Kidney and Adrenal Glands

Abstract

In the kidney, imaging studies like ultrasonography (US), MRI, and CT are very accurate in diagnosing renal cell carcinomas (RCCs) and benign cysts. Only <10% of adult renal lesions are candidates for FNA, and FNA plays a very important role in diagnosis and patient management. For pediatric tumors like Wilms tumor, because of the recent changes made in staging criteria, FNA procedure no longer leads to clinical upstaging; this may increase the use of FNA in pediatric population. Recently a more conservative treatment of a small renal lesion (<3 or 4 cm) has been introduced, and a preoperative diagnosis is often required. In the adrenal gland, the most common lesions are metastasis and adrenal adenoma. The most common metastases are lung carcinoma, breast carcinoma, melanoma, and RCC. The primary tumors of the adrenal gland fall into two categories: adrenal cortical adenoma and carcinoma in the cortex and pheochromocytoma in the medulla. FNA proved to be a very effective tool to distinguish benign adrenal nodules from metastatic tumors in the workup of known malignancy at other sites and diagnose infections such as histoplasmosis, tuberculosis, or cryptococcosis that may mimic a primary adrenal tumor. Recently EUS-guided FNAB has been successfully performed on adrenal glands and played an important role in the preoperative assessment of lung carcinoma.