Adrenal Cystic Lesions: A Clinicopathological Analysis of 25 Cases with Proposed Histogenesis and Review of the Literatu
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Adrenal Cystic Lesions: A Clinicopathological Analysis of 25 Cases with Proposed Histogenesis and Review of the Literature Hui-Ping Chien & Yu-Sun Chang & Pei-Sung Hsu & Jen-Der Lin & Yi-Chin Wu & Hui-Lang Chang & Cheng-Keng Chuang & Ke-Hung Tsuei & Chuen Hsueh
Published online: 30 October 2008 # Humana Press Inc. 2008
Abstract Adrenal cystic lesions are uncommon and we analyzed clinical and pathologic features of 25 such cases from a single institute over 23 years. There were 16 pseudocysts, eight endothelial cysts, and one epithelial cyst. Seven of eight endothelial cysts were confirmed to be lymphangiomatous by D2-40 immunostaining. We suggest that pseudocysts and endothelial cysts may have different histogenesis. The proposed mesothelial origin of adrenal epithelial cyst cannot be confirmed in our example. Seven adrenal pseudocysts were associated with tumor, including two pheochromocytomas, one neuroblastoma, one adrenal cortical carcinoma, one adrenal cortical adenoma, one myelolipoma, and one schwannoma. The distinction of true H.-P. Chien : C. Hsueh (*) Department of Pathology, Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Kuei-Shan, Taoyuan, Taiwan, Republic of China e-mail: [email protected] Y.-S. Chang : Y.-C. Wu : C. Hsueh Chang Gung Molecular Medicine Research Center and Graduate Institute of Basic Medical Sciences, Chang Gung University, Taoyuan, Taiwan P.-S. Hsu Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan J.-D. Lin Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan H.-L. Chang : C.-K. Chuang : K.-H. Tsuei Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
cystic lesion from cystic neoplasm is important and requires thorough sampling of the specimens. Keywords D2-40 . adrenal cystic lesions . endothelial cyst . pseudocyst . epithelial cyst immunohistochemistry
Introduction Although the first case of adrenal cyst was described in 1670 by Greselius, cystic lesions in the adrenal gland are uncommon and only few large series have been reported [1–8]. The case numbers were generally small including eight cases by Meideiros et al. [7], 12 cases by Bellantone et al. [3], and 15 cases by Erbil et al. [5]. The largest series was reported by Erickson et al. in 2004 with a total number of 41 cases at a single institute [4]. Our study was the second largest including 25 such cases. Wahl found nine adrenal cystic lesions in 13,996 autopsies with an incidence of 0.064% [8]. However, a true incidence of adrenal cystic lesions may be higher because the small-sized lesions are often clinically silent. Their diagnostic rate has been increased in last two decades due to the common use of imaging studies with improved techniques. Terrier and Lecène have initially classified adrenal cystic lesions into hemorrhagic cysts, endothelial cysts, congenital retention cysts, cystic adenomas, and parasitic cysts [9]. Subsequent classifications have been proposed and the one by Barron and Em
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