[Large adrenal pseudocyst mimicking cystic pheochromocytoma: excision minimising laparoscopic access]

Adrenal cysts and pseudocysts are rare and usually benign and asymptomatic; they are discovered either accidentally or during examination for non-specific abdominal discomfort. Less frequently, they may cause gastrointestinal symptoms or abdominal or lumbar pain, particularly when they are quite large. Histologically, they are classified as epithelial, endothelial, parasitic and pseudocysts (with a fibrous wall but no epithelium). The differential diagnosis for adrenal cysts must consider cystic adrenal carcinoma and cystic pheochromocytoma, which are both extremely rare, but more severe and difficult to treat.

A 55 year-old woman reported right-side flank pain; imaging studies discovered a 10 cm cystic adrenal tumour, with radiological indications of cystic pheochromocytoma. Total transperitoneal laparoscopic excision was performed through three access ports. The cyst was drained by intra-abdominal bagging and aspiration before excision, in order to minimise surgical incisions. Pathological study showed benign pseudocyst.

As less invasive laparoscopic procedures become widespread, an increasing number of case reports and series of cases regarding adrenal cyst operations have recently been reported. A review of the literature shows that the cysts are generally benign, but it is not always possible to identify cystic adrenal carcinoma or cystic pheochromocytoma from the radiology image. Draining the cyst using an aseptic and oncologically safe procedure is useful for minimising surgical wounds and increases the benefits of laparoscopic access.