Fine needle aspiration cytology of primary and metastatic lesions of the adrenal gland. A series of 188 biopsies with radiologic correlation.

OBJECTIVE

To determine the efficacy of fine needle aspiration (FNA) in the diagnosis of primary and metastatic lesions of the adrenal gland in conjunction with the radiologic size of the lesion.

STUDY DESIGN

One hundred eighty-eight FNA biopsies performed between 1988 and 1992 with a diagnostic rate of 86% (161 cases) were reviewed and correlated with the radiologically (computed tomography, ultrasound) measured size of the lesion and follow-up.

RESULTS

Eighty-one cases (43%) were primary adrenal lesions, and 80 (43%) were metastatic tumors. Three large cell lymphomas and two adrenal histoplasmoses were also noted. The most common primary site of metastatic tumors was the lung; these 55 cases (29%) included 47 adenocarcinomas and 3 small cell, 2 large cell and 3 squamous cell carcinomas. The other metastatic tumors were 5 melanomas, 7 renal cell carcinomas and 1 mixed müllerian tumor. The size of the metastatic tumors averaged 5.1 +/- 2.5 cm (+/- SD) and ranged from 1.5 to 10 cm in greatest diameter. Benign cortical nodules (61 cases, 32%) were the most common primary adrenal lesion, followed, in decreasing frequency, by 11 cortical neoplasms/carcinomas, 5 pheochromocytomas and 1 myelolipoma. The benign cortical nodules/adenomas measured an average of 2.4 +/- 0.8 cm in greatest diameter and ranged from 1 to 4 cm. The cortical neoplasm/carcinoma sizes ranged from 4 to 12 cm.

CONCLUSION

These data suggest that FNA in conjunction with the radiologically measured size of adrenal lesions is a specific and sensitive method of evaluating primary and metastatic lesions of the adrenal gland. It is also an important diagnostic tool in cancer staging, obviating open surgical procedures for many patients.