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Three uncommon adrenal incidentalomas: a 13-year surgical pathology review.
[adrenal incidentaloma]
The
discovery
of
adrenal
incidentalomas
due
to
the
widespread
use
of
sophisticated
abdominal
imaging
techniques
has
resulted
in
an
increasing
trend
of
adrenal
gland
specimens
being
received
in
the
pathology
laboratory
.
In
this
context
,
we
encountered
three
uncommon
adrenal
incidentalomas
.
The
aim
of
this
manuscript
is
to
report
in
detail
the
three
index
cases
of
adrenal
incidentalomas
in
the
context
of
a
13
-
year
retrospective
surgical
pathology
review
.
The
three
index
cases
were
investigated
and
analyzed
in
detail
with
relevant
review
of
the
English
literature
as
available
in
PubMed
and
Medline
.
A
13
-
year
retrospective
computer-based
histopathological
surgical
review
was
conducted
in
our
laboratory
and
the
results
were
analyzed
in
the
context
of
evidence-based
literature
on
adrenal
incidentalomas
.
A
total
of
94
adrenal
specimens
from
incidentalomas
were
identified
,
accounting
for
0
.
025
%
of
all
surgical
pathology
cases
.
In
all
76
.
6
%
were
benign
and
23
.
4
%
were
malignant
.
A
total
of
53
females
(
56
.
4
%
)
and
41
males
(
43
.
6
%
)
aged
4
to
85
 
years
were
identified
.
The
benign
lesions
included
cortical
adenoma
(
43
.
1
%
)
,
pheochromocytoma
(
29
.
3
%
)
and
inflammation
/
fibrosis
/
hemorrhage
(
8
.
3
%
)
.
Metastatic
neoplasms
were
the
most
common
malignant
lesions
(
50
%
)
followed
by
primary
adrenocortical
carcinomas
(
31
.
8
%
)
and
neuroblastoma
(
13
.
6
%
)
.
These
cases
were
discovered
as
adrenal
incidentalomas
that
led
to
surgical
exploration
.
The
three
index
cases
of
adrenal
incidentalomas
with
unusual
pathologies
were
encountered
that
included
(
a
)
adrenal
ganglioneuroma
,
(
b
)
periadrenal
schwannoma
and
(
c
)
primary
adrenal
pleomorphic
leiomyosarcoma
.
These
cases
are
discussed
,
with
a
literature
and
clinicopathological
review
.
Adrenal
lesions
are
uncommon
surgical
specimens
in
the
pathology
laboratory
.
However
,
higher
detection
rates
of
adrenal
incidentalomas
aided
by
the
ease
of
laparoscopic
adrenalectomy
has
resulted
in
increased
adrenal
surgical
specimens
leading
to
unsuspected
diagnostic
and
management
dilemmas
.
Accurate
pathological
identification
of
common
and
uncommon
adrenal
incidentalomas
is
essential
for
optimal
patient
management
.
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