Non-adrenal tumors of the adrenal area; what are the pitfalls? - 16/06/20
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Iconographies | 10 |
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Highlights |
• | Not all adrenal masses are of adrenal origin. |
• | Diagnostic pitfalls are most frequently left-sided due to the wide variety of anatomical structures surrounding the adrenal gland. |
• | Some non-adrenal masses present specific radiological characteristics, but that is not invariably the case; CT-scan or MRI can provide mistaken information. |
• | Discovery of a presumably adrenal mass necessitates assessment of hormonal secretion so as to rule out a secreting tumor, particularly a pheochromocytoma. |
• | While image-guided biopsy is indispensable in the event of suspected sarcoma, its interest will vary according to the characteristics of the suspected tumor. |
• | Positron emission tomography and 18-Fluorodeoxyglucose are not suited to determination of the adrenal origin of adrenal masses. |
• | When differential diagnosis proves impossible, surgery is required. It may nonetheless be necessary to modify operating strategy and conserve the adrenal gland when the lesion seems exterior to the gland. |
Summary |
Discovery of an adrenal mass is nowadays a frequent situation. While adrenal tumors can cause a variety of symptoms, more often than not they are diagnosed incidentally on imaging exams such as CT-scan or MRI performed for another purpose. However, any retroperitoneal supra-renal mass can have an extra-adrenal origin. Indeed, operated non-adrenal masses initially but wrongly diagnosed as an adrenal disease represent about 3.5% of adrenalectomies. These differential diagnoses principally include retroperitoneal tumors that are malignant in two thirds of cases (lymphomas, sarcomas, neurogenic or germinal tumors), and more rarely vascular anomalies or congenital malformations, which are most frequently left-sided due to the wide variety of anatomical structures surrounding the left adrenal gland. Several lesions can originate from the adrenal gland or be located near the gland (paraganglioma, ganglioneuroma). Even though unilateral adrenalectomy is associated with low morbidity, ignorance of these differential diagnoses can cause ill-adapted management; overly conservative surgery in case of sarcoma is one example. Some of these lesions have characteristic clinical or imaging features (cystic lymphangioma, angiomyolipoma…). In other cases, assessment of hormonal secretion is required and additional exams (MRI, percutaneous biopsy, PET-scan with 18-Fluorodeoxyglucose) can correct an erroneous diagnosis. The above diagnostic approach allows appropriate management (with or without surgery). The purpose of this review was to highlight the main differential diagnoses of adrenal masses, to describe their characteristics, and to discuss their therapeutic management.
Le texte complet de cet article est disponible en PDF.Keywords : Adrenal incidentaloma, Adrenal, Adrenalectomy, Retroperitoneal mass
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Vol 157 - N° 3
P. 217-230 - juin 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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