ePoster #1| Adrenal pseudocyst: Case report and review of literature

ePoster #1 | Clinical Science | Abdominal/Laparoscopy

F Lambreton, J Perone, A Perez, S Samreen

Presenter: Fernando Lambreton, MD, University of Texas Medical Branch – Galveston

Introduction/Objective: Adrenal incidentaloma has a reported incidence of 1-4%. Adrenal cysts are uncommon lesions that are usually benign, with an incidence of 0.06-0.18%. Pseudocysts are the second most common type of adrenal cyst and are characterized by an absence of a formal epithelium. These are more common in females and are usually present in the 4th to 5th decade of life.

Case Presentation: We present the case of a 57-year-old female who was being evaluated at our outpatient clinic for a recurrent ventral hernia. CT scan of the abdomen incidentally revealed a 7.2 cm right adrenal tumor with peripheral calcifications, and a Hounsfield unit measurement of 26 (per CT, possibly due to previous hemorrhage). The patient reported no symptoms that could be attributed to the mass. Evaluation by Endocrinology revealed that it was a non-functional mass, and the patient was referred to the General Surgery clinic for resection. Due to its large size and unusual CT findings, resection was indicated. She underwent robotic assisted laparoscopic right adrenalectomy through an abdominal approach. The patient was discharged on postoperative day 1 after an uneventful recovery. Pathology revealed an adrenal pseudocyst.

Discussion: Only 7% of adrenal pseudocysts are malignant, and the risk is higher in larger ones (>6 cm). Most are diagnosed incidentally, and are frequently mistaken for cystic lesions of the adjacent organs (pancreas, spleen, kidney, retroperitoneum, etc.). They are usually asymptomatic and nonfunctional, but when they’re large they may complicate with hemorrhage, infection, rupture, and/or mass effect on adjacent structures. There are multiple imaging modalities that can aid in preoperative diagnosis, including CT, MRI, and EUS, but most will be definitively diagnosed on pathology after excision.

Conclusion: We present a rare adrenal tumor that has low malignant potential, and can present with unusual CT findings (such as calcifications). Infrequently, these can result in highly morbid complications. This case exemplifies that adrenal incidentalomas are amenable to a robotic approach in carefully selected and appropriately worked up patients.

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