Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
BMC Urol. 2023 Apr 15;23(1):60. doi: 10.1186/s12894-023-01238-1.
Adrenal incidentalomas are radiologically discovered tumors that represent a variety of pathologies, with the diagnosis clinched only on surgical pathology. These tumors may be clinically monitored, but triggers for surgery include size > 4 cm, concerning features on radiology, or hormonally functioning. Adrenal oncocytic neoplasms (AONs) are notably rare and typically nonfunctional tumors that are discovered as incidentalomas and exist on a spectrum of malignant potential.
We discovered an exceptionally large (15 cm in the greatest dimension) incidentaloma in a 73-year-old man with left back pain and he was treated with robotic-assisted adrenalectomy. Surgical pathology was consistent with AON of borderline uncertain malignant potential; adjuvant mitotane and radiation were omitted based on shared decision-making.
Large AONs are rare, usually benign tumors that can be safely treated with robotic-assisted adrenalectomy. Surgical pathology is the crux of diagnosis and post-operative management, as it informs both the initiation of adjuvant therapy and the stringency of post-operative surveillance.
肾上腺意外瘤是影像学发现的肿瘤，代表了多种病理学特征，只有手术病理学才能确诊。这些肿瘤可以临床监测，但手术指征包括肿瘤直径>4cm、影像学上有可疑特征或功能性肿瘤。肾上腺嗜酸细胞瘤（AON）是非常罕见的，通常为无功能性肿瘤，作为意外瘤被发现，其恶性潜能存在一定的范围。
我们在一名 73 岁男性中发现了一个巨大的（最大径 15cm）意外瘤，他有左侧背痛，接受了机器人辅助肾上腺切除术。手术病理学符合交界性不确定恶性潜能的 AON；根据共同决策，省略了辅助米托坦和放疗。
大的 AON 罕见，通常为良性肿瘤，可通过机器人辅助肾上腺切除术安全治疗。手术病理学是诊断和术后管理的关键，它不仅决定了辅助治疗的开始，还决定了术后监测的严格程度。
