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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a case of myelolipoma of the adrenal gland diagnosed by ultrasound-guided fine-needle aspiration in a patient with bronchogenic carcinoma who was noted to have a 5-cm adrenal mass on computerized tomography during evaluation for metastatic disease. The cytologic features are characteristic and consist of mature adipocytes and bone marrow elements that are most clearly demonstrated on Wright-stained cytospin material. This case illustrates the importance of fine-needle aspiration in the evaluation of radiologically detected adrenal masses in patients with known malignancies. A cytologic diagnosis of benign or metastatic disease can eliminate the need for formal surgical exploration in selected cases.
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PMID:Adrenal myelolipoma: fine-needle aspiration of an asymptomatic retroperitoneal mass. 356 77

We reviewed 106 cases of adrenal masses of all types in all age groups. Thirty-three contained calcium visible on radiographs, sonography, or computed tomography (CT). Neuroblastoma was the most common calcified adrenal mass (10 cases), and occurred only in children. Adrenal cyst (6 cases) was the most common calcified adrenal mass in adults. Other calcified adrenal masses included 5 cortical adenomas, 4 adrenal carcinomas, 3 cases of adrenal hemorrhage, 2 adrenal metastases, 2 pheochromocytomas, and 1 histoplasmoma. Calcification within an adrenal mass is therefore nonspecific. All the adrenal cysts had a characteristic radiographic pattern, showing only peripheral curvilinear calcification. The presence and pattern of calcium in an adrenal mass must be correlated with other imaging features (e.g., size, homogeneity, enhancement pattern, margination) to allow correct differential diagnosis. This can best be done by CT.
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PMID:Calcified adrenal masses. 360 94

Magnetic resonance imaging was performed in 30 patients with adrenal masses. The abnormalities included adrenal adenomas (n = 10), carcinomas (n = 2), pheochromocytomas (n = 12), and adrenal metastases (n = 6). By the ratio of the signal intensity of the adrenal mass to that of the liver, adenomas could be distinguished from adrenal metastases, adrenal carcinomas, and pheochromocytomas. Metastases and pheochromocytomas could generally be differentiated.
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PMID:Adrenal masses differentiated by MR. 394 Apr 3

Magnetic resonance (MR) imaging of the adrenal glands with a prototype surface coil was compared with conventional body coil images in five healthy volunteers and 15 patients with adrenal disease. The spectrum of abnormalities included five nonfunctioning cortical adenomas, of which two were in hyperplastic glands, four adrenal metastases, three pheochromocytomas, a functioning adenoma, a myelolipoma, and a partially calcified, cystic adrenal mass. In both body and surface coil images, anatomic detail was superior on T1-weighted images compared with T2-weighted images obtained with identical imaging time because of decreased motion artifact and superior contrast. In the T1-weighted studies, high-resolution surface coil images showed a threefold improvement in signal-to-noise ratio (SNR) over body coil images, which was manifest by better intrinsic resolution of small adrenal lesions and clearer definition of the extrinsic relationships of large masses to nearby organs. In addition, inferior vena caval invasion by two right adrenal metastases was better demonstrated using the surface coil than body coil MR or computed tomography (CT). Limitations of surface coil imaging include restriction in the field of view to a single gland and additional time required for patient positioning. Since the sensitivity of surface coils diminishes with depth, gains in SNR were limited in large patients with deeper adrenal glands. Despite these limitations, dramatic improvements in SNR and anatomic resolution indicate that surface coil MR imaging will be competitive with CT for examining the adrenal glands.
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PMID:Surface coil MR imaging of abdominal viscera. Part II. The adrenal glands. 404 51

Certain malignant neoplasms commonly metastasize to the adrenal glands, whereas others do so only infrequently. In the latter circumstance, an adrenal mass is likely to be benign. We report 3 patients with malignant neoplasms (hepatoma, transitional cell carcinoma of the bladder, and squamous cell carcinoma of the vulva) that do not commonly metastasize to the adrenals in whom computed tomographic (CT) demonstration and guided aspiration of adrenal masses significantly affected patient management. CT guided aspiration of adrenal masses is safe and accurate and is recommended whenever a diagnosis of adrenal metastasis would alter the staging or therapy of the primary neoplasm.
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PMID:CT demonstration and guided aspiration of unusual adrenal metastases. 629 91

Computed tomography has become an important diagnostic modality in the preoperative staging of patients with bronchogenic carcinoma. The adrenal glands represent one of the most frequent sites of metastasis. Therefore, an isolated adrenal mass discovered on preoperative thoracoabdominal CT poses a diagnostic problem. Three hundred thirty patients with histologically proved nonsmall-cell bronchogenic carcinoma were evaluated. Thirty-two had adrenal masses without further evidence of disease in the abdomen. Eight of these 32 masses were metastases, 17 were proved adenomas, and seven did not undergo biopsy. Thus, in the patients with nonsmall-cell bronchogenic carcinoma, an isolated adrenal mass is more likely benign than metastatic, and biopsy is advocated prior to withholding potentially curative surgery.
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PMID:Isolated adrenal masses in nonsmall-cell bronchogenic carcinoma. 647 83

A series of 16 patients with adrenal masses were biopsied percutaneously under computed tomography (CT) guidance with 18- to 22-gauge modified Chiba needles. Adrenal adenomas, cysts, metastases, melanoma, and adrenal hemorrhage were identified. Of nine oncologic patients, four had adrenal metastases, while five had other nonmalignant adrenal masses. Thus, an adrenal mass in an oncologic patient is not always metastases. No complications occurred. The diagnostic evaluation of an adrenal mass in selected cases should include CT-guided percutaneous aspiration as a safe and reliable alternative to open surgical biopsy. CT-guided biopsy can be performed as an outpatient procedure, avoiding the cost of hospitalization and the morbidity of surgery.
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PMID:The computed tomography-guided adrenal biopsy. An alternative to surgery in adrenal mass diagnosis. 670 99

Preoperative chest computed tomographic (CT) scans in 84 patients with biopsy-proved non-small cell bronchogenic carcinoma were reviewed. At least one adrenal gland was visualized in 70 of these. Evidence of a solid adrenal mass was present in 18 (14.5%) glands in 15 (21.4%) patients. Percutaneous needle aspiration under CT guidance confirmed metastatic malignancy in the four patients who were biopsied. Because the documented presence of adrenal metastases in non-small cell lung cancer makes surgical resection or local irradiation inappropriate, it is recommended that both adrenal glands in their entirety be specifically included whenever a staging chest CT examination is performed in patients with such tumors. Percutaneous needle biopsy for pathologic confirmation of the nature of solid adrenal masses discovered in this process is also useful.
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PMID:Preoperative CT evaluation of adrenal glands in non-small cell bronchogenic carcinoma. 697 84

Adrenal disease can be manifested by endocrine dysfunction or anatomic abnormalities detected by cross-sectional imaging modalities. With the advent of newer and more reliable in vitro assays and a better understanding of the spectrum of adrenal pathology, the physician can now adopt a more accurate and cost-effective approach to the diagnosis of adrenal disease. Both functional and anatomic imaging modalities can play an important role in the evaluation of the incidental adrenal mass, the early detection of adrenal metastases, differentiation of the various causes of Cushings's syndrome, selection of patients for potentially curative surgery in primary aldosteronism and adrenal hyperandrogenism, and localization of pheochromocytomas and neuroblastomas. The usefulness of the adrenal cortical radiopharmaceutical, 131I-6-beta-iodomethylnorcholesterol (NP-59), and the adrenal medullary radiopharmaceuticals, 131I and 123I-metaiodobenzylguanidine (MIBG), is detailed for these various clinical settings and the role of NP-59 and MIBG is contrasted to that of the cross-sectional modalities, computed tomography and magnetic resonance imaging (MRI). Incidental adrenal masses are common, but malignancies are few. Imaging studies select those patients who require a further evaluation by biopsy examination or adrenalectomy. In the hyperfunctioning endocrine states, such as Cushing's syndrome, primary aldosteronism, adrenal androgenism, and pheochromocytoma, correlation of biochemical findings with both functional and anatomic imaging is necessary to avoid inappropriate and ineffective surgical intervention, yet not miss an opportunity for curative resection. Lastly, MIBG and MRI are complementary in the detection and staging of neuroblastoma.
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PMID:Adrenal cortical and medullary imaging. 757 43

CT is the imaging procedure of choice for detecting adrenal masses. In patients with biochemical evidence of an adrenal endocrine syndrome, CT can detect or exclude an adrenal mass in a high percentage of cases. Radionuclide scintigraphy is a useful adjunct in selected cases to characterize an adrenal mass as functional cortical (NP-59) or medullary (MIBG) tissue. In this article, the spectrum of adrenal imaging findings in patients with Cushing's syndrome, Conn's syndrome (primary aldosteronism), and pheochromocytoma is described and illustrated. In patients without an adrenal endocrine syndrome, an adrenal mass is detected on CT as an incidental finding or during a search for metastatic disease. Although pathognomonic findings of adrenal hemorrhage or myelolipoma are occasionally demonstrated, most adrenal masses have nonspecific morphological CT features. Differentiation of common benign adenomas from nonadenomatous adrenal masses, including metastases, remains an important clinical problem. This article reviews the current status, advantages, and limitations of the following methods to characterize an adrenal mass: (1) percutaneous adrenal biopsy, (2) NP-59 scintigraphy, (3) unenhanced CT densitometry, and (4) opposed-phase chemical shift MRI.
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PMID:Adrenal imaging. 757 78


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