Evaluation and surgical resection of adrenal masses in patients with a history of extra-adrenal malignancy

doi:10.1067/msy.2001.118369

Surgery

Volume 130, Issue 6, December 2001, Pages 1060-1067

Presented at the 22nd Annual Meeting of the American Association of Endocrine Surgeons, Atlanta, Ga, April 28-May 1, 2001.

https://doi.org/10.1067/msy.2001.118369 Get rights and content

Abstract

Background. Adrenal abnormalities are often identified on imaging studies performed during the staging of patients presenting with a new malignancy or restaging of patients with a history of a malignancy. Methods. We reviewed the records of patients who underwent surgical resection of an adrenal mass identified in the setting of previously or newly diagnosed extra-adrenal malignancy. Results. Eighty-one patients with an adrenal mass and recently diagnosed malignancy (n = 24) or history of a malignancy (n = 57) underwent adrenalectomy. In 42 patients (52%) the adrenal mass was a metastasis. In 39 patients (48%) the adrenal mass was an additional primary adrenal tumor process: 19 pheochromocytomas, (14 syndrome-associated, 5 sporadic), 13 cortical adenomas, 3 adrenocortical carcinomas, 2 ganglioneuromas, and 2 cases of nodular hyperplasia. Conclusions. In this series nearly half of the patients with cancer and an adrenal mass had adrenal pathologic condition independent of their primary malignancy. Despite the presence of a newly diagnosed malignancy or history of malignancy, all patients with an adrenal mass should undergo a standard hormone evaluation to confirm that the mass is not a functional neoplasm. An assumption that the adrenal mass is metastatic disease will be wrong in up to 50% of such patients. (Surgery 2001;130:1060-7.)

Section snippets

Patients and methods

The medical records of 196 patients with tumors involving the adrenal gland who were referred for evaluation and underwent adrenalectomy at The University of Texas M. D. Anderson Cancer Center from 1971 to 2000 were reviewed. Of these patients, 115 had no history of extra-adrenal malignancy; none of these patients had metastasis to the adrenal gland from an unknown primary cancer, confirming the rare nature of this presentation.⁷ Eighty-one of the 196 patients had 1 or more previously or

Results

There were 81 patients with an adrenal mass in the setting of a prior or concurrent diagnosis of 1 or more extra-adrenal malignancies who were treated by adrenalectomy. Ten of the patients had 2 extra-adrenal malignancies, resulting in a total of 91 cancer diagnoses (Table I).

. Extra-adrenal cancer diagnoses in 81 patients presenting with an adrenal mass^*

Cancer diagnosis	No. of patients	Prior diagnosis of extra-adrenal cancer	Synchronous diagnosis of extra-adrenal cancer	Unilateral adrenal mass	Empty Cell

Discussion

Relatively few studies have addressed the issue of appropriate evaluation and surgical treatment of adrenal masses in patients with a history of malignancy. Reports of adrenal incidentaloma often specifically exclude patients with synchronous or metachronous extra-adrenal malignancies,¹¹ whereas most reports of adrenalectomy for metastatic cancer exclude those with primary adrenal tumors.4, 5 Table IV compares the present series with prior series that included patients with adrenal metastases

Discussion

Dr Paul Gauger (Ann Arbor, Mich). This is an excellent paper with a very important message. I have an inherited abhorrence for FN biopsy of the adrenal, but certainly this is one of the settings in which one commonly sees it done, a history of malignancy elsewhere. I am curious about how the use of needle biopsy factored into the patients in this study, and how you would reconcile the use of that now that you have shown us that so many of these lesions are actually not metastases. Certainly

Acknowledgements

We thank Lisa Garcia for manuscript preparation.

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Citation Excerpt :
Focal hypermetabolism seen on FDG PET/CT imaging can also be helpful in differentiating metastasis from benign adrenal tumors (Fig. 9 and 10). FDG uptake in an adrenal tumor more than liver favors of metastasis and no uptake is an indicator of benignity.8,21,24-26 Lymphoma can occasionally involve the adrenals.
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^*: Reprint requests: Jeffrey E. Lee, MD, Department of Surgical Oncology, Box 444, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030.

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American Association of Endocrine SurgeonsEvaluation and surgical resection of adrenal masses in patients with a history of extra-adrenal malignancy*

Abstract

Section snippets

Patients and methods

Results

Discussion

Discussion

Acknowledgements

Surgery

Surgery

Surgery

Hum Pathol

Am J Surg

J Thorac Cardiovasc Surg

Surgery

Surgery

Incidentally discovered adrenal masses

Endocr Rev

Surgical management of adrenal metastases from lung cancer

Surg Oncol

The role of resection in the management of melanoma metastatic to the adrenal gland

Surgery

The role of surgery in the treatment of clinically isolated adrenal metastasis

Cancer

American Association of Endocrine Surgeons
Evaluation and surgical resection of adrenal masses in patients with a history of extra-adrenal malignancy*