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.

Inside of an adrenal cyst

This is a 36-year old menstruating female who accused abdominal pain of non-specific pattern during the last days. Abdominal ultrasound and computer tomography confirmed a left adrenal mass of 6 centimetres with cystic appearance without solid elements. No other causes of abdominal pain were identified. Adrenalectomy was performed. The pre- and post-operatory panel of endocrine assessments was normal. Pathological report confirmed an endothelial cyst at the level of a normal adrenal gland. The endothelial cells are introduced in hematoxylin eosin stain at histological report (Figure I: 4X, Figure II: 40X). The immunochemistry reaction is positive for factor VIII in cyst cells of adrenal origin. (Figure III: FVIII positive immunostain in fused and cubic cells, 20X, Figure IV: FVIII in fused cells, 20X). Further on the clinical evolution was good. Adrenal cysts may be endothelial related, epithelial derived and pseudocysts. They are found in both adults and children but the level of evidence varies from cases series to cases reports. (1,2,3) The risk of malignancy or rupture are the major complications. (1) Endothelial cysts seem more frequent in women. (2) The scenario of detection may be of a typical adrenal incidentaloma or starting from non-specific local as seen here.

A Giant Lymphatic Cyst of the Adrenal Gland: Report of a Rare Case and Review of the Literature

Lymphatic type of adrenal cysts is most common; however, this type of endothelial cyst is quite rare in excessively large adrenal cysts. A 37-year-old Japanese woman was admitted to our institution with distension of her left flank and the upper quadrant of her abdomen. Abdominal ultrasonography revealed a cystic lesion with a homogenous anechoic texture, and measuring 21 cm in diameter. Computed tomography and magnetic resonance imaging displayed a giant cystic lesion adjacent to the liver, pancreas, kidney, and spleen. The origin of the cyst was not identified. We were not able to make a preoperative diagnosis; therefore, the patient underwent resection of the mass by open laparotomy for therapeutic diagnosis. Intraoperatively, the mass was identified to be cystic and adhered to the left adrenal gland. It was filled with more than 2000 mL of serous brown-red fluid. The content of the cyst contained no atypical cells on cytological examination. The wall of the cyst was composed of a lining of a single layer of lymphatic vessel–derived cells, and the cyst was pathologically classified as a true cyst. No abdominal symptoms were observed and a postoperative radiological work-up showed no evidence of recurrence during a 6-year follow-up period. We describe a case of a patient with a giant lymphatic cyst of the adrenal gland. The preset data suggest that surgeons should decide treatment strategy for large adrenal cysts in consideration of hormonal function, degree of size, and possibility of malignancy.