[Cystic type adrenal mass. Clinical-radiologic contribution to 7 cases treated with surgery]

The aim of the study was to evaluate the accuracy of our imaging protocol with regard to adrenal masses of cystic nature. Seventy-four adrenal lesions were surgically removed over the period 1998-2002. Of these 7 were diagnosed as cysts or pseudocysts. All the patients were studied by abdominal US, CT and/or MRI. In 2 cases, an adrenal primary malignancy was suspected. The lesions of 2 more patients, radiologically identified as cysts, were interpreted as hepatic echinococcus cyst and mesenteric cyst, respectively; these patients underwent open surgery. In 3 cases an adrenal cystic tumour was correctly diagnosed and a laparoscopic adrenalectomy performed. The histopathological examination of the surgical specimens showed that the preoperative diagnosis failed to ascertain the true nature of the lesion in 4/7 cases (57%). The 2 suspected adrenal carcinomas turned out to be an epithelial cyst and a pseudocyst, respectively; the suspected hepatic echinococcus cyst and the mesenterial cyst were adrenal pseudocysts. Two of the 3 remaining cases were endothelial cysts and the third a pseudocysts. In the presence of adrenal masses of cystic nature, the preoperative diagnosis may easily be inaccurate and adversely influence the surgical approach, especially if a misdiagnosis of primary adrenal malignancy is made.