entity that is usually nonfunctional and asymptomatic. Their association with adrenal neoplasms was rarely described in the literature. We report a unique case of a 40 -year-old woman who was referred for evaluation of a left adrenal incidentaloma with subclinical Cushing’s syndrome. The tumor was suspicious for malignancy regarding computed tomography scan (CT scan) features. Therefore, a laparoscopic left partial adrenalectomy was performed. Pathology examination showed multilocular spaces lined by endothelial cells which are compatible with endothelial adrenal cyst, associated to an adrenocortical adenoma. We further discuss the management of adrenal cyst with review of the literature.

Abnormal presentation of haemorrhagic adrenal cyst

An 81-year-old patient presented with fever and lethargy for 3 weeks. There were no other signs or symptoms of infection. Detailed history revealed a fall onto his right flank, prior to the start of fever. All microbiological, autoimmune and oncological investigations were negative. CT scan of chest, abdomen and pelvis showed haemorrhage in a previously diagnosed simple adrenal cyst. The cyst was non-functioning. The patient continued to spike fever in the following 4 weeks, otherwise remained stable. The patient was managed conservatively as haemoglobin level was stable. Repeated scan showed signs of improvement. He was discharged after 5 weeks. He remained afebrile and asymptomatic at the planned endocrinology outpatient follow-up after 8 weeks.

A retroperitoneal supra-adrenal non-communicating gastric duplication cyst: a case report and comprehensive literature review

Background Gastric duplication cyst is a rare congenital anomaly. It is usually located in close proximity to the stomach. Nevertheless, there have been seldom reports in the literature that describe unusual locations. Retroperitoneal gastric duplications cysts are extremely rare and are usually confused with renal or adrenal cysts. Case presentation In this case report, we are presenting a 2-year-old girl with a complaint of bouts of abdominal pain, found to have a retroperitoneal supra-adrenal cyst on imaging. She underwent laparoscopic resection of the cyst with uneventful post-operative course. The histopathological diagnosis was surprisingly gastric duplication cyst. Conclusion In our review of the literature, the variability of this condition and its clinical manifestation are apparent. We also conclude that this diagnostic entity should be part of the differential diagnosis of intraperitoneal or retroperitoneal cysts and that laparoscopic resection of retroperitoneal cysts is the preferred approach.

Coincidence of Large Adrenal Cyst and Prominent Hyporeninemic Hyperaldosteronism

A 67-year-old Japanese woman who had end-stage renal disease was referred to our hospital for kidney transplantation. Abdominal CT revealed a large adrenal mass with inhomogeneity. She had a history of hospitalization for stroke and heart failure and exhibited prominent hyporeninemic hyperaldosteronism. Histological examination of the resected tumor with anti-CYP11B2 antibody indicated that she had a vascular endothelial cyst with primary aldosteronism (PA) due to multiple adrenocortical micronodules. This report implicates the pathological interaction between adrenal vascular cysts and PA-mediated vascular damage of the adrenal vein.

Novel Presentation of Retroperitoneal Cyst-A Clinical Case Report

Cystic lesions of the adrenal gland are usually rare, seen in 1/5750 to 1/250,000 of the population. They may be true cysts, infectious cysts, malignancies with cystic degeneration, or pseudocysts. Adrenal cysts are rare in the differential diagnosis of Retroperitoneal Cysts (RPC) and may be treated. They can be correctly identified through pathological testing. Here, the author presents a case of giant adrenal cyst in a young 38-year-old female.

A case of successful surgical treatment of patient with adrenal cyst using 3-d modeling

Aim. Demonstration of potentials of preoperative planning and implementation of surgical resection in patients with adrenal cysts. A clinical observation of a successful surgical treatment of a rare pathology cyst of the right adrenal is presented. The choice of surgical treatment tactics is determined by the size of tumor and clinical presentation of the disease. The surgical treatment was accomplished laparoscopically which permitted to reduce the time of recovery and rehabilitation of the patient. In this clinical observation, the benefit of using 3D-modeling of the surgical area was shown for visualization of topographic and anatomic peculiarities and facilitation of the intraoperative navigation with the help of Avtoplan program developed by Samara State Medical University. Conclusion. Preoperative 3D-modeling permits to prepare to surgical intervention taking into account individual anatomic peculiarities of a patient, and to determine the optimal volume of the operation.

Ritka előfordulású, nagy méretű mellékvese-haemangioma sikeres sebészi kezelése

Összefoglaló. A mellékvese-haemangiomák ritkán előforduló, nehezen diagnosztizálható elváltozások, melyek sebészi eltávolítása gyakran nagy fokú technikai jártasságot igényel. Vizsgálatunkban egy 69 éves nőbeteg esetét ismertetjük, akinél fogyás és hypertonia miatt végzett kivizsgálás mellékvesecisztát feltételezett, valamint felvetette adrenocorticalis carcinoma jelenlétét. A preoperatív kivizsgálás során (CT és MRI) a felmerülő malignitás miatt sebészi eltávolítás vált szükségessé. A kezdeti laparoszkópos transperitonealis technikát követően a bonyolult elhelyezkedés, illetve vérzés miatt kis méretű, paramedián metszésből konvertáltunk, és bal oldali nyitott adrenalectomiát végeztünk, valamint a vese caudalis részéről egy folyadéktartalmú képletet távolítottunk el. A szövettani feldolgozás a vese középső harmadának magasságából reszekált cisztát, valamint a cranialis lokalizációról eltávolított, ritka előfordulású mellékvese-haemangiomát igazolt. A ritkán előforduló és többnyire bizonytalan preoperatív diagnózissal bíró mellékvese-haemangiomák sebészi eltávolítása nagy méretük, kompresszióra való hajlamuk, valamint malignitást utánzó megjelenésük miatt is indokolt. A laparoszkópos transperitonealis adrenalectomia extra nagy méretű (>10 cm ) és malignus tumorok, illetve nagy méretű haemangiomák eltávolítására is alkalmas eljárás. A mellékvese-haemangiomák sebészi reszekciója nagyfokú körültekintést igényel, megnövekedett vérzéshajlamuk, valamint a gyakori, nagyerekhez való közeli elhelyezkedés miatt a konverzió veszélye is jelentősen növekszik. Orv Heti. 2020; 161(47): 2006–2010. Summary. Adrenal hemangiomas are rare. Their preoperative diagnosis is usually vague, and often require advanced surgical skills for resection. We herein describe the case of a 69-year-old female patient initially presented with weight loss and hypertension. Preoperative Computed Tomography (CT) and magnetic resonance imaging (MRI) confirmed the presence of an adrenal cyst and possible adrenocortical carcinoma requiring surgical intervention. After initial laparoscopic transperitoneal approach, conversion to open surgery through a small paramedian incision was carried out due to the lesion’s problematic location and continuous intraoperative bleeding. Open adrenalectomy along with the removal of a fluid-bearing lesion from the caudal pole of the kidney was performed. Histology confirmed a cyst removed from the mid-third, and a rare occurring adrenal hemangioma from the cranial part of the kidney. Adrenal hemangiomas usually bear uncertain preoperative diagnosis. Surgical removal becomes necessary in case of increasing size, potential to compress neighbouring structures and possible malignancy. Laparoscopic transperitoneal adrenalectomy is a feasible approach for the removal of extra large (>10 cm) and even malignant lesions as well as for large hemangiomas. Surgery of adrenal hemangiomas require a high level of caution, moreover, their potential for bleeding and frequent vicinity to nearby vascular structures may increase the need for open surgery. Orv Hetil. 2020; 161(47): 2006–2010.

Laparoscopic management of an adrenal cyst – A case report

Adrenal cysts are generally rare clinical entity, but due to advances in imaging diagnostic methods, detection incidental cases are increasing. Therefore, discussions about the therapeutic management of these cases are more numerous, due to the growing number of cases. We present a case of a 29-year-old woman who has had complaints of headaches and right low back pain in the last week. She had a history of high blood pressure in the past 6 months. Clinical examination was essentially normal. Routine blood investigations including a workup for pheochromocytoma was normal. CT abdomen and pelvis showed 8x8x8cm cyst in the right adrenal gland. We decided to perform a laparoscopic excision of the adrenal cyst and successfully excised the adrenal cyst, fully saving the adrenal gland. Laparoscopic excision of the adrenal cyst seems to be the best recommended treatment option for these pathologies. The probability of recurrence after surgical excision is low.