Malignant and unclear histological findings in incidentalomas.
BACKGROUND
The management of incidentalomas with tumor size 3 cm and larger is still under controversial discussion.


METHODS
Clinical charts of 65 patients who underwent adrenalectomy for an incidentaloma were reviewed.


RESULTS
Sixty-five patients were operated. There were 28 men and 37 women with a median age of 56.9 years. Median size of all resected lesions was 4.1 cm. Indications for surgery were tumor size equal and larger than 3 cm, recurrent pain, hormone status and patients' fear of malignancy. In 45 patients, the adenomas did not meet the defined criteria of malignancy. There were 9 cases of adrenal hyperplasia, and two cysts and two hematomas were found in 4 patients. Moreover, 1 schwannoma and 1 myelolipoma were removed. In 3 patients, a primary adrenocortical carcinoma of 3.4, 4.0, and 5.0 cm in diameter, respectively, was identified. In 1 patient, an adrenal cortical carcinoma of 10.0 cm in diameter was operated. In 1 patient, the status (size: 4.5 cm) could not be determined conclusively.


CONCLUSIONS
Hormonal activity should be determined independent of the size, and lesions with hormonal activity should be resected; in the presence of hormonally inactive masses, removal of tumors of 3 cm and larger in size is recommended.
Duenschede
F
F
Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany. dünschede@ach.klinik.uni-mainz.de
Bittinger
F
F
Heintz
A
A
Musholt
T
T
Korenkov
M
M
Kann
P
P
Ewald
P
P
Gockel
I
I
Junginger
T
T
D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy; D003940:Diagnostic Techniques, Endocrine; D005260:Female; D006728:Hormones / Q000378:metabolism; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D006728:Hormones