ADRENAL CYSTIC LESIONS - REPORT OF 12 SURGICALLY TREATED CASES AND REVIEW OF THE LITERATURE

Adrenal cysts are rare (0,064%-0,18% in autopsy series) and less than 500 cases have been reported in the western literature. Incidental dia gnosis of adrenal cysts, however, is reported with increasing rates. W e observed 12 patients with adrenal cyst. Each of them had a careful l aboratory and instrumental evaluation; all the patients were operated. In our series about 67% of the patients were symptomatic (6 patients with abdominal pain, 1 with palpable mass, 1 with hemorrhagic shock). No biochemical alteration was observed. Conversely we observed an unus ual subclinically hyperfunctioning cystic adenoma, potentially progres sive to a clinically recognizable endocrine syndrome. US, CT and MRI h ad a sensitivity of 66,7%, 80% and 100% respectively. Adrenalectomy wa s performed in all patients. The pathological findings were: 1 epithel ial cyst (cystic adenoma), 2 endothelial cysts (vascular cystic ectasi a with adenomatous adrenocortical hyperplasia and 1 vascular cyst) and 9 pseudocysts. On the basis of these results, we conclude that a care ful hormonal, morpho-functional and instrumental evaluation is indicat ed in all adrenal cysts, even if the available diagnostic procedures, even when combined, cannot always define their nature. Surgical excisi on, when possible by laparoscopic approach, is indicated in presence o f symptoms, endocrine abnormalities (even when subclinic), complicatio ns, suspicion of malignancy and/or large size (>5 cm). Adrenal gland m ust be excised en bloc, also because of the possible presence of other adrenal lesions. (C) 1998, Editrice Kurtis.