The incidentally discovered adrenal mass. N Engl J Med

Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
New England Journal of Medicine (Impact Factor: 54.42). 03/2007; 356(6):601-10. DOI: 10.1056/NEJMcp065470
Source: PubMed
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    • "The adrenal gland is a relatively frequent site for metastatic disease [3]. The most common malignant lesions that metastasize to the adrenal gland include malignant melanoma, breast, lung, kidney, esophagus, pancreas , liver, stomach, and colon cancers [4] [5] [6]. In patients with a primary neoplasm, in whom an adrenal metastasis is an important consideration, most adrenal masses are benign, commonly non-hyper functioning adenomas [7]. "
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    ABSTRACT: Purpose: Our aim was to evaluate the diagnostic value of MRI using different param-eters in differentiation of adenomas versus non-adenomas adrenal lesions. Materials and methods: Forty-five patients with 48 adrenal masses (28 lipid rich adenomas, 3 lipid poor adenomas, 15 metastases and 2 lymphoma) were retrospectively evaluated with MRI. The mean diameter of adrenal mass, T2WI signal, signal drop on chemical shift imaging (CSI) and enhancement pattern were assessed separately and in various combinations. Accuracies, sensitivi-ties, specificities, PPV, NPV and P values by Chi-square test were calculated for individual and combined parameters. Results: Signal drop on CSI and enhancement pattern were the most statistically significant diag-nostic discriminators of adenomatous and non-adenomatous lesions with accuracies, specificities and sensitivities of 93.8%, 90.3%, 100% and 91.7%, 93.5%, 88.2%, respectively (P-value <0.0001). The best performance of a combination of parameters was obtained after exclusion of the size, with an accuracy of 89.6% (P-value <0.0001). Conclusion: The most specific predictors for adrenal mass characterization were CSI signal drop and Gd-DTPA enhancement characteristics. Combining the MR parameters did not prove superior (S. Emad-Eldin). Peer review under responsibility of Egyptian Society of Radiology and Nuclear Medicine.
    07/2014; 45(3). DOI:10.1016/j.ejrnm.2014.06.004
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    • "2) Neuroblastoma , Gangiloneuroma and pheochromocytoma which arise from medulla of the adrenal glands. Most adrenal pheochromocytomas and all adrenocortical adenomas are benign tumors, which do not metastasize, but which may still cause significant health problems by giving rise to hormonal imbalances (Young 2007). Hyperadrenocorticism (HAC) is caused by either excessive pituitary ACTH secretion, as in pituitary-dependent hyperadrenocorticism (PDH), or an autonomously functioning tumor of the adrenal cortex (AT)(Feldman et al. 1996). "
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    • "As adrenal glands may host metastases from other organs, a total body CT was thoroughly assessed and found negative for the presence of a different primary tumor or distant metastases. The patient was submitted to an open right adrenalectomy [5] and microscopic examination showed complete tumoral excision and no ipsilateral lymph nodal invasion. Histological examination of the specimen on H&E staining revealed rosettes of neoplastic cells with small size rounded cores (Figure 2). "
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    ABSTRACT: MYCN is a well-known oncogene overexpressed in different human malignancies including neuroblastoma, rhabdomyosarcoma, medulloblastoma, astrocytoma, Wilms' tumor, and small cell lung cancer. While neuroblastoma is one of the most common childhood malignancies, in adults it is extremely rare and its treatment is based on pediatric protocols that take into consideration stage and genotypic features, such as MYCN amplification. Although neuroblastoma therapy has evolved, identification of early stage patients who need chemotherapy continues to pose a therapeutic challenge. The emerging prognostic role of MYCN phenotype of this disease is currently under investigation as it may redefine MYCN amplified subgroups. We describe an unusual case of adult neuroblastoma with MYCN amplification diagnosed incidentally and discuss possible therapeutic dilemmas.
    12/2013; 2013:393128. DOI:10.1155/2013/393128
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