DOI QR코드

DOI QR Code

Clinicopathological Features of Adrenal Tumors: a Ten-year Study in Yazd, Iran

  • Zahir, Shokouh Taghipour (Pathology Medicine, Medical Faculty, Shahid Sadoughi University of Medical Sciences) ;
  • Aalipour, Ezatollah (Research committee, Medical Faculty, Shahid Sadoughi University of Medical Sciences) ;
  • Barand, Poorya (Research committee, Medical Faculty, Shahid Sadoughi University of Medical Sciences) ;
  • Kaboodsaz, Mansoureh (Internal Medicine, Medical Faculty, Shahid Sadoughi University of Medical Sciences)
  • Published : 2015.07.13

Abstract

Background: Adrenal tumors are relatively uncommon, and have different presentations, so we decided to evaluate the clinico-pathological characteristics of benign and malignant tumors in a ten-year period. Materials and Methods: This cross sectional-analytical study was conducted on adrenal resection samples taken during 2004-2014 in three hospitals in Yazd province. Data were analyzed using SPSS software, version 17. Chi-square and Fisher's exact test were used as appropriate Results: A total of 71 patients with adrenal tumors were analyzed, including 32 (45.1%) men and 39 (54.9%) women with an overall mean age $37.7{\pm}19.9$ (range: 6-75 years). Some 50.7% of lesions were benign and 49.3% were malignant. Neuroblastoma was the most malignant lesion (32.3%) followed by adrenocortical carcinoma (8.4%). Among the benign lesions pheochromocytoma was the most common (25.3%) followed by adrenocortical adenoma (12.6%). While 64% of tumors were functional 36% were non functional. Significant correlation was seen between the age of patient and type of tumor (P=0.001). In patients between 14-40 years old no malignant lesions was found, although under 14 years old all of the tumors were malignant. Malignant lesions mostly presented with abdominal pain, abdominal mass and anorexia (57.2%, 45.7% and 45.7%) respectively. Benign lesions mostly presented with paroxysmal hypertension, headache and abdominal pain (61.2%, 47.2% and 44.4%) respectively. Conclusions: Since the trend of adrenal tumors is on the rise based on this and other studies, suspected cases should undergo prompt hormonal and radiological assessment. Early diagnosis and treatment could prevent tumor progression and reduce mortality and morbidity rates.

Keywords

References

  1. Anon, (2015). [online] Available at: http://American Society of Clinical Oncology (ASCO)
  2. Audenet F, Mejean A, Chartier-Kastler E, Roupret M (2013). Adrenal tumours are more predominant in females regardless of their histological subtype: a review. World J Urol, 31, 1037-43. https://doi.org/10.1007/s00345-012-1011-1
  3. Ayala-Ramirez M, Jasim S, Feng L, et al ( 2013). Adrenocortical carcinoma: clinical outcomes and prognosis of 330 patients at a tertiary care center. Eur J Endocrinol, 169, 891-9 https://doi.org/10.1530/EJE-13-0519
  4. Bezjak M, Sesar P, Ulamec M, et al (2013). [Adrenal myelolipoma--report of 15 patients]. Acta Med Croatica, 67, 255-8.
  5. Ciftci AO, Senocak ME, Tanyel FC, Buyukpamukcu N (2001). Adrenocortical tumors in children. J Pediatr Surg, 36, 549-54. https://doi.org/10.1053/jpsu.2001.22280
  6. Degenhart C(2014). [Adrenal tumors: Principles of imaging and differential diagnostics]. Radiologe, 54, 998-1006. https://doi.org/10.1007/s00117-014-2690-y
  7. Fassnacht M, Libe R, Kroiss M, et al (2011). Adrenocortical carcinoma: a clinician's update. Nat Rev Endocrinol, 7, 323. https://doi.org/10.1038/nrendo.2010.235
  8. Fitzgerald PA, Goldsby RE, Huberty JP, et al (2006). Malignant pheochromocytomas and paragangliomas: a phase II study of therapy with high-dose 131I-metaiodobenzylguanidine (131I-MIBG). Ann N Y Acad Sci, 1073, 465-90. https://doi.org/10.1196/annals.1353.050
  9. Gao XN, Tang SQ, Lin J (2007). Clinical features and prognosis of advanced neuroblastoma in children. Zhongguo Dang Dai Er Ke Za Zhi, 9, 351-4.
  10. Gokuldas Shenoy M, Selvaraju K (2013). Clinicopathological analysis of pheochromocytoma: a retrospective study. WebmedCentral ENDOCRINE SURGERY, 4.
  11. Icard P, Goudet P, Charpenay C, et al (2001). Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group. World J Surg, 25, 891. https://doi.org/10.1007/s00268-001-0047-y
  12. Ilias I, Pacak K (2008).A clinical overview of pheochromocytoma/paraganglioma and carcinoid tumors. Nucl Med Biol, 35.
  13. Jiang CX, Zeng Z, Wang T, et al (2011). [Pheochromocytomas in adrenal medulla or extra-adrenal and multiple endocrine neoplasms:a clinicopathologic analysis of 181 cases]. Zhonghua Bing Li Xue Za Zhi, 40,762-6.
  14. Kanagarajah P, Ayyathurai R, Manoharan M, Narayanan G, Kava BR (2012). Current concepts in the management of adrenal incidentalomas. Urol Ann, 4, 137-44 https://doi.org/10.4103/0974-7796.102657
  15. Kerkhofs TM, Verhoeven RH, Van der Zwan JM, Dieleman J, Kerstens MN (2013). Adrenocortical carcinoma: a population-based study on incidence and survival in the Netherlands since 1993. Eur J Cancer, 49, 2579-86. https://doi.org/10.1016/j.ejca.2013.02.034
  16. Keskin S, Tas F, Vatansever S (2013). Adrenocortical carcinoma: clinicopathological features, prognostic factors and outcome. Urol Int, 90, 435-8. https://doi.org/10.1159/000345489
  17. Li L, Dou J, Gu W, et al (2014). [Clinical analysis of 4049 hospitalized cases of adrenal lesions]. Zhonghua Yi Xue Za Zhi, 94, 3314-8.
  18. Lyu X, Liu L, Yang L, Gao L, Wei Q (2014). Surgical management of adrenal cysts: a single-institution experience. Int Braz J Urol, 40, 656-65. https://doi.org/10.1590/S1677-5538.IBJU.2014.05.11
  19. Major P, Pedziwiatr M, Matlok M, et al (2012). Cystic adrenal lesions - analysis of indications and results of treatment. Pol Przegl Chir, 84, 184-9.
  20. Mantero F, Terzolo M, Arnaldi G, et al (2000). A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab, 85, 637-44.
  21. Mehdiabadi GB, Arab E, Rafsanjani KA, Ansari S, Moinzadeh AM (2013). Neuroblastoma in Iran: An Experience of 32 Years at a Referral Childrens Hospital. Asian Pac J Cancer Prev, 14, 2739-42 . https://doi.org/10.7314/APJCP.2013.14.5.2739
  22. Michalkiewicz E, Sandrini R, Figueiredo B, et al (2004). Clinical and outcome characteristics of children with adrenocortical tumors: a report from the International Pediatric Adrenocortical Tumor Registry. J Clin Oncol, 22, 838-45. https://doi.org/10.1200/JCO.2004.08.085
  23. Missaoui N, Khouzemi M, Landolsi H, Jaidene L, et al (2011).Childhood Cancer Frequency in the Center of Tunisia. Asian Pac J Cancer Prev, 12, 537-42.
  24. O'Neill CJ, Spence A, Logan B, et al (2010) Adrenal incidentalomas: risk of adrenocortical carcinoma and clinical outcomes. J Surg Oncol, 102, 450-3 https://doi.org/10.1002/jso.21553
  25. Omura M, Saito J, Yamaguchi K, Kakuta Y, Nishikawa T (2004). Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypertens Res, 27, 193-202. https://doi.org/10.1291/hypres.27.193
  26. P.dziwiatr M, Natkaniec M, Kisialeuski M, et al (2014) .Adrenal incidentalomas: should we operate on small tumors in the era of laparoscopy?. Int J Endocrinol, 2014 .
  27. Sadler C, Goldfarb M (2014). Risk estimator for adrenal tumor functionality. World J Surg, 38, 2019-24. https://doi.org/10.1007/s00268-014-2524-0
  28. Sebastiano C, Zhao X, Deng FM, Das K (2013). Cystic lesions of the adrenal gland: our experience over the last 20 years. Hum Pathol, 44, 1797-803. https://doi.org/10.1016/j.humpath.2013.02.002
  29. Stojadinovic A, Ghossein RA, Hoos A, et al (2002) .Adrenocortical carcinoma: Clinical, morphologic and molecular characterization. J Clin Oncol, 20, 941-950. https://doi.org/10.1200/JCO.20.4.941
  30. Treska V, Wirthova M, Hadravska S, Mukensnabl P, Kuntscher V, Kreuzberg B, et al (2006) [Giant bilateral adrenal myelolipoma associated with congenital adrenal hyperplasia]. Zentralbl Chir, 131, 80-3. https://doi.org/10.1055/s-2006-921375
  31. Zhang J, Wang C, Gao J, et al (2014). Adrenal cortical neoplasms: a study of clinicopathological features related to epidermal growth factor receptor gene status. Diagn Pathol, 23, 19.
  32. ZHANG Zhen-huan, LIU De-chun (2008).Clinical and pathological analysis of 62 cases of adrenal masses. Journal of Huaihai Medicine, China, 2008-05