title: Laparoscopic approach to a large adrenocortical oncocytoma: A case report and review of the literature.
abstract: BACKGROUND
  Adrenocortical oncocytomas are extremely rare tumors, considered to be non-functional and of low malignant potential. Despite the great advance in laparoscopic techniques, there are extremely limited reports of laparoscopic approach of adrenocortical oncocytomas. Herein is presented a challenging case of laparoscopic approach to a large adrenocortical oncocytoma, underlining the safety and feasibility of laparoscopy in the surgical management of these extremely rare adrenal tumors.
  
  
  METHODS
  A 34 year-old male was referred for surgical evaluation after the incidental discovery of a large right adrenal mass, during ultrasound examination due to renal colic. Further imaging evaluation revealed a well circumscribed capsule around the mass was demonstrated, with no evidence of infiltration of the neoplasm to periadrenal tissues. The patient was scheduled for laparoscopic right adrenalectomy, running an uneventful postoperative period. Histopathology revealed the presence of an adrenal oncocytoma.
  
  
  CONCLUSIONS
  Recent studies have demonstrated that approximately one third of adrenocortical oncocytomas are associated with hormonal hypersecretion, as well as that one fifth of them demonstrate malignant biological behavior. From this point of view, there is emerging evidence in favor of the necessity of surgical excision as the treatment of choice. In spite of the progress of laparoscopic surgery, only three cases of laparoscopic excision of these tumors have been reported up to date.
  
  
  CONCLUSIONS
  Laparoscopic surgery offers a safe alternative in confronting adrenocortical neoplasms, even when the biological behavior of the tumors cannot be pre-operatively evaluated in a definite way.
authors.affiliation: First Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Q. Sofias 114 Av, 11527 Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kekis
authors.forename: Charalampos
authors.initials: C
authors.lastname: Seretis
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lagoudianakis
authors.forename: George
authors.initials: G
authors.lastname: Gemenetzis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Koronakis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Keramidaris
authors.forename: Ioannis
authors.initials: I
authors.lastname: Manouras
authors.forename: Andreas
authors.initials: A
authors.lastname: Manouras