[Adrenal pseudocysts. Therapeutic attitude].
OBJECTIVE
Cystic tumors of the adrenal gland are uncommon, but are being increasingly more frequently diagnosed during routine radiological evaluation as "incidentalomas". We discuss the differential diagnosis, therapeutic approach and the existing controversies concerning the management of this tumor type.


METHODS
Two additional cases of adrenal pseudocyst in two women aged 47 and 38 years are presented. In one case the tumor was discovered incidentally, whereas the other case presented with acute pain arising from intracystic hemorrhage.


RESULTS
The fist patient had a cystic tumor of 8 cm with some inner walls. Fine needle aspiration biopsy revealed a benign cystic lesion of the right adrenal gland. At laparotomy, an 8.5 x 4.5 cm multiloculated cystic lesion was excised. The second patient presented with abdominal pain due to intracystic hemorrhage. A Doppler US did not disclose any vessel inside the lesion. We performed a lumbotomy and excised a 7.5 x 6 cm cystic tumor located in the right adrenal gland. Both lesions were diagnosed as adrenal pseudocyst; the second case was a hemorrhagic one.


CONCLUSIONS
The therapeutic approach in adrenal cystic tumors can be based upon the radiological and cytological findings since malignant cystic tumors are uncommon. A clear liquid and a negative cytology practically discard malignant tumors. Furthermore, cystic adenocarcinomas are usually large and the cystic liquid is cloudy with abundant cellularity. Surgical treatment is justified in the symptomatic, big or complex tumors (mixed, non-homogeneous).
Martín Fernández
J
J
Servicio de Cirugía General, Complejo Hospitalario de Ciudad Real, España.
Delgado Portela
M
M
Ladrón Gil
C
C
Casanueva Luis
T
T
Ramia Angel
J M
JM
Cubo Cintas
T
T
Hernández Calvo
J
J
D000307:Adrenal Gland Diseases / Q000175:diagnosis / Q000601:surgery; D000328:Adult; D003560:Cysts / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged
Pseudoquistes suprarrenales. Actitud terapéutica.