Needle biopsy of the adrenal gland: retrospective review of 54 cases.

A retrospective review of 54 cases of adrenal gland needle biopsy in 53 patients is presented. The cases included 43 fine-needle aspirations (FNA), six core-needle biopsies, and five cases in which both types of needle biopsy were done. Clinical or histologic follow-up was available in 28 of the 36 specimens deemed adequate for evaluation. Metastatic malignancies represented the largest group of cases (19), with lung being the most common primary site (8). The series included four cases of metastatic hepatocellular carcinoma. Probable adrenocortical adenoma was the next most common diagnosis (12 cases). Cases causing diagnostic confusion included a case of metastatic well-differentiated hepatocellular carcinoma which was initially confused with an adrenocortical adenoma and a probable adrenocortical adenoma which was mistaken for a metastatic small round cell malignancy. (This case is unproved because of lack of clinical or histologic follow-up). By evaluating only those cases with histologic confirmation or clinical follow-up greater than one year, the sensitivity of needle biopsy for the presence of malignancy was 95% and the specificity was 100%. The cytologic findings are described with attention to the potential problem of confusing primary adrenocortical neoplasms with metastases from hepatocellular carcinoma.