Department of Pathology and Laboratory Medicine, Saskatoon, Saskatchewan, Canada.
World J Surg Oncol. 2012 Apr 27;10:64. doi: 10.1186/1477-7819-10-64.
The discovery of adrenal incidentalomas due to the widespread use of sophisticated abdominal imaging techniques has resulted in an increasing trend of adrenal gland specimens being received in the pathology laboratory. In this context, we encountered three uncommon adrenal incidentalomas.The aim of this manuscript is to report in detail the three index cases of adrenal incidentalomas in the context of a 13-year retrospective surgical pathology review.
The three index cases were investigated and analyzed in detail with relevant review of the English literature as available in PubMed and Medline. A 13-year retrospective computer-based histopathological surgical review was conducted in our laboratory and the results were analyzed in the context of evidence-based literature on adrenal incidentalomas.
A total of 94 adrenal specimens from incidentalomas were identified, accounting for 0.025% of all surgical pathology cases. In all 76.6% were benign and 23.4% were malignant. A total of 53 females (56.4%) and 41 males (43.6%) aged 4 to 85 years were identified. The benign lesions included cortical adenoma (43.1%), pheochromocytoma (29.3%) and inflammation/fibrosis/hemorrhage (8.3%). Metastatic neoplasms were the most common malignant lesions (50%) followed by primary adrenocortical carcinomas (31.8%) and neuroblastoma (13.6%). These cases were discovered as adrenal incidentalomas that led to surgical exploration.The three index cases of adrenal incidentalomas with unusual pathologies were encountered that included (a) adrenal ganglioneuroma, (b) periadrenal schwannoma and (c) primary adrenal pleomorphic leiomyosarcoma. These cases are discussed, with a literature and clinicopathological review.
Adrenal lesions are uncommon surgical specimens in the pathology laboratory. However, higher detection rates of adrenal incidentalomas aided by the ease of laparoscopic adrenalectomy has resulted in increased adrenal surgical specimens leading to unsuspected diagnostic and management dilemmas. Accurate pathological identification of common and uncommon adrenal incidentalomas is essential for optimal patient management.
由于腹部影像学技术的广泛应用，发现了越来越多的肾上腺意外瘤，导致送往病理实验室的肾上腺标本数量不断增加。在此背景下，我们遇到了三个罕见的肾上腺意外瘤病例。本文旨在详细报告 13 年回顾性外科病理检查中这三个肾上腺意外瘤的病例。
详细研究了这三个病例，并查阅了 Pubmed 和 Medline 上可用的相关英文文献。在我们的实验室中进行了一项为期 13 年的基于计算机的回顾性组织病理学外科检查，并结合肾上腺意外瘤的循证文献对结果进行了分析。
共发现 94 例肾上腺意外瘤标本，占所有外科病理病例的 0.025%。所有病例中良性肿瘤占 76.6%，恶性肿瘤占 23.4%。共发现 53 名女性（56.4%）和 41 名男性（43.6%），年龄 4 至 85 岁。良性病变包括皮质腺瘤（43.1%）、嗜铬细胞瘤（29.3%）和炎症/纤维化/出血（8.3%）。转移性肿瘤是最常见的恶性肿瘤（50%），其次是原发性肾上腺皮质癌（31.8%）和神经母细胞瘤（13.6%）。这些病例是作为肾上腺意外瘤发现的，导致了手术探查。遇到了三个具有不同病理表现的罕见肾上腺意外瘤病例，包括（a）肾上腺神经节瘤，（b）肾上腺周围神经鞘瘤和（c）原发性肾上腺多形性平滑肌肉瘤。对这些病例进行了讨论，并进行了文献和临床病理复习。
肾上腺病变在病理实验室中并不常见。然而，由于腹腔镜肾上腺切除术的便利性，肾上腺意外瘤的检测率有所提高，导致肾上腺手术标本数量增加，从而带来了意想不到的诊断和治疗难题。准确识别常见和罕见的肾上腺意外瘤对于患者的最佳管理至关重要。
