Giant Adrenal Pseudocysts: An Enigma for Surgeons

Area of Science:

• Endocrinology
• Surgical Pathology
• Abdominal Imaging

Background:

• Adrenal pseudocysts are uncommon cystic lesions of the adrenal gland, characterized by a fibrous wall lacking epithelial lining.
• These lesions can grow significantly, presenting diagnostic challenges due to their differential diagnoses including various neoplasms.
• Existing literature consists primarily of small case series and individual case reports.

Observation:

• A series of five patients with indeterminate abdominal cystic lesions were diagnosed with adrenal pseudocysts.
• Patients presented with non-specific abdominal symptoms or symptoms of a functional adrenal tumor.
• Lesion sizes varied from 6 to 30 cm, exhibiting diverse radiological features; percutaneous biopsy was inconclusive in two instances.
• Adrenal origin was not suspected preoperatively in four of the five cases.

Findings:

• Surgical excision was performed for all five patients.
• Post-excision, symptoms resolved, malignancy was excluded, and the diagnosis of adrenal pseudocyst was confirmed.
• This series highlights the diagnostic difficulty and successful management of adrenal pseudocysts.

Implications:

• Adrenal pseudocysts should be considered in the differential diagnosis of large, indeterminate abdominal cystic masses.
• Surgical management is crucial for definitive diagnosis and therapeutic resolution.
• Increased awareness may improve preoperative diagnosis and management strategies for these rare entities.