title: Malignant and unclear histological findings in incidentalomas.
abstract: 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.
authors.affiliation: Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany. dünschede@ach.klinik.uni-mainz.de
authors.forename: F
authors.initials: F
authors.lastname: Duenschede
authors.forename: F
authors.initials: F
authors.lastname: Bittinger
authors.forename: A
authors.initials: A
authors.lastname: Heintz
authors.forename: T
authors.initials: T
authors.lastname: Musholt
authors.forename: M
authors.initials: M
authors.lastname: Korenkov
authors.forename: P
authors.initials: P
authors.lastname: Kann
authors.forename: P
authors.initials: P
authors.lastname: Ewald
authors.forename: I
authors.initials: I
authors.lastname: Gockel
authors.forename: T
authors.initials: T
authors.lastname: Junginger
mesh_terms: 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
chemical_list: D006728:Hormones