Spectrum of Adrenal Lesions on Fine-Needle Aspiration Cytology: A Tertiary Care Centre Experience

Introduction  Fine-needle aspiration cytology (FNAC) is an easy, quick, and specialized technique to distinguish neoplastic from non-neoplastic adrenal lesions, yet limited to tertiary care centers. It helps in analyzing symptomatic, as well as incidental adrenal lesions with high sensitivity and specificity. Aim  This study was conducted to determine the cytological spectrum of adrenal lesions in a tertiary care center. Material and Methods  This was a retrospective study which included a total of 19 cases of adrenal FNAC received from June 2017 till June 2019 in a north Indian tertiary care university hospital. All the lesions were broadly classified into non-neoplastic and neoplastic categories. The non-neoplastic lesions were divided into infective causes and cystic lesions. Neoplastic lesions were further grouped into benign and malignant lesions. Immunohistochemical findings were retrieved from the hospital records wherever accessible. Results  A total of 19 cases were aspirated, of which 16 cases (84.20%) yielded satisfactory material. Six cases (31.57%) showed non-neoplastic pathology of which one was a cystic lesion, three were infective (two histoplasmosis and one tuberculosis), and two showed only benign adrenal cortical cells in a setting of known extra-adrenal primary malignancy. The neoplastic group comprised of 10 cases (52.63%) of which 4 cases showed metastatic carcinomatous deposits from a known extra-adrenal primary malignancy and 6 cases showed primary adrenal neoplasm (one case of myelolipoma, one case of pheochromocytoma, and four cases of adrenal neoplasm) which were then subjected to biopsy and immunohistochemistry. A final diagnosis of pheochromocytoma was made in three cases, adrenocortical carcinoma in one case, and one case was inconclusive because of nonrepresentative biopsy. Conclusion  Image-guided fine-needle aspiration cytology of adrenal lesions helps to determine the exact nature of the infection, avoids unnecessary surgery, and helps in targeted management. However, histopathological evaluation with immunohistochemistry remains the diagnostic modality of choice with regard to neoplastic lesions.