Contemporary review of large adrenal tumors in a tertiary referral center.
BACKGROUND
Large adrenal tumors (LATs, ≥6 cm) are uncommon and associated with malignancy in 25% of cases. Their surgical management remains debatable. The aim of the present report was to evaluate the current incidence, nature and management of LAT.


METHODS
We carried out a retrospective review of LATs managed in a tertiary referral center (2002-2011).


RESULTS
Eighty-one patients were included (out of a total of 750 with adrenal tumors, 11%). Nine patients had no surgical intervention (11%). Fifty-two LATs were malignant (64%): adrenocortical carcinoma (44%), metastasis (27%) and pheochromocytoma (21%). Patients with malignant tumors exhibited a poorer 5-year overall survival than those with benign tumors (53.4% versus 96.3%, p=0.001). Disease-related mortality was approximately 60%, 29% and 0% for those with metastasis, adrenal carcinoma and malignant pheochromocytoma, respectively. The recurrence rate was the same for the three malignant sub-groups (30%).


CONCLUSIONS
LATs are rare and more frequently malignant than previously reported. Some are benign and do not require for surgical intervention. Surgical indication and approach should be tailored for each patient.
Department of Endocrine Surgery, Aix-Marseille University and Timone Hospital, Marseille, France. dianemege@hotmail.fr.
Diane
D
Mege
David
D
Taieb
Aoife
A
Lowery
Anderson
A
Loundou
Catherine
C
DE Micco
Frederic
F
Castinetti
Isabelle
I
Morange
Jean-François
JF
Henry
Frederic
F
Sebag
D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
Adrenal; adrenocortical carcinoma; laparoscopy; large adrenal tumor; malignancy; pheochromocytoma