Advertisement

Surgery for adrenal angiomyelolipoma: an individualized concept

  • Frank WeberEmail author
  • Azim Shaibekov
  • Felix Nensa
  • Xiangtai Zeng
  • Henning Dralle
Original Article
  • 20 Downloads

Abstract

Background

Because adrenal angiomyelolipoma (AAML) is rare and uniformly benign, the indications for surgery are ill defined.

Methods

Among a series of 156 patients with adrenal pathologies surgically treated between 2013 and 2018, 12 patients were operated with the diagnosis of an AAML. The clinical as well as imaging parameters forming the individual indications for surgery were analyzed.

Results

Preoperative diagnosis consistent with AAML was made in all 12 patients. The mean size of surgically removed AAML was 82.3 mm (45–150 mm). Gender and affected side were evenly distributed. Local symptoms but lack of radiological signs suspicious for malignancy or size increase were observed in 4 of 12 patients (group 1, 33%). In contrast, 4 of 12 patients (group 2, 33%) showed radiological signs suspicious for malignancy but lacked local symptoms. Additional 4 of 12 patients (group 3, 33%) showed both local symptoms and radiological signs suspicious for malignancy. Patients with local symptoms harbored significantly larger tumors compared to those patients that lacked local symptoms (93.9 mm ± 32.8 vs. 59.3 mm ± 2.7, p = 0.021). Patients with radiologically suspicious signs were older (60 years ± 9.9 vs. 53 years ± 5.4, p > 0.05), and time to surgery was shorter (4.4 months ± 3 vs. 6.0 months ± 3.0, p > 0.05). Importantly, surgical approach was not influenced by tumor size (p = 0.65). However, patients with suspicious imaging were more likely to be operated by conventional open approach (4 of 8 vs. 0 of 4, p = 0.08). The minimal invasive approach was associated with shorter hospital stay (7 days, ± 1.3 vs. 14.2 days, ± 8.8, p = 0.038). All lesions that showed radiological signs suspicious for malignancy proved benign in final histology.

Conclusion

Large AAML present a clinical challenge. The presence of local symptoms and/or radiological signs suspicious for malignancy identifies three groups of patients that define the concept of an individualized indication for surgery in AAML. A minimal invasive approach can be advocated even for large AAML with radiological signs suspicious for malignancy.

Keywords

Adrenal incidentaloma Adrenal angiomyelolipoma Laparoscopic adrenalectomy Surgery 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee (votum of the ethics committee Medical Faculty, University Duisburg-Essen: No.19-8597-BO) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Campbell MJ, Obasi M, Wu B, Corwin MT, Fananapazir G (2017) The radiographically diagnosed adrenal myelolipoma: what do we really know? Endocrine 58(2):289–294.  https://doi.org/10.1007/s12020-017-1410-6 CrossRefGoogle Scholar
  2. 2.
    JGt B, Brunt LM (2012) Evaluation and management of adrenal incidentaloma. J Surg Oncol 106(5):557–564.  https://doi.org/10.1002/jso.23161 CrossRefGoogle Scholar
  3. 3.
    Decmann A, Perge P, Toth M, Igaz P (2018) Adrenal myelolipoma: a comprehensive review. Endocrine 59(1):7–15.  https://doi.org/10.1007/s12020-017-1473-4 CrossRefGoogle Scholar
  4. 4.
    Wale DJ, Wong KK, Viglianti BL, Rubello D, Gross MD (2017) Contemporary imaging of incidentally discovered adrenal masses. Biomed Pharmacother 87:256–262.  https://doi.org/10.1016/j.biopha.2016.12.090 CrossRefGoogle Scholar
  5. 5.
    Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, Tabarin A, Terzolo M, Tsagarakis S, Dekkers OM (2016) Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol 175(2):G1–G34.  https://doi.org/10.1530/EJE-16-0467 CrossRefGoogle Scholar
  6. 6.
    Stolle H, Jonetz-Mentzel L, Krautschick-Wilkens AW (2006) Spontaneous rupture of an adrenal angiomyolipoma. Aktuelle Urol 37(6):443–444; quiz 421-442.  https://doi.org/10.1055/s-2006-944287 CrossRefGoogle Scholar
  7. 7.
    Takanami K, Kaneta T, Morimoto R, Satoh F, Nakamura Y, Takase K, Takahashi S (2014) Characterization of lipid-rich adrenal tumors by FDG PET/CT: are they hormone-secreting or not? Ann Nucl Med 28(2):145–153.  https://doi.org/10.1007/s12149-013-0793-6 CrossRefGoogle Scholar
  8. 8.
    Fujiyoshi F, Nakajo M, Fukukura Y, Tsuchimochi S (2003) Characterization of adrenal tumors by chemical shift fast low-angle shot MR imaging: comparison of four methods of quantitative evaluation. AJR Am J Roentgenol 180(6):1649–1657.  https://doi.org/10.2214/ajr.180.6.1801649 CrossRefGoogle Scholar
  9. 9.
    Su HC, Huang X, Zhou WL, Dai J, Huang BX, Cao WL, Sun FK (2014) Pathologic analysis, diagnosis and treatment of adrenal myelolipoma. Can Urol Assoc J 8(9–10):E637–E640.  https://doi.org/10.5489/cuaj.422 CrossRefGoogle Scholar
  10. 10.
    Peppa M, Boutati E, Koliaki C, Papaefstathiou N, Garoflos E, Economopoulos T, Hadjidakis D, Raptis SA (2010) Insulin resistance and metabolic syndrome in patients with nonfunctioning adrenal incidentalomas: a cause-effect relationship? Metabolism 59(10):1435–1441.  https://doi.org/10.1016/j.metabol.2010.01.007 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Frank Weber
    • 1
    Email author
  • Azim Shaibekov
    • 1
  • Felix Nensa
    • 2
  • Xiangtai Zeng
    • 1
  • Henning Dralle
    • 1
  1. 1.Division of Endocrine Surgery, Medical FacultyUniversity Duisburg-EssenEssenGermany
  2. 2.Institute of Diagnostic and Interventional Radiology and Neuroradiology, Medical FacultyUniversity Duisburg-EssenEssenGermany

Personalised recommendations